A calcineurin inhibitor immunosuppressant
Ciclosporin
A strong immunosuppressant used to prevent transplant rejection and to treat severe eczema, psoriasis and similar conditions.
What is Ciclosporin?
Ciclosporin is a powerful immunosuppressant from the calcineurin inhibitor group, used to stop the body rejecting a transplanted organ and to treat severe autoimmune conditions such as eczema, psoriasis and rheumatoid arthritis. It calms the immune system, which lowers rejection and inflammation but also raises the risk of infections. It has a narrow safety margin, so regular blood tests are needed to keep the level in the body just right and to watch the kidneys and blood pressure. Importantly, the different brands are not interchangeable, so it should always be prescribed and dispensed by brand, and grapefruit juice should be avoided.
Education and reference only. This is a plain-language guide to Ciclosporin — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Ciclosporin is a calcineurin inhibitor, a type of medicine that dampens down the immune system. It is used after organ transplants (such as kidney, liver and heart) to stop the body attacking the new organ, and to treat severe autoimmune and inflammatory conditions like eczema, psoriasis, rheumatoid arthritis and nephrotic syndrome. It is taken as capsules or a liquid by mouth, and is sometimes given by drip in hospital. Because it works on the immune system as a whole, it is a specialist medicine used under close supervision.
How it works
Ciclosporin blocks a signalling pathway (calcineurin) inside certain white blood cells called T-cells, which are key drivers of the immune response. By quietening these cells, it stops the immune system from attacking a transplanted organ and reduces the overactive immune activity behind conditions such as severe eczema and psoriasis. The trade-off is that a calmer immune system is also less able to fight infections. Because the amount in the blood matters so much, dosing is guided by regular blood-level tests.
Company & origin
Originated / developed by: Generic (originally Novartis).
A long-established calcineurin inhibitor used in the UK to prevent transplant rejection and to treat severe autoimmune and inflammatory conditions.
Practical use
How to take Ciclosporin
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it exactly as prescribed, always sticking to the same brand, as the brands are not interchangeable.
- Take it at the same times each day, in a consistent way in relation to food, so your blood levels stay steady.
- Avoid grapefruit and grapefruit juice, which can raise the level of ciclosporin in your body.
- Attend all your blood tests, as these guide your dose and check your kidneys and blood pressure.
- Never stop it suddenly or change the dose yourself, and tell your team promptly about any signs of infection.
- Tell every prescriber and pharmacist that you take ciclosporin, as many medicines and even some herbal products interact with it.
Weighing it up
Advantages & disadvantages of Ciclosporin
Advantages
- Effectively prevents organ rejection and can control severe autoimmune disease when other treatments have failed.
- Works relatively quickly in conditions such as severe eczema and psoriasis.
- Available as capsules and liquid, with dosing fine-tuned using blood-level tests.
Disadvantages
- Has a narrow safety margin and needs regular blood tests and close monitoring.
- Commonly raises blood pressure and can damage the kidneys over time.
- Increases the risk of infections and, with long-term use, certain cancers, and interacts with many medicines and grapefruit.
Practical use
Good to know
The single most important point with ciclosporin is that the brands are not interchangeable, so it must always be prescribed and dispensed by brand name (such as Neoral) and you should not be switched between brands without specialist supervision. It has a narrow therapeutic range, meaning the difference between too little and too much is small, so blood tests to measure the level are central to safe use. It commonly raises blood pressure and can harm the kidneys, so both are checked regularly. It increases the risk of infections and, with long-term use, certain skin cancers, so sun protection and prompt reporting of infections matter. Grapefruit and grapefruit juice raise the level in the body and should be avoided, and many other medicines interact with it, so always check before starting anything new.
Who should not take it / use with caution
- People with poorly controlled high blood pressure or significant kidney problems may be unable to take it or need extra caution.
- It is generally avoided alongside certain other treatments and in active untreated infections or some cancers.
- Those who cannot attend regular monitoring blood tests are not suitable for it without arrangements in place.
Monitoring
- Regular blood tests to measure the ciclosporin level and keep it within the target range.
- Routine checks of kidney function, blood pressure and salts in the blood.
- Ongoing watch for infections, skin changes and other side effects, with sun protection advised.
Side effects
- High blood pressure, kidney effects, tremor, headache and increased body or gum hair growth are common.
- Raised risk of infections, swollen gums, tingling, nausea and changes in salts in the blood.
- Less commonly, kidney damage with long-term use and a higher risk of certain skin cancers.
Key interactions
- Grapefruit juice and medicines such as some antifungals, certain antibiotics and some blood pressure drugs can raise its level dangerously.
- Other medicines, including some epilepsy drugs and St John's wort, can lower its level and risk rejection.
- Combining it with other medicines that affect the kidneys or potassium, or other immunosuppressants, needs careful supervision.
Available as: Capsules and oral liquid taken by mouth, and a form given by drip in hospital.
Answers
Ciclosporin: frequently asked questions
Why must I always have the same brand of ciclosporin?
The brands are not interchangeable, so switching can change the level in your body and risk rejection or side effects; it should always be prescribed and dispensed by brand.
Why can't I drink grapefruit juice?
Grapefruit and its juice raise the amount of ciclosporin in your blood, which can increase side effects, so they should be avoided.
Why do I need so many blood tests?
Ciclosporin has a narrow safety margin, so blood tests measure the level to guide your dose and also check your kidneys and blood pressure.
Does it make infections more likely?
Yes, because it calms the immune system, so report signs of infection promptly and follow advice on vaccinations and avoiding ill contacts.
Can I stop it if I feel well?
No. Stopping suddenly can lead to rejection or a flare of your condition, so never change or stop it without specialist advice.
The wider class
About Calcineurin inhibitors
Ciclosporin belongs to the calcineurin inhibitors class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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