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Why am I being treated with this medicine?
Ciclosporin (cyclosporin, also known as Neoral) is used to attempt to induce remission in acute severe ulcerative colitis. It is used in hospital when patients have not responded to standard treatment for inflammatory bowel disease, including steroids. The use of Ciclosporin has been demonstrated to reduce the need for a surgical operation to remove the large bowel (called a colectomy). It is also used in other groups of patients including those with rheumatoid arthritis, psoriasis and with organ transplantation.
How does Ciclosporin work?
Ciclosporin suppresses inflammation by dampening down your body’s immune system. The immune response is what caused the inflammation and ulceration of your bowel.
What are other names for these medications?
Ciclosporin [cyclosporin], is occasionally referred to by the brand name which is Neoral.
How much will I need to take and how often?
Your dose will be calculated depending on your weight and rounded up to the nearest capsule size, your health care professional will advise you how much you should take. The total dose is usually 5 mg/Kg per day, given in divided doses about 12 hours apart. The dose may be adjusted according to response and blood levels of the drug.
Some patients in hospital may be started on Ciclosporin given intravenously (into a vein) at first, and then convert to oral medication. The dose may be adjusted according to its clinical response, Ciclosporin blood levels, blood pressure and kidney function. You will have regular blood tests during your treatment which will check the level of the medication in your blood; this will help to make sure you are on the correct dose. You will need to take your medication every day.
Neoral (Ciclosporin) comes as a gel-filled capsule and is available in four different strengths – 100mg (grey), 50mg (white) 25mg (grey) and 10mg (white). Neoral is also available as a liquid. Neoral is taken twice a day. Ideally the two doses should be taken 12 hours apart at 10.00am and 10.00pm. The times should be fixed as much as possible, to ensure accurate blood levels are obtained, as this will enable appropriate blood levels to be achieved. It is therefore very important that you don’t take your dose of Cyclosporin until after blood levels have been taken.
How do I take this medication?
The capsules should be taken with a mouthful of water and swallowed whole. Ciclosporin should be taken on an empty stomach, or at least 1 hour before, or 2 hours after a meal (as food affects its absorption). Whole grapefruit and grapefruit juice should be avoided in the hour before you take the capsules as they can increase Ciclosporin levels in the blood. It is important to check the label on your tablet container so you know which strength tablets you have been given as this will affect the number of tablets you need to take.
How long do they take to work?
The benefits of Ciclosporin are often seen quite quickly (within days).
How long will I need to take this medication for?
If you tolerate this then you will be on this medication usually for 3 months, during this period your clinician may start you on alternative therapies to maintain clinical remission, so that the Ciclosporin can be weaned off and eventually stopped. Do not stop taking your medication unless your health professional tells you to, even if you feel well.
What do I do if I miss a dose?
If you forget a dose, take it as soon as you remember as long as it is not almost time for your next dose, as you need to leave 12 hours in-between doses. Do not double up on your next dose, just continue taking the tablets as directed but make a note of it in your diary and remember to tell your doctor on your next visit. If you take too much, then contact your health professional as soon as possible.
Can I take other medicines and alcohol with this drug?
Ciclosporin is compatible with most other medicines but always remind your health professional that you are taking Ciclosporin if a new medication is being prescribed for you. You will also need to tell the Pharmacist if you buy any “over the counter medicines” that you are taking Ciclosporin.
Certain medications interact with Ciclosporin, these include non-steroidal anti-inflammatory drugs (eg Ibuprofen), St John’s Wart and erythromycin. Alcohol can be taken in moderation, however for general health reasons it is best to remain within the Department of Health advised limits. High level of alcohol intake can seriously affect blood levels of the drug.
What checks will I need?
Ciclosporin can raise your blood pressure and affect the kidneys. We recommend that your blood pressure, blood count and kidney function are checked every 2 days for the 1st week. Your treatment monitoring will be managed by your hospital team or shared between the hospital and GP.
You will be monitored closely whilst you are taking this medicine. You will need regularly blood tests for three months. This test will check the level of the medication in your blood, this will help to make sure you are on the correct dose.
Can I have immunisations whilst I am on this medication?
The Department of Health advises you should have an annual flu vaccine, please book one at your local GP practice. It may be unsafe to have certain vaccines, you should not have any live vaccines, as these contain live viruses such as: Polio, yellow fever, rubella, MMR, BCG. However, you may be able to have the inactivated polio vaccine. It is important that you check with your health professional prior to having any vaccines.
Will I need to take any special precautions while I am taking this medication?
Your body’s resistance to infection is likely to be reduced whilst taking Ciclosporin. Therefore, you should avoid contact with people who have an obvious infection. You should contact your health professional if you begin to feel unwell and think you may have caught an infection. You can potentially become seriously unwell from the viruses that cause chickenpox, measles, shingles, and pneumococcal disease. If you come into contact with anyone who has these conditions tell your health professional as soon as possible.
Will this medication affect fertility or pregnancy?
Inform your health professional if you are thinking about pregnancy or are pregnant. You should avoid becoming pregnant while you are taking Ciclosporin. Make sure you have discussed with your doctor which types of contraception are suitable for you and your partner. If you do have any questions, then discuss them with your health professional.
Can I breastfeed whilst taking this medication?
You should not breast feed if you are taking Ciclosporin.
What are the possible side effects of taking this medication?
All medicines can cause unwanted side effects. Some people taking Ciclosporin will experience unwanted side effects initially, however not everyone will get them and as your body adjusts to the medication the side effects may improve over a few weeks. The monitoring of your blood will enable early identification of some adverse effects.
Most will not suffer any of these known side effects. If you do experience any of these symptoms, then contact your health professional.
- Nausea and tiredness are common, but wear off within weeks
- Increased hair growth. This can be removed or coloured.
- Slightly enlarged or sore gums. If problematic see your dentist.
- Tremor or shakiness of the hands.
- High blood pressure, kidney dysfunction and liver inflammation. All are monitored for as they can be reversed by stopping/reducing dose.
- Increased risk of infections. Please inform a member of your inflammatory bowel disease team if you come into contact with chickenpox, as you may need preventative treatment.
- Headache and abdominal cramps can occur in the early stages.
- Hot, burning, numbness in the hands and feet. This normally lessens after a couple of weeks.
- Metallic taste in the mouth
- Painful periods or lack of periods.
You will need to speak to your health professional before you make any changes to how you take your medication, or dosage. Do not stop taking your medication until you have spoken to your health professional.
Keep all medicines out of the reach of children. Never give any medicine prescribed for you to anyone else. It may harm them even if their symptoms are the same as yours.