Imunofar (Ciclosporin)

Ciclosporin acts on the immune system by inhibiting T‑cell activation, making it useful in several immune‑mediated conditions.

• Organ transplant rejection: prevents graft rejection and helps preserve organ function.
• Rheumatoid arthritis: reduces joint inflammation and slows disease progression.
• Psoriasis: decreases skin cell proliferation and improves plaque lesions.

• Ciclosporin binds to the intracellular protein cyclophilin, forming a complex that inhibits the phosphatase activity of calcineurin. This blockade prevents dephosphorylation of nuclear factor of activated T‑cells (NF‑AT), reducing interleukin‑2 (IL‑2) gene transcription and consequently diminishing T‑cell activation and proliferation.

Ciclosporin may cause a range of adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Headache: mild to moderate pain often reported during therapy.
• Tremor: fine shaking of the hands or limbs.
• Hypertension: elevated blood pressure requiring monitoring.
• Hyperlipidaemia: increased cholesterol or triglyceride levels.
• Gum hyperplasia: overgrowth of gingival tissue.
• Nausea: occasional stomach upset.

Serious or Rare Side Effects

• Nephrotoxicity: impaired kidney function that may be irreversible.
• Infections: heightened susceptibility to bacterial, viral or fungal infections.
• Malignancy: increased risk of certain cancers with long‑term use.
• Severe allergic reaction: rash, swelling, or anaphylaxis.
• Hepatotoxicity: liver enzyme elevations or liver injury.
• Seizures: rare neurologic events.

Ciclosporin requires careful monitoring and patient education to minimise risks.

• Renal monitoring: assess serum creatinine and glomerular filtration rate regularly.
• Blood pressure control: check and manage hypertension throughout treatment.
• Lipid profile: monitor cholesterol and triglycerides periodically.
• Infection vigilance: avoid use in patients with active, uncontrolled infections.
• Store at room temperature: keep in the original packaging, protect from moisture and direct sunlight.

Ciclosporin interacts with several drug classes; some combinations must be avoided while others need close observation.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole): can markedly increase ciclosporin levels.
• Nephrotoxic agents (e.g., aminoglycosides): may exacerbate kidney damage.
• Macrolide antibiotics (e.g., clarithromycin): raise ciclosporin concentrations.
• Certain antivirals (e.g., ritonavir): potentiate immunosuppressive effect.

Moderate Interactions (Monitor Closely)

• Calcium channel blockers (e.g., diltiazem): may modestly increase drug levels.
• Statins (e.g., simvastatin): risk of myopathy requires dose adjustment.
• NSAIDs: can affect renal function when combined.
• Diuretics: may influence electrolyte balance and blood pressure.