What Is Cyclosporine?

Cyclosporine is an oral medication that can be used to treat adults with severe psoriasis. It is sold in the United States under several different brand names including Sandimmune® and Neoral®. Cyclosporine is a strong systemic medication that has an effect on the entire body to treat psoriasis symptoms¹.

Cyclosporine is usually recommended only for patients with severe psoriasis who²:

• have an otherwise healthy immune system
• have already tried phototherapy and/or at least one other type of systemic medicine, but it did not work well enough
• are not able to take other types of systemic medicines

How does cyclosporine work to treat plaque psoriasis?

People with psoriasis have an overactive immune system that causes an excessive number of new skin cells to be produced at a rate that is too fast for the older skin cells to die and be shed naturally. Psoriasis plaques are formed by a buildup of older skin cells on the surface of the skin.

Cyclosporine is a type of drug called an immunosuppressant. It works by stopping or reducing the activity of certain types of immune cells that are responsible for triggering the production of new skin cells². This causes fewer new skin cells to be produced, which can help to reduce psoriasis plaques.

Treatment with cyclosporine can have a relatively quick effect on psoriasis symptoms, with some patients seeing effects within a couple of weeks, although it can take up to a couple of months to reach its full effect. Studies have reported that up to 80%-90% of patients have significant improvement in their symptoms after 3-4 months⁴.

Cyclosporine can cause some serious side effects if taken for longer periods of time. Healthcare providers will weigh the benefits of treatment with the potential for side effects in recommending whether or not a patient should continue treatment with cyclosporine for more than one year⁵.

Who can take cyclosporine?

Cyclosporine reduces the function of the entire immune system to treat psoriasis symptoms¹. Therefore, treatment with cyclosporine is not suitable for people who already have a weakened immune system for any other reason, such as an active infection like HIV, or who are taking any other type of medicine that suppresses the immune system. Other people who should generally not receive treatment with cyclosporine include²:

• people with high blood pressure that is uncontrolled by medication
• people with a kidney condition
• people with cancer or a history of cancer
• people undergoing radiation therapy
• people with severe gout
• women who are pregnant, planning to become pregnant, or breastfeeding

What are the possible side effects of taking cyclosporine?

If a person is treated with cyclosporine for a long time, it can increase the risk of developing kidney damage, high blood pressure, or lymphoma.¹

Taking cyclosporine can also cause some less serious short-term side effects. These include⁶:

• high cholesterol
• increased sensitivity to the sun
• tiredness
• gout
• excessive body hair growth
• tingling/burning in the arms and legs
• headache
• muscle, bone, and joint pain
• swelling and growth of extra gum tissue
• tremors
• diarrhea
• flu-like symptoms
• upset stomach and heartburn

Cyclosporine has a boxed warning, the strictest warning from the US Food and Drug Administration (FDA). It has this warning because there is an increased risk of developing skin cancer if you are being treated with cyclosporine and have a history of treatment with¹:

• PUVA or UVB phototherapy
• methotrexate or other similar medications
• coal tar
• radiation therapy
• other drugs that suppress your immune response

Healthcare providers will monitor patients carefully during and after treatment with cyclosporine for signs of any of these serious side effects. To help reduce the risk of these serious side effects, patients will usually have their dose of cyclosporine tapered off and stopped after symptoms improve².

These are not all the possible side effects of cyclosporine. Talk to your doctor about what to expect when taking cyclosporine. You also should call your doctor if you have any changes that concern you when taking cyclosporine.

Can cyclosporine be used with other treatments or drugs?

In general, cyclosporine can be used in combination with the following psoriasis treatments²:

• topical vitamin D analogues, such as Dovonex (calcipotriene) and Vectical (calcitriol)
• topical corticosteroids

Health care providers may recommend alternating treatment with cyclosporine with other types of psoriasis treatments to reduce side effects.

Patients are not usually advised to take cyclosporine at the same time as:

• PUVA or UVB phototherapy
• methotrexate
• other immunosuppressive treatments

It is very important to let your healthcare provider know about any and all medicines, vitamins, or supplements you are taking before starting treatment with cyclosporine. Cyclosporine can interact badly with many other kinds of medicines and foods, including⁶:

• certain antibiotics
• antifungals
• gastrointestinal medicines
• calcium channel blockers
• anticonvulsants
• anti-inflammatory medicines
• other-the-counter medicines such as aspirin and ibuprofen
• John’s wort
• grapefruit and grapefruit juice
• foods high in potassium, such as bananas, tomatoes, raisins, and carrots