Cyclosporine vs Protopic

The dose is set by body weight, then adjusted by blood pressure and kidney tests, not by how the skin looks.

Starting dose: About 2.5 mg per kilogram of body weight a day, split into two doses. A severe flare may start around 4 to 5 mg per kilogram a day to get control quickly.

Going up: Raised in small steps every two to four weeks if response is poor, and only if the tests are stable.

Coming down: Once the skin is calm, the dose comes down in stages, to give the next treatment time to work.

Total course: Short by design. Many courses run 8 to 16 weeks. Guidelines advise no more than about a year of continuous treatment, less where possible.

Twice a day, about 12 hours apart, at the same times daily. Be consistent about food: always with meals or always without, because switching changes absorption. Swallow capsules whole and leave them in the foil until you take them.

On the liquid, mix it with orange or apple juice in a glass cup, stir and drink it straight away, then rinse the cup with more juice and drink that too. Never use grapefruit juice.

Take it when you remember unless the next dose is close, then skip it. Never take two at once. Tell the prescriber if you miss more than a dose or two, or vomit soon after taking it, because the dose is built around your blood level.

Cyclosporine is monitored more closely than any other skin drug, and that monitoring is why it can be used at all. Blood pressure is measured at every visit, often at home. Kidney function is checked by blood test, twice before starting for a reliable baseline, then every couple of weeks for a month or two, then monthly once the dose is steady. The same draws cover potassium, magnesium, uric acid, liver enzymes, blood counts and cholesterol. Drug blood levels are routine in transplant care, not usually needed at dermatology doses.

Two numbers drive the decisions. A rise in creatinine of about a quarter above your baseline, confirmed on a repeat test, means dropping the dose; about half means stopping. New high blood pressure means lowering the dose or adding a blood pressure medicine, and the choice matters: diltiazem and verapamil push levels up, amlodipine does not.

The interaction list is long. Drugs that raise levels include the azole antifungals, clarithromycin and erythromycin, and some HIV and hepatitis C medicines. Drugs that lower it include rifampin, phenytoin, carbamazepine and St John's wort. It also raises statin levels, so that dose is often reduced, and it interacts with colchicine, digoxin, methotrexate and potassium-sparing water tablets. Bring every prescription, supplement and herbal product to the first visit.

The time limit is the point of all this. Kidney damage builds with continuous use and part of it can be permanent, so guidelines cap continuous treatment at about a year and most dermatology courses are far shorter. Long or repeated use also raises the risk of skin cancer, lymphoma and serious infection, so skin checks continue afterward.

First 2 weeksStarting: Itch settles first, often within days, and sleep improves. Tingling or burning in the hands and feet, headache and mild nausea are common early. Blood pressure and kidney tests get checked.

Weeks 2 to 6Working: Redness, weeping and thickness improve clearly. Chronic hives that antihistamines do not control usually settle within a month. Extra hair growth on the face, arms and body and swollen or tender gums start now; both are dose-related and reverse after stopping.

Weeks 8 to 16Plaque psoriasis: Large improvement, often near-clear at the higher end of the dose range. Usually where the course ends and another treatment takes over.

VariableSevere inflammatory ulcers: In pyoderma gangrenosum it stops the ulcer spreading while healing catches up. Response times differ a lot.

ThroughoutThe tests: Blood pressure creeping up and kidney numbers drifting decide whether the dose drops or the drug stops. Neither causes symptoms, which is why the tests are not optional.

Generic capsules are cheap next to biologics, part of why the drug is still used. Branded versions cost more without working better.

The visible cost is not the whole cost. Repeated blood tests, blood pressure checks and appointments add up, and none are optional. It is cheaper per month than a biologic but taken for only a few months, so the comparison depends on what comes after.

Insurance generally covers it for severe psoriasis. Eczema coverage varies more in the United States, where that use is off-label.