Introduction

Name

• Ciclosporin.

Class of drug

• Immunosuppressive agent.

Description

Chemical name

• Ciclosporin A.

Molecular formula

• C62H111N11O12.

Physical properties

• Eye ointment.
• Eye drops.
• Capsules.
• Solution for injection.
• Solution for oral administration.

Storage requirements

• <25°C.
• Oral solution: a jelly-like formation may occur below 15°C which is however reversible at temperatures up to 25°C without affecting the quality of the product.

Uses

Indications

• Keratoconjunctivitis sicca Keratoconjunctivitis sicca in the dog.
• Chronic superficial keratitis Chronic superficial keratitis (pannus) (German Shepherd pannus).
• Perianal fistula Perianal fistula and sebaceous adenitis.
• Atopy Skin: atopy.
• Immune-mediated disorders.

Administration

Pharmacokinetics

Precautions

Interactions

With other drugs

• Various substances are known to competitively inhibit or induce the enzymes involved in the metabolism of ciclosporin, in particular cytochrome P450 (CYP 3A4). Dosage adjustment of the interacting medicine may be required.
• Azoles (eg ketoconazole) cause clinically relevant increases in the blood concentration of ciclosporin in dogs.
• Ciclosporin is a substrate and an inhibitor of the MDR1 P-glycoprotein transporter. Therefore, the co-administration of ciclosporin with P-glycoprotein substrates such as macrocyclic lactones could decrease the efflux of such drugs from blood-brain barrier cells, potentially resulting in signs of CNS toxicity. 
• Ciclosporin can increase the nephrotoxicity of aminoglycoside antibiotics and trimethoprim.
• Treatment with the product may result in decreased immune response to vaccination.

Adverse Reactions

Further Reading

Publications

Refereed papers

• Recent references from PubMed and VetMedResource.

Other sources of information

• Based on Small Animal Formulary. Tennant B (1999) 3rd edn. Cheltenham: BSAVA.
• Plumb D (1999) Veterinary Drug Handbook. 3rd edn. Ames: Iowa State University Press.
• Regnier A & Ward D (1999) Clinical Pharmacology and Therapeutics. In:Veterinary Ophthalmology 3rd edn. Ed K Gelatt. Baltimore: Lippincott, Williams and Wilkins.
• MSD Animal Health UK Limited Optimune 2 mg/g Eye Ointment for Dogs. Website: www.vmd.defra.gov.uk/productinformationdatabase/files/SPC_Documents/SPC_138967.PDF
• Elanco Atopica Soft Capsules for Dogs, 10 mg, 25 mg, 50 mg, 100 mg. Website: www.vmd.defra.gov.uk/productinformationdatabase/files/SPC_Documents/SPC_89084.PDF
• Elanco Atopica 100 mg/mL Oral Solution for Cats and Dogs. Website: www.vmd.defra.gov.uk/productinformationdatabase/files/SPC_Documents/SPC_328729.PDF
• Virbac UK Cyclavance 100 mg/mL Oral Solution for Cats and Dogs. Website: www.vmd.defra.gov.uk/productinformationdatabase/files/SPC_Documents/SPC_564989.PDF; vet-uk.virbac.com/home/products/dogs/dermatology/cyclavance.html
• Sporimune 100 mg/mL Oral Solution for Cats and Dogs. Website: www.vmd.defra.gov.uk/productinformationdatabase/files/SPC_Documents/SPC_618485.PDF
• Novartis Pharmaceuticals UK Ltd Sandimmun Concentrate for Solution for Infusion 50 mg/mL (human authorized medicine).