What is it?

Cyclosporin is a drug that affects the immune system in the body (i.e. an immunosuppressant).

Indications for use

The main use is in organ transplantation for prevention of donor organ rejection. It is being increasingly used to control difficult inflammatory conditions, such as, rheumatoid arthritis and severe ulcerative colitis, which are not responding to standard therapy.

How is it taken?

It is usually given intravenously during an in-patient stay and the dose is calculated according to body weight. The doctor will work out the correct dose and regime for your case. Once remission has been achieved [usually up to 7 days] the drug will be given in tablet form.

Monitoring

Due to the potential adverse effects on the kidneys (nephrotoxicity), it is extremely important to have regular blood checks whilst taking the medication. It is also possible, although less likely, that the blood cells in the bone marrow and also the liver may be affected. The monitoring tests should be as follows:

• full blood count
• liver function test
• urea and electrolyte levels
• cyclosporin drug levels
• Urinalysis and blood pressure.

Initially these tests should be carried out on a 2 weekly basis for 3 months then monthly thereafter whilst continuing on the treatment.

NB: Any abnormality on testing should be reported to the doctor or IBD nurse immediately for further advice.

Contraindications

This drug should not be taken if you have impaired kidney function. It is best avoided in pregnancy. If you are planning a pregnancy or become pregnant whilst taking the treatment you should speak to your doctor as soon as possible for further advice. You should not breastfeed whilst on treatment.

Are there any side effects?

It is possible that some side effects may occur during treatment. These may include some of the following:
• GI disturbances e.g. diarrhoea, nausea/vomiting, abdominal pain.
• Kidney problems
• Raised blood pressure
• Excessive hair growth
• Sore swollen gums
• Abnormal liver function tests
• Fatigue

Some of these effects may settle as treatment becomes established, or may respond to a dose reduction. Medication may be needed to control blood pressure, excessive hair growth may require depilitory cream and sore gums may improve with oral hygiene products. You should contact your doctor or IBD nurse for further advice if these measures fail to improve the symptoms.

Other side effects may occur, but less frequently such as:

• Headache
• Rash (possibly allergic)
• Mild anaemia
• Raised potassium
• Gout
• Low magnesium
• Raised cholesterol
• Weight gain
• Swelling of the feet and ankles
• Altered nerve sensations
• Confusion
• Convulsions
• Menstrual problems e.g. painful periods or the periods may stop altogether
• Muscle weakness/cramps
• Reduced platelets

Although this list of possible side effects may seem quite alarming, it does not mean that you will have all, or indeed any of them. The fact that your doctor has decided that this treatment is required to help control your symptoms, means that you have a difficult disease that needs strong medication to bring it under control and therefore reduce the risks of complications as well as possibly avoid the need for surgery.

You should be reassured that you will be closely monitored whilst taking this treatment and if any side effects do arise that these will be dealt with accordingly.

Your compliance with the monitoring is essential in the safety of your treatment.

Are there any special precautions?

Other drugs or foods can sometimes affect the absorption of your medication, or react with it to cause unpleasant effects.
Whilst taking Cyclosporin it is important that you do not eat, or drink the juice of grapefruit as this can increase plasma concentration levels and cause toxicity.

Other medications which can cause interactions, include:

• Antidepressants
• Anti epileptics (e.g. phenytoin) can cause low levels
• Blood pressure tablets (i.e. ACE inhibitors such as Captopril & Enalapril) can cause raised potassium in the blood
• Some antibiotics, (e.g. Ciprofloxacin and Trimethoprim) can increase the risk of kidney damage
• Bile acids (e.g. Ursodeoxycholic acid) can decrease absorption
• Ulcer-healing drugs (e.g. Cimetidine) can increase concentration

There may be other important considerations and therefore, you should let your doctor know about all your regular medications before starting treatment. Do not start any new medications without speaking to your doctor or IBD nurse first.