環孢素

用途

• Keratoconjunctivitis sicca (KCS)
• Keratoconjunctivitis sicca (KCS)
• German Shepherd Pannus (chronic superficial keratitis)

給藥方式

可能的副作用

• Mild ocular irritation upon application
• Aggravation of ophthalmic herpes virus infections (especially in cats)

注意事項與禁忌

• Feline keratoconjunctivitis sicca associated with active herpes virus infection
• Feline eosinophilic keratitis (historically, though newer evidence varies, the monograph notes it is not promising)
• > **Important:** Discontinuation of therapy usually results in the return of clinical signs of KCS within a few days. Use with caution in the face of ulcerative keratitis, although it is generally considered safe when concurrent antibiotic therapy is administered. Compounded formulations should be avoided if an approved commercial product (Optimmune) is available and effective.

藥物相互作用

• Itraconazole: Inhibits cytochrome P450 metabolism of ciclosporin, increasing blood concentrations up to five-fold. Dose reduction (halving dose or doubling interval) is required.
• Ketoconazole: Inhibits cytochrome P450 metabolism of ciclosporin, significantly increasing blood concentrations.
• Diltiazem: Competitively inhibits enzymes involved in ciclosporin metabolism, increasing serum levels.
• Doxycycline: Inhibits enzymes involved in ciclosporin metabolism, increasing serum levels.
• Aminoglycosides: Increased risk of nephrotoxicity; concomitant use is not recommended.
• NSAIDs: Increased risk of nephrotoxicity; concomitant use is not recommended.
• Quinolones: Increased risk of nephrotoxicity; concomitant use is not recommended.
• Trimethoprim/Sulphonamides: Increased risk of nephrotoxicity; concomitant use is not recommended.
• ACE inhibitors: Increased risk of hyperkalaemia.
• Macrocyclic lactones (e.g., ivermectin, milbemycin): Ciclosporin inhibits MDR1 P-glycoprotein, decreasing the efflux of macrocyclic lactones from the blood-brain barrier, potentially resulting in CNS toxicity.

常見問題