How does it work?

This medicine contains the active ingredient ciclosporin, which is a type of medicine called an immunosuppressant. It works by dampening down the body's immune system. Ciclosporin suppresses the immune system by preventing white blood cells called T lymphocytes from producing substances called lymphokines. Lymphokines normally stimulate the growth of T and B lymphocytes, which are white blood cells responsible for regulating and triggering immune responses. They provide defence against infection and foreign cells. By preventing the production of lymphokines, ciclosporin suppresses the action of T and B lymphocytes. This prevents certain immune responses from occurring  the immune system is suppressed. If you have received an organ or bone marrow transplant, the donor cells, although matched as close as possible to yours, will not be identical. As a result, your immune system will try to reject the transplanted tissue. Ciclosporin prevents this by suppressing the activity of the cells in your immune system that would normally attack the transplanted tissue. The skin conditions psoriasis and dermatitis are also affected by the immune system. It is thought that T cells over-react to a stimulus in these conditions, causing the scaling and inflammation of the skin. Ciclosporin can be used in severely disabling and resistant forms of these conditions to suppress the action of the T cells and therefore improve the scaling of the skin. Rheumatoid arthritis, and a syndrome involving the kidneys called nephrotic syndrome, are also treated with ciclosporin in certain cases. These conditions are thought to be caused by inappropriate activity of the immune system towards the body's own cells. T cells are involved in producing inflammation as part of their immune function, thus suppressing their action can help to reduce the inflammation in the joints seen in arthritis, and the inflammation in the kidneys seen in the nephrotic syndrome.

What is it used for?

A syndrome caused by kidney inflammation, characterised by a large amount of protein in the urine, swelling, weight gain and high blood pressure (nephrotic syndrome)

Prevention and treatment of graft-versus-host disease, where the cells from transplanted tissue attack the cells of the transplant recipient

Prevention of organ or tissue rejection following kidney, liver, heart, lung, combined heart-lung, pancreas or bone marrow transplant

Severe atopic dermatitis for which conventional treatments are ineffective or inappropriate

Severe psoriasis for which conventional treatment is ineffective or inappropriate

Severe rheumatoid arthritis for which conventional disease-modifying antirheumatic drugs are ineffective or inappropriate

Treatment of transplant rejection in people previously receiving other immunosuppressants

Warning!

This medicine can cause the amount of potassium in your bloodstream to increase. For this reason you should avoid consuming large amounts of foods that have a high potassium content, for example dried fruit, bananas, tomatoes and 'low sodium' salt, while you are taking the medicine. You should also avoid potassium supplements.

It is important that you have regular blood tests to monitor your kidney and liver function and the level of potassium and lipids in your blood while you are taking this medicine.

Individuals having long term or intense immunosuppressive treatment are at increased risk of developing lymphomas and other cancers, particularly skin cancer. Therefore, to reduce the risk of skin cancer, you should minimise your exposure to strong sunlight and UV light by wearing protective clothing and using a sunscreen with a high protection factor. Discuss this with your doctor.

Neoral capsules should be swallowed whole with a mouthful of water. If you are taking Neoral oral solution your dose should be diluted immediately before taking with water, or orange juice/squash or apple juice to improve the taste. Stir the mixture well and drink at once. Neoral oral solution should never be diluted with grapefruit juice. In addition, you should not eat grapefruit or drink grapefruit juice in the hour before taking your dose of Neoral capsules or Neoral oral solution, as this can interfere with the medicine.

The measuring device for Neoral oral solution should not be allowed to come into contact with the liquid you use to dilute your dose. The measuring device should not be rinsed with water, alcohol or any other liquid. If it is necessary to clean it, the outside should be wiped with a dry tissue.

Your blood pressure should be regularly monitored while you are taking this medicine. If your blood pressure rises too high you may be prescribed a medicine to lower it.

Different brands of ciclosporin are not interchangeable. You should make sure you know which brand you normally take, and that you receive the correct brand each time your prescription is dispensed.

If you are taking this medicine for psoriasis you should not receive light treatment, such as PUVA, or other UV light treatment, while taking this medicine. You should also avoid sun beds and excessive unprotected sun exposure.

This medicine increases your susceptibility to infections because the suppressed immune system is less able to fight them. For this reason, consult your doctor immediately if you develop a sore throat, any infections, or begin to feel generally unwell.

Use with caution in

Children

Elderly people

High blood uric acid level (hyperuricaemia)

Not to be used in

Dermatitis patients under 16 years of age

Nephrotic syndrome patients with uncontrolled high blood pressure, uncontrolled infections, or any kind of malignancy

Psoriasis and dermatitis patients with abnormal kidney function, uncontrolled high blood pressure, uncontrolled infections or any kind of malignancy (except of the skin)

Rheumatoid arthritis patients under 18 years of age

Rheumatoid arthritis patients with abnormal kidney function, uncontrolled high blood pressure, uncontrolled infections, or any kind of malignancy

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

The safety of this medicine for use during pregnancy has not been established. It is not recommended for use in pregnancy unless considered essential by your doctor. Seek medical advice from your doctor.

This medicine passes into breast milk and women taking this medicine should therefore not breastfeed. Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Fatigue

Weight gain

High blood uric acid level (hyperuricaemia) which can cause kidney problems and gout

Increased susceptibility to infections

Decreased kidney function

High blood potassium level (hyperkalaemia)

Loss of appetite

High blood pressure (hypertension)

Increase in the level of fats eg cholesterol in the blood (hyperlipidaemia)

Disturbances of liver function

Disturbances of the gut such as nausea, vomiting, diarrhoea or abdominal pain

Shaking, usually of the hands (tremor)

Swollen gums

Increased body hair

Headache

Rash

Muscle cramps

Pins and needles (paraesthesia)

The side effects listed above may not include all of the side effects reported by the drug's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

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