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.