Ciclosporin

Complete blood count, liver values, kidney values, electrolytes (Mg, K), urinalysis, lipids, hepatitis B/C, HIV serology, blood pressure.

p.o., i.v.

2–3 mg/kg bw/day initially, increasing by 0.5–1 mg/kg bw/day in case of insufficient efficacy, up to a maximum of 5 mg/kg bw/day in 2 divided doses.

2–4 weeks.

Nephrotoxic drugs, liver diseases, other immunosuppressants, previous phototherapy, live vaccines. Annual flu and pneumococcal vaccination recommended, individual risk assessment for HIV infection. Combination with statins: Danger of myopathies CAVE: The effect of progesterone-containing contraceptives may be reduced.

Renal dysfunction, uncontrolled arterial hypertension, severe infections, malignancies, except excised epithelial skin tumors, lactation, chronic hepatitis B (positive HBsAg), simultaneous PUVA therapy, pre-existing immunosuppression.

Creatinine increase by ≥30 % -> liquid, possibly dose reduction. Arterial hypertension >160/90mmHg -> antihypertensive therapy (calcium antagonists). Gingival hyperplasia -> dental hygiene, possibly stop. Tremor, rising lipid levels.
UV exposure → UV protection.

Leukopenia, aplastic anemia, agranulocytosis → dose reduction, possibly discontinuation.

Side effects at 3–5 mg/kg are usually limiting and last only a few weeks to months. For inflammatory skin diseases no longer than 12 months due to calcineurin inhibitor-induced nephropathy and increased carcinogenesis.