Ciclosporin : Introduction

Ciclosporin is a calcineurin inhibitor widely used in immunosuppressive therapy since 1984 to prevent rejection in solid organ transplants. It works by suppressing T lymphocyte activation, which plays a crucial role in allograft rejection and the immune response to infections. Ciclosporin is typically used alongside antiproliferative agents (such as azathioprine or mycophenolate mofetil) and corticosteroids like prednisolone.

Due to variations in bioavailability between generic formulations, ciclosporin must be prescribed by brand name to ensure consistent therapeutic levels. Neoral® is the preferred brand for liver transplant patients. The drug requires careful dose titration and regular monitoring of blood levels to avoid toxicity and ensure efficacy. Clinicians must be mindful of drug interactions and recommend vaccinations like pneumococcal and annual influenza, while avoiding live vaccines due to the patient's immunocompromised state.

Ciclosporin's immunosuppressive effects increase the risk of infections (e.g., listeriosis) and malignancies in transplant recipients. Its suppression of T-cell responses weakens immune defense, making patients more susceptible to infections and impairing immune surveillance against cancer. Long-term use is associated with a higher risk of post-transplant malignancies, requiring careful management and alternative immunosuppressive strategies for high-risk patients or those with a history of cancer.