Cyclosporin

Indication:
Immunosuppressive therapy in Ulcerative colitis or Crohns disease.

Formulations:
Capsules 25mg, 50mg, 100mg
Injection 50mg/ml
Liquid 100mg/ml
Enema (manufactured special) 50ml enema

Dose:
IV 1mg/kg BD adjust dosage according to levels

Oral 2.5mg/kg BD adjust dosage according to levels

Rectal 5mg/kg of cyclosporin suspension (Neoral) in 50ml of suspending agent
(the oral solution is added to the suspending agent prior to administration)
Leave in for at least 60 mins OD or BD reducing frequency as necessary.
Cyclosporin is absorbed so a level should be taken after 7 days

Side-effects:
Dose dependant increase in serum creatinine and urea.
Fatigue, gingival hypertrophy, GI disturbances, burning sensation in hands and feet, tremor, headache, hypertension, weight increase, pancreatitis, dysmenorrhoea or amenorrhoea and neuropathy.

Interactions:
* Cyclosporin levels increased by concomittant administration of grapefruit juice, erythromycin, cimetidine, methylprednisolone, metoclopramide, tacrolimus (FK506), ketoconazole, itraconazole and fluconazole.
* Cyclosporin levels decreased by concomittant administration of rifampicin, phenobarbitone, phenytoin, carbamazepine and heparin.
* Nephrotoxicity is enhanced by concomittant administration of aminoglycosides, amphotericin, ciprofloxacin, diclofenac and frusemide.

Notes:
Cyclosporin injection contains polyethoxylated castor oil which has been associated with anaphylaxis. Observe patient for at least 30 minutes after starting infusion and at frequent intervals thereafter.
Trough whole blood levels 100-150 microgram/L.
Oral liquid should not be administered down NG tube nor mixed with grapefruit juice. Can be mixed with orange juice(or squash) or apple juice.
Cyclosporin injection can be administered via a Y site with intralipid 10% or 20%.

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