Menelri (Ciclosporin)

Menelri (ciclosporin) is used in immune‑mediated conditions where inhibition of T‑cell activation is required, particularly in organ transplantation and severe dermatologic or rheumatologic diseases.

• Organ transplant rejection: prevents graft rejection by suppressing immune response, helping maintain transplanted organ function.
• Severe psoriasis: reduces skin inflammation and plaque formation, improving disease severity in patients unresponsive to conventional therapies.
• Rheumatoid arthritis: diminishes joint inflammation and damage by modulating immune activity in patients with active disease.

• Ciclosporin binds to the intracellular protein cyclophilin, forming a complex that inhibits calcineurin phosphatase activity. This blockade prevents dephosphorylation of nuclear factor of activated T‑cells (NF‑AT), reducing transcription of interleukin‑2 and other cytokines essential for T‑cell activation and proliferation, thereby producing immunosuppression. The effect is dose‑dependent and reversible upon discontinuation, allowing modulation of immune response without complete ablation of host defenses.

Ciclosporin may cause a range of adverse reactions, varying from mild to potentially serious.

Common Side Effects

• Headache: mild to moderate headache occurring early in therapy.
• Tremor: fine hand tremor that may affect coordination.
• Gingival hyperplasia: overgrowth of gum tissue, may require dental care.
• Hyperlipidemia: elevation of cholesterol or triglyceride levels in blood tests.
• Nausea: occasional stomach upset, often transient.
• Diarrhea: loose stools, usually mild and self‑limiting.

Serious or Rare Side Effects

• Nephrotoxicity: decline in renal function, potentially leading to renal failure.
• Hypertension: persistent high blood pressure that may need antihypertensive medication.
• Infections: heightened risk of bacterial, viral or fungal infections, including opportunistic pathogens.
• Hepatotoxicity: liver enzyme elevations or hepatitis in rare cases.
• Malignancy: increased long‑term risk of certain cancers such as lymphoma.

When prescribing ciclosporin, clinicians should observe several precautions to minimize risks and ensure safe use.

• Renal monitoring: assess serum creatinine and glomerular filtration rate regularly.
• Blood pressure control: monitor and treat hypertension throughout therapy.
• Lipid management: check lipid profile periodically and treat dyslipidemia as needed.
• Infection vigilance: screen for active infections and vaccinate appropriately before initiation.
• Drug level monitoring: maintain therapeutic trough concentrations to balance efficacy and toxicity.
• Store at ambient temperature: keep tablets in original container, protect from moisture and heat, store below 25 °C.

Ciclosporin interacts with several medicines that can alter its concentration or increase toxicity.

Major Interactions (Avoid)

• Ketoconazole and other strong CYP3A4 inhibitors: markedly increase ciclosporin levels, risking nephrotoxicity.
• Rifampicin and other potent CYP3A4 inducers: substantially lower ciclosporin concentrations, reducing efficacy.
• Nephrotoxic antibiotics (e.g., aminoglycosides): additive renal toxicity.

Moderate Interactions (Monitor Closely)

• Calcium channel blockers (e.g., diltiazem): may raise ciclosporin levels modestly.
• NSAIDs: can impair renal function when combined.
• Statins (especially simvastatin): increased risk of myopathy due to elevated statin levels.