Common use of xx/xxx Clause in Contracts

xx/xxx. Adverse drug reactions Many side effects associated with ciclosporin therapy are dose- dependent and responsive to dose reduction. Common Nausea, vomiting, abdominal pain, diarrhoea, gingival hyperplasia, tremor, headache, paraesthesia. • Hypertension Hypertension (BP >130/>80mmHg) is a commonly encountered adverse effect which the GP will be best placed to monitor and treat. Standard antihypertensives can be used but avoid diltiazem, nicardipine, felodipine and verapamil as they may increase plasma ciclosporin levels. • Benign gingival hyperplasia This is relatively common with ciclosporin especially when nifedipine is co-prescribed. Patients should be advised to brush their teeth twice daily. • Hirsutism Hirsutism may be a problem, particularly to dark skinned females. Facial hair bleaches and depilatory creams are safe and often effective but electrolysis should be avoided because of infection risk. • Headache, tremor, and paraesthesiae These adverse effects are frequently seen. If persistent or severe, they may reflect toxic levels of ciclosporin. In this case, the patient should be referred back to the specialist. • Hepatic dysfunction and hyperlipidaemia Hepatic dysfunction and hyperlipidaemia should be routinely monitored for. In the event of increased lipids being found, restriction of dietary fat and, if appropriate, a dose reduction, should be considered. Some statins are contra-indicated with ciclosporin or must be used at a lower dose (see under interactions) .Ciclosporin may enhance statin myopathy. • Nephrotoxicity An acute nephrotoxicity may occur with ciclosporin which is usually identified by serum creatinine monitoring and is reversible by dose reduction. If serum creatinine consistently >30% above patients baseline, decrease ciclosporin dose by 25-50%. A chronic nephrotoxicity may also occur requiring withdrawal of this drug. • Cancer risk Like all immunosuppressant’s, ciclosporin increases the risk of developing lymphomas and other malignancies, particularly those of the skin. Patients should be advised to avoid excessive exposure to the sun and use high factor sunscreens. For full list see BNF or SPC at xxx.xxxxxxxxx.xxx.

xx/xxx. Adverse drug reactions Many side effects associated with ciclosporin therapy are dose- dependent and responsive to dose reduction. Common Nausea, vomiting, abdominal pain, diarrhoea, gingival hyperplasia, tremor, headache, paraesthesia. •  Hypertension Hypertension (BP >130/>80mmHg) is a commonly encountered adverse effect which the GP will be best placed to monitor and treat. Standard antihypertensives can be used but avoid diltiazem, nicardipine, felodipine and verapamil as they may increase plasma ciclosporin levels. •  Benign gingival hyperplasia This is relatively common with ciclosporin especially when nifedipine is co-prescribed. Patients should be advised to brush their teeth twice daily. •  Hirsutism Hirsutism may be a problem, particularly to dark skinned females. Facial hair bleaches and depilatory creams are safe and often effective but electrolysis should be avoided because of infection risk. •  Headache, tremor, and paraesthesiae These adverse effects are frequently seen. If persistent or severe, they may reflect toxic levels of ciclosporin. In this case, the patient should be referred back to the specialist. •  Hepatic dysfunction and hyperlipidaemia Hepatic dysfunction and hyperlipidaemia should be routinely monitored for. In the event of increased lipids being found, restriction of dietary fat and, if appropriate, a dose reduction, should be considered. Some statins are contra-indicated with ciclosporin or must be used at a lower dose (see under interactions) .Ciclosporin may enhance statin myopathy. •  Nephrotoxicity An acute nephrotoxicity may occur with ciclosporin which is usually identified by serum creatinine monitoring and is reversible by dose reduction. If serum creatinine consistently >30% above patients baseline, decrease ciclosporin dose by 25-50%. A chronic nephrotoxicity may also occur requiring withdrawal of this drug. •  Cancer risk Like all immunosuppressant’s, ciclosporin increases the risk of developing lymphomas and other malignancies, particularly those of the skin. Patients should be advised to avoid excessive exposure to the sun and use high factor sunscreens. For full list see BNF or SPC at xxx.xxxxxxxxx.xxx.