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Ciclosporin therapy


Ciclosporin is indicated for the treatment of active Rheumatoid Arthritis that has not responded to other disease-suppressing drugs. It is normally used together with Non Steroidal Anti-inflammatory Drugs for patients who have not responded to or have not been able to tolerate drugs such as Gold or Methotrexate. Response to treatment cannot be expected before three months and may not occur until after six months of treatment.

CONTRA-INDICATIONS

DOSAGE

MONITORING


PRE TREATMENT SCREENING EACH MONITORING VISIT
  • Blood pressure: minimum of 2 measurements
  • Serum creatinine: minimum of 2 measurements
  • Serum potassium
  • Serum lipids
  • Full blood count
  • Liver function tests
  • Serum urate
  • Blood pressure
  • Serum creatinine
  • Serum potassium
  • Lipids (after 1 month)
  • Full blood count (monthly)
  • Urate (after 1 month)

ADVERSE EVENTS

LABORATORY EVENTS VALUES ACTION
Serum creatinine > 30% above baseline Reduce dose
Serum creatinine > 50% above baseline Halve dose
Serum creatinine Elevated levels do not fall after one month of lower dose STOP + seek advice
Serum potassium Above reference range Any interacting drugs? If not, reduce dose.
Serum lipids Significant increase after one month STOP Ciclosporin
Serum urate Significant increase after one month Any interacting drugs? If not, reduce dose.

CLINICAL ADVERSE EVENTS MANAGEMENT
BP > 150/95 Treat appropriately eg: Nifedipine.
Stop Ciclosporin if uncontrolled.
Hypertrichosis Stop if unacceptable
Nausea, vomiting, dyspepsia. STOP if unacceptable
Gingival hypertrophy Stop if unacceptable

Ciclosporin flow chart
Ciclosporin patient advice leaflet
Source: Dr PR Crook, Consultant Rheumatologist.
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