Uveitis Information Group (Scotland)

NEORAL (Cyclosporin)

Before Using Your Medicine

Tell your doctor before you start taking NEORAL if the answer to any of the following questions is yes:

1. Do you suspect that you have had an allergic reaction to, or been upset by any of the ingredients in NEORAL (listed in "WHAT'S IN YOUR MEDICINE")?
2. Do you have any kidney problems or have you had any disease, which may have affected your kidneys?
3. Do you have high blood pressure?
4. Do you have an infection of any type?
5. Have you been told that you have any kind of tumour?
6. Do you have any liver problems or have you had any disease, which may have affected your liver?
7. Have you been told that you have high levels of potassium in your blood or that you have gout?
8. Do you have any skin conditions other than severe psoriasis or severe eczema?
9. Are you taking any other medicines (either bought or prescribed)?
   Some medicines can interfere with your treatment, so make sure to check with your doctor or pharmacist before taking any other medicines. In particular, tell your doctor if you are taking any of the following:

   • Antibiotics or antifungal medicines for treatment of infection
   • Oral contraceptive tablets
   • Any medicines for heart problems or high blood pressure
   • Anti-epileptic medicines
   • Cholesterol lowering medicines
   • Other immunosuppressive medicines (e.g. prednisolone)
   • Sleeping tablets
   • Potassium supplements
   • Medicines to encourage urination
   • Anti-inflammatory medicines (i.e. NSAIDs) e.g. diclofenac
   • Light treatment (PUVA or other UV treatment) for your skin condition
   • Colchicine
   • Clarythromycin (an antibiotic used to treat infections)
   • Danazol (used to treat menstrual disorders, endometriosis and breast problems)
   • Tacrolimus. Because tacrolimus "dampens down" your immune system in a similar way to cyclosporin, if you take tacrolimus and cyclosporin together your immune system may be "dampened down" too much. If this happens you may be more likely to get infections.
   • St John's Wort: The herbal remedy St John's Wort (Hypericum perforatum) should not be taken at the same time as this medicine. If you already take St John's Wort, consult your doctor before stopping the St John's Wort preparation.
10. Are you pregnant, or planning to become pregnant?
11. If you do become pregnant whilst taking NEORAL, tell your doctor.
12. Are you breast feeding?
13. Have you recently received any vaccinations or are you planning to have any vaccinations?
14. Are you likely to be exposed to the sun a great deal without protecting your skin with a sun block cream?
15. Do you regularly use a sun bed?

Taking Your Medicine

• Your doctor will work out the correct dose of NEORAL for you depending on your body weight and whether you are taking NEORAL
• Your doctor will also tell you how often to take your medicine.
• the total dose is usually no more than 5 mg/kg body weight per lean body mass
• Your doctor will adjust your dose to one that is ideal for you. To do this he may need to do some blood tests.
• Follow your doctor's instructions exactly and never change the dose yourself, however well you feel.
• Do not stop taking your medicine unless your doctor tells you to, however well you feel.
• Ask your doctor or pharmacist if you are unsure about how much medicine to take or when to take it.
• Remove the capsule from the foil as shown in the picture.
• Place the capsule in your mouth. Take a mouthful of water, then swallow the capsule whole. You may drink more water afterwards. Do not eat grapefruit or drink grapefruit juice for 1 hour before taking your dose as it may interfere with your medicine.

Missed Dose

If you forget to take a dose, take another one as soon as you remember, unless it is almost time for your next dose. Then go on as before.

Overdose

If you accidentally take too much of your medicine, tell your doctor immediately, or go to your nearest casualty department.

After Taking Your Medicine

Most people benefit from taking this medicine, but a few people can be upset by it.

First few weeks

• The dose of this medicine needs to be carefully adjusted by your doctor. Too much can affect the kidneys, the liver and blood pressure. You will, therefore, have regular blood tests and visits to the hospital. This will give you the chance to talk to your doctor about your treatment and mention any problems you are having.
• If you develop a sore throat, any infections or begin to feel generally unwell see your doctor immediately.
• Side-effects that have sometimes been reported in patients taking cyclosporin include shakiness of the hands, upset stomach or abdominal pain, tiredness and sensations of heat in the hands and feet.

After first few weeks

• Swollen gums related to poor dental hygiene and exaggeration of normal growth of hair on the body or face may occur.
• More rarely, headaches, skin rash, increased weight, fluid retention, confusion, feelings of numbness or tingling, muscle weakness or cramps, fits, gout, raised cholesterol levels, slight swelling of the breast tissue, changes in the menstrual period in women, and loss of vision have also been reported.
• In liver transplant patients, vision and movement disturbances, and loss of concentration have also been reported as side-effects. However, although these effects have been reported in patients taking cyclosporin, they may not have actually been due to the medicine.

In the long run

There is a theoretical risk of malignancy (cancer) if you take cyclosporin for many years. It appears to be mainly a problem for patients who have had kidney transplants and is thought to be the result of the transplanted kidney being infected with a virus that can cause tumours. These are mainly tumours of the lymph glands (lymphomas). In patients who take cyclosporin for eye problems there is no evidence of an increased risk of lymphoma

Storing Your Medicine

• Leave your capsules in the foil. Only remove them when it is time to take your medicine.
• It is important not to store your capsules in a hot place (maximum temperature 25°C).
• Store your medicine in a safe place where children cannot reach it. Your medicine could harm them.
• Do not use this medicine after the expiry date shown on the carton/blister foil.
• If your doctor decides to stop your treatment, return any leftover medicine to the pharmacist. Only keep it if your doctor tells you to.