Cyclosporine (Neoral®)

Cyclosporine (Neoral®) is an immunosuppressant psoriasis medication that is also frequently used in organ transplantation. It is very effective, but because of its cost and potentially serious side-effects it is usually reserved for people with severe, disabling, and/or treatment-resistant psoriasis. You must be regularly monitored by your doctor while taking this medication.

How the treatment works

Cyclosporine suppresses your body's immune system and slows the rapid production of skin cells.

Advantages/Benefits

• Pill form usually taken 1 or 2 times daily.
• Onset of effect is rapid (4-8 weeks), improvement is often seen within the first 4 weeks.
• Highly effective for severe psoriasis, especially helpful for treating flare-ups.
• Can be used intermittently in short-term courses and combined with other topical and systemic therapies.
• Multiple short courses are prescribed to reduce the potential for toxicity.

Disadvantages/Risks

• Long-term use leads to kidney damage, although the damage is often reversible if patients stop taking the medication.
• Total duration of therapy should not exceed 1-2 years to avoid severe adverse effects.
• Regular assessments through blood and urine tests, and blood pressure monitoring is required throughout the treatment period.
• Rebounds are common if the dosage is tapered or when the medication is stopped.
• Side-effects include flu-like symptoms, nausea, diarrhea, hair growth, high blood pressure, numbness and tingling, and kidney damage.
• Because cyclosporine suppresses the body's immune system, there is an increased risk of infections and certain cancers, such as skin cancer and lymphomas (cancers involving certain white blood cells of the immune system), but reported incidences usually involve use in organ transplantation where the medication is used long-term and at higher doses.
• Cyclosprine cannot be used at the same time with PUVA or UVB phototherapy, methotrexate or other immunosuppressive agents, coal tar or radiation therapy.

Comments & Suggestions

• You must advise your doctor of every side-effect that you are experiencing, so that symptoms can be mitigated with dose adjustments, the addition of other treatments, or even temporary discontinuation of therapy.
• Be certain to attend each scheduled clinic visit and complete laboratory tests that are requisitioned by your doctor.
• Take sun protective measures, such as apply a broad-spectrum sunscreen daily and wear long-sleeved tops and hats to avoid the effects from photodamage.