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. There is also an increased risk of developing skin cancer if a patient has been treated with cyclosporine and also has a history of treatment with1:
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.
Taking cyclosporine can also cause some less serious short-term side effects. These include6:
- high cholesterol
- increased sensitivity to the sun
- excessive body hair growth
- tingling/burning in the arms and legs
- muscle, bone, and joint pain
- swelling and growth of extra gum tissue
- flu-like symptoms
- upset stomach and heartburn
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
- 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
- gastrointestinal medicines
- calcium channel blockers
- 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