Ciclosporin

What is this medication for?

Ciclosporin is used in conditions such as Systemic Lupus Erythematosus, psoriasis, eczema and to prevent rejection of transplanted organs. It “tames” your immune system and in turn, tunes down the aggressiveness of its attack against parts of your body e.g. kidney, bone marrow, skin.

How should I take or use this medication?

• Ciclosporin is usually given twice daily. The dose will vary for each person depending on factors such as severity of the disease and your response to the treatment.
  • Your doctor will work out the correct dose of Ciclosporin for you depending on your body weight and your condition. Your doctor will also tell you how often to take your medicine. Always follow your doctor’s instructions.
  • For oral capsules: Swallow with a glass of water. Do not break or crush them and do not take any capsules that have broken or split open.
  • For oral suspensions:
    • Always use the syringe provided by the manufacturer to ensure that the correct dose is taken.
      • After use, wipe the outside of syringe using a dry tissue only. Do not rinse with water or any other cleaning agents.
    • You may consider diluting the suspension further with orange juice at room temperature in a glass cup (do not use plastic or styrofoam cups). Drink the entire mixture immediately after mixing.
• You may take Ciclosporin with or without food.
  • Take this medication consistently in relation to time of day and meals. For example, if you usually take it at 8am and 8pm, followed by your breakfast and dinner 30minutes later, keep to this same routine every day.
• Do not stop taking your medication without checking with your healthcare professional.
  • Treatment will continue for as long as you need the medication’s effects to prevent your organs from being targeted by your immune system.

What should I do if I forget to take or use this medication?

If you forget to take a dose, take it as soon as you remember. Then take your next dose at the usual time. 

However, if it is almost time for your next scheduled dose, skip this missed dose completely and resume the next dose at your usual time.

Do not take two doses to make up for the missed dose.

What precautions should I take when taking or using this medication?

• Inform your healthcare professional if:
  • You have cancer, kidney problems, or high blood pressure.
  • You are allergic to this medication or any of the other ingredients of this medication
  • You are pregnant, planning to become pregnant, or breastfeeding.
  • You are taking any other medications, including supplements, traditional medications and herbal remedies.
• Avoid prolonged sun exposure. Use sunscreen (SPF 30 or higher) and wear protective clothing when outdoors.

Ciclosporin comes in various brands and formulations. Do not switch brands unless instructed by your doctor. This is because different brands may affect your body differently.

What are some common side effects of this medication? ​

• More than 10% of people will experience:
  • Increase in kidney marker
  • High blood pressure
    • Check your blood pressure frequently
  • Headache including migraine
    • May go away after a few days. If headache is persistent, inform your healthcare professional during your next visit. Your doctor may adjust the dose.
  • Tremor
    • May go away after a few days. If tremor is persistent, inform your healthcare professional during your next visit. Your doctor may adjust the dose.
  • Increased levels of fats (triglyceride) or sugar in the blood
    • Your doctor will monitor your blood fat (triglyceride) and sugar levels regularly
  • Inflammation/overgrowth of gums
    • This may appear soon after treatment is started and is more common in younger patients
    • Severity depends on the condition of your teeth and whether there is proper brushing/flossing (pay particular attention to the base of the teeth)
    • Ensure good oral hygiene and visit your dentist regularly
  • Hair overgrowth in male-like pattern (e.g. face, chest, back)
  • Increased uric acid in your blood, or gout
    • Your doctor will perform routine blood tests to monitor your uric acid, as well as monitor your gout symptoms
    • Seek medical attention if you develop intense joint pain and swelling (most commonly on the big toes) that comes on suddenly, especially in the middle of the night, redness and/or warmth of affected joint
• Other common side effects include:
  • Nausea, vomiting, diarrhea
    • You may take this medication after food to reduce this side effect. 
    • If vomitting occurs within 30 minutes of taking this medication, repeat the dose. 
• This medication weakens your body’s immune system and your body may not be as efficient at fighting infections. You may therefore be at higher risk of infection such as infections of the brain, skin, mouth, stomach and intestines, lungs and urinary tract.
  • Seek prompt advice from your doctor when you develop any symptoms of infection e.g. fever, sore throat, yellow/green phlegm, pain or burning sensation during urination.
• You may need regular blood tests as instructed by your doctor to monitor for side effects and the amount of this medication in your body.

Talk to your doctor, pharmacist or nurse if you have or are concerned with any side effects. This includes any side effects not listed in this leaflet. However, do not stop taking your medicine unless you have discussed with your doctor.

What are some rare but serious side-effects that I need to seek medical advice immediately? 

The symptoms of a drug allergy include one or more of the following:

• Swollen face/eyes/lips/tongue
• Difficulty in breathing
• Itchy skin rashes over your whole body

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Some serious side effects of Ciclosporin include:

• Yellowing of your skin and whites of the eyes 
• Dark coloured urine or light-coloured stools 
• Excessive diarrhea and/or vomiting, or loss of appetite
• Unable to pass urine suddenly

If you experience any of these symptoms, you should stop your medication and see your healthcare professional immediately.

What food or medication should I avoid when I take or use this medication?

• Avoid taking grapefruits, pomelo, pomegranate during treatment with Ciclosporin.
• You should avoid live vaccines such as live polio, yellow fever, rubella (German measles), MMR (measles, mumps and rubella), live typhoid vaccine and BCG (tuberculosis). 
• Flu and pneumococcal vaccines are safe and may be given if required.
• Always check with the doctor or pharmacist first before using any new medications including over-the-counter medicines.
• Do not take any supplements, alternative or herbal medicines without informing your doctor.

How should I store this medication?

Store in a cool and dry place, away from direct sunlight. Keep this medication away from children.

Keep the foil of the capsules sealed, and only remove the capsules just before taking the dose. It is normal that you notice a strong and distinctive smell when you open the packaging.

For the oral solution, refer to the product leaflet and packaging for detailed storage instructions. 

How do I throw away this medication safely? ​

Pack this medication into a black trash bag and seal it tightly before throwing into the rubbish chute or bin.