Before starting
Required
- Baseline
- Pregnancy test two tests 8-10 days apart in women of child bearing potential; exclude before initiating
- Albumin
- ALT or AST
- Blood pressure
- Full blood count
- Height
- Liver function tests
- Serum creatinine (for creatinine clearance) or Calculated glomerular filtration rate
- Vaccination status
- Weight
Vaccination status
Consider vaccination against pneumococcus and influenza prior to starting treatment.
After started or dose changed
Required
- Every 2 weeks for minimum 6 weeks until dose stable; then 3 monthly
- Albumin
- ALT or AST
- Full blood count
- Serum creatinine (for creatinine clearance) or Calculated glomerular filtration rate
Ongoing once stable
Required
- At least every 12 weeks
- Albumin
- ALT or AST
- Full blood count
- Serum creatinine (for creatinine clearance) or Calculated glomerular filtration rate
Abnormal results
Respond to absolute levels
Consider stopping treatment and contacting a specialist any of the following develop:
Blood pressure
- BP greater than 140/90mmHg. Manage in accordance with hypertension guidelines.
Full blood count
- WCC less than 3.5 x 109/L,
- Neutrophils less than 1.6 x 109/L
- Unexplained eosinophilia greater than 0.5x 10 9/L
- Platelets less than 140 x 109/l
- Unexplained fall in serum albumin less than 30g/L
- MCV greater than 105f/L then check B12, folate, thyroid-stimulating hormone levels. If abnormal treat; if normal discuss with specialist team.
Liver function
- AST or ALT increase to greater than 100units/ml
Renal function
- Creatinine increase greater than 30% above baseline over 12 months
- Calculated GFR less than 60ml/min/1.73m2 (repeat in 1 week, if still more than 30% from baseline, withhold and discuss with specialist team)
Investigate if urinary protein
If urinary protein is at 2+ or more, a mid-stream urine sample should be taken, and:
- if there is evidence of infection, this should be treated appropriately;
- if the urine sample is sterile (no infection present) and the urinary protein 2+ or more persists on two consecutive measurements, stop ciclosporin and discuss with specialist team.
Notes
Advice to patients
Advise patients to seek urgent medical attention if they develop symptoms such as:
- Skin or mucosal reaction (rash, pruritus, mouth or throat ulceration)
- Sore throat
- Fever
- Unexplained bruising or bleeding
- Nausea, vomiting, diarrhoea or weight loss
- Diffuse alopecia
- Breathlessness, infection or cough
- Peripheral neuropathy
Both male and female patients should be aware of the advice on conception and contraception
Bibliography
- Ledingham J, Gullick N, Irving K et al. BSR and BHPR Standards, Guidelines and Audit Working Group, BSR and BHPR guideline for the prescription and monitoring of non-biologic disease-modifying anti-rheumatic drugs, Rheumatology, Volume 56, Issue 6, June 2017, Pages 865–868 [cited June 2020]
- NICE Clinical Knowledge Summaries (CKS). DMARDs – mycophenolate. Updated Jul 2018 [cited 30/07/2020]
- Medicines and Healthcare products Regulatory Agency (MHRA). Mycophenolate mofetil, mycophenolic acid: updated contraception advice for male patients. Drug Safety Update volume 11 issue 7; February 2018: 2. [cited 30/07/2020].
- Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press [cited 30/04/2020]
- Roche Products Limited. Summary of Product Characteristics – Cellcept 500mg Film-Coated Tablets. Last revised 02/2020 [cited 30/07/2020]
- Specialist Pharmacy Service. Switching between liquid and tablet/capsule formulations – Which medicines require extra care? Published 17/07/2020
Enquiries about this page
Contact us if you have any enquiries about the drug monitoring information on this page.