Patients on immunosuppressive therapy have an increased risk of infections. Since infections have a potential to trigger acute porphyric attacks vigilance is motivated regarding signs or symptoms of infection and/or possible symptoms of a porphyric attack. Side effects like nausea and vomiting may potentially be porphyrinogenic through reduction in carbohydrate intake.

Infections are common in patients using immunosuppressants and since infections might trigger an acute porphyric attack, vigilance regarding signs and symptoms of an infection and/ or a porphyric attack is recommended. Common adverse reactions of ciclosporin that can be confused with an acute porphyric attack are nausea and vomiting. These side effects may potentially be porphyrinogenic if leading to a decrease in carbohydrate intake.

Ciclosporin does not induce cytochrome P450 enzymes. It is an inhibitor of CYP 3A4, but no evidence point to irreversible inhibition.

Cyclic polypeptide.

Ciclosporin is a calcineurin inhibitor, used to prevent transplant rejection. It is also used in the treatment of other conditions where immunosuppression is desired. It is administered orally or as an intravenous infusion.

Significant

Ciclosporin is metabolized by CYP3A4 and in vitro and interaction studies show that ciclosporin is an inhibitor of CYP 3A4. Listet by Zhou et al. as a possible mechanism-based inhibitor, but due to lacking evidence it is not suspected to be an irreversible inhibitor. Ciclosporin does not induce cytochrome P450 enzymes.

Experimental data on mice point to porphyrogenicity in the same class as barbiturate, which probably is the cause for warning against the drug in other drug lists.

C. Andersson; patient report: tolerated (n=1).

One report of activation of possible porfyric symptoms in a previously undiagnosed female AIP patient immediately after a kidney transplant, with improvement after discontinuing ciclosporin (Marsden et al. 2008). However, because the symptoms occurred in connection with a surgical procedure it is likely that a number of other factors could be responsible. It is also possible that some of the patients symptoms was due to common side effects of ciclosporin. Reports of uneventful use: Barone et al 2001, Field 2006 et al, Turton-Weeks et al 2001 and Warholm et al 2003.

Uneventful use reported in 1 patient with acute porphyria.