Introduction
Ciclosporin is an immunosuppressant widely used to prevent transplant rejection.
Mechanism of action
Decreases clonal proliferation of T cells by reducing IL-2 release. It acts by binding to cyclophilin forming a complex which inhibits calcineurin, a phosphatase that activates various transcription factors in T cells
Indications
- Following organ transplantation
- Rheumatoid arthritis
- Psoriasis (has a direct effect on keratinocytes as well as modulating T cell function)
- Ulcerative colitis
- Pure red cell aplasia
Adverse effects
Adverse effects of ciclosporin (note how everything is increased - fluid, BP, K+, hair, gums, glucose)
Interestingly for an immunosuppressant, ciclosporin is noted by the BNF to be 'virtually non-myelotoxic'.
- Nephrotoxicity
- Hepatotoxicity
- Fluid retention
- Hypertension
- Hyperkalaemia
- Hypertrichosis
- Gingival hyperplasia
- Tremor
- Impaired glucose tolerance
- Hyperlipidaemia
- Increased susceptibility to severe infection
Interestingly for an immunosuppressant, ciclosporin is noted by the BNF to be 'virtually non-myelotoxic'.