This information sheet answers some common questions patients ask about ciclosporin. Further information can be found in the information leaflet supplied by the manufacturer or from your consultant neurologist, specialist nurse or pharmacist.

Why Have I Been Prescribed This Medication?

Ciclosporin (also know as cyclosporin, Neoral) may be prescribed for patients with a range of neurological conditions including myasthenia, inflammatory myopathies and neuropathies, vasculitis and other immune-mediate central and peripheral nervous system conditions that require continuous or repeated courses of corticosteroids (steroids, prednisolone). Ciclosporin is referred to as a 'steroid-sparing agent' as it may allow the dose of steroids taken, to be kept to a minimum.

How Does It Work?

Ciclosporin belongs to a group of medicines called immunosuppressants. Your immune system helps to protect you against infections. However, sometimes it can over react or react abnormally and cause illness. Ciclosporin reduces the production of antibodies by 'damping down' the activity of the body's immune system.

What Dose Do I Take?

The dose of ciclosporin depends on your body weight and the medical condition being treated. The starting dose is 1mg/kg body weight and increasing if there are no adverse effects to 2.5-3mg/kg. The dose may be adjusted according to response and blood levels of the drug.

How Do I Take It?

Ciclosporin comes in tablet form.

• You should always take the medicine as directed by your consultant neurologist
• Always read the manufacturers information leaflet. There may be additional information there that you could find useful
• You should take ciclosporin with or immediately after food to help reduce stomach upsets
• Do not take your dose with whole grapefruit juice as these increase ciclosporin levels and its effects
• Never take more than the dose prescribed by your doctor. If you or someone else has taken an overdose of ciclosporin, contact your GP or go to the nearest A&E department immediately. If possible, take the container with you.

How Long Does It Take To Work?

After starting ciclosporin patients may expect to see a gradual improvement in symptoms after a period of two to three months. It may take much longer to have a maximal response. You may be on other medications to cover this period.

How Long Will I Be Taking It?

The length of time you will be taking ciclosporin depends on your condition being treated. Ciclosporin does not cure the condition and you may need to take it for several years to keep your symptoms under control. Do not stop taking your medicine unless you consultant neurologist tells you to, however well you feel.

What do I do If I Miss a Dose?

What Are The Common Side Effects

All medicines can cause unwanted side effects which usually improve as your body adjusts to the new medicine. Some of the common side effects you may experience in the early weeks of treatment are:

• Hirsutism
• Slightly enlarged or sore gums. Your dentist will be able to suggest a treatment if it becomes a problem
• Metallic taste in the mouth
• Shakiness of the hands
• Hot or burning sensations in the hands and feet. This normally lessens after a couple of weeks
• You may feel a little sick in the early stages, possibly with some abdominal discomfort
• Women taking ciclosporin may experience cramps and painful periods. Their periods might stop whilst on ciclosporin
• Increases in blood pressure and effects on the kidney
• Increased risk of infections. If you are in close contact with anyone who has chicken pox or shingles, inform your doctor as soon as possible

Do I Need Any Special Checks Whilst on Ciclosporin?

Ciclosporin can have an effect on your blood cell levels and on how your liver and kidneys work. Before starting ciclosporin, patients must have a blood pressure check, a full blood count and liver and kidney function tests. You will require these every two weeks for the first three months and then every three months thereafter. This is to monitor the effect of ciclosporin and whether the dose of your medication needs to be changed.

If you feel unwell, develop a sore throat or any infections, or are unsure about certain reactions, contact your specialist nurse, GP or pharmacist before taking ciclosporin.

As the dose of ciclosporin is weight related, you will need to have your weight checked regularly to ensure the dose is calculated correctly. This can be done at your local surgery along with your blood tests. A ciclosporin suppresses the immune system, this increases the risk of developing cancers, particularly of the skin and lymphoid system. Exposure to sunlight and UV light should be limited. You should apply a high factor sunscreen when out in the sun.

Does Ciclosporin Interfere With My Other Medicine?

Ciclosporin can interact with a large number of other medicines inlcuding non-steroidal anti-inflammatories e.g. ibuprofen, St. John's-wort, erythromycin and rosuvastatin. Always check with a doctor or pharmacist before taking any other medicine including those bought over the counter.

It is safe to drink alcohol in moderation whilst on ciclosporin. Excessive alcohol intake can seriously affect levels of ciclosporin in the blood.

You should avoid having live vaccines such as polio and rubella. The flu jab is not contraindicated. Check with your GP or pharmacist before having any vaccinations.

Is Ciclosporin OK in Pregnancy and Breastfeeding?

If you are planning to become pregnant whilst on ciclosporin, you should discuss with your neurologist first. You should not breastfeed if you are taking ciclosporin.

You can read more about myasthenia and pregnancy here.

Keep All medicines out of reach of children

Never give any medication prescribed for you to anyone else

3,4-DAP