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Ciclosporin ocular

Drugs List

  • ciclosporin 0.1% eye drops 0.3ml unit dose
  • IKERVIS 1mg/ml eye drops emulsion 0.3ml unit dose
  • VERKAZIA 1mg/ml eye drops emulsion 0.3ml unit dose
  • Therapeutic Indications


    Keratoconjunctivitis sicca
    Vernal keratoconjunctivitis

    Severe keratitis in adults with dry eye disease (keratoconjunctivitis sicca), which has not improved despite treatment with tear substitutes.

    Treatment of severe vernal keratoconjunctivitis (VKC) in children from 4 years of age and adolescents.



    Keratoconjunctivitis sicca
    Instil 1 drop into the affected eye(s) once daily at bedtime.


    Vernal keratoconjunctivitis
    Children over 4 years:
    Instil 1 drop into the affected eye(s) four times a day.

    Maintain treatment at recommended dose if signs and symptoms persist. Reduce to 1 drop twice daily once adequate control is achieved.

    Additional Dosage Information

    If a dose is missed, treatment should continue with the next dose as planned. The dose should not exceed 1 drop for each instillation into the affected eye(s).


    Children under 4 years
    Ocular infection
    Ocular or periocular malignancies
    Periocular infection

    Precautions and Warnings

    Children aged 4 to 18 years
    Wearing of contact lenses
    History of viral ocular infection
    Ocular herpes simplex infection

    Advise patient blurred vision may affect ability to drive/operate machinery
    Exclude ocular & periocular malignacies or pre-malignancies before therapy
    Exclude ocular or periocular infection prior to treatment
    Not all available brands are licensed for all indications
    Not all available brands/formulations are licensed for use in children
    Treatment to be prescribed under the supervision of a specialist
    Contains cetalkonium chloride - May cause eye irritation
    Administer other ophthalmic products at least 15 minutes apart
    For single use only
    To reduce systemic absorption compress lacrimal sac during administration
    KCS: Response to treatment should be reassessed every 6 months
    Female: Ensure adequate contraception during treatment
    Advise patient to avoid touching the eye/other surfaces with container tip
    KCS: Remove contact lenses before use and re-insert at wake-up time
    VKC: Use of contact lenses not recommended

    Pregnancy and Lactation


    Use ciclosporin with caution during pregnancy.

    The manufacturer advises that ciclosporin eye drops are not recommended during pregnancy and that they should only be used when the benefits outweigh the risks. Studies in animals have shown reproductive toxicity following systemic administration of ciclosporin at exposure considered sufficiently in excess of the maximum human exposure, indicating little relevance to the clinical use of this medication. Data available from organ transplant recipients indicate that, compared with other immunosuppressive agents, ciclosporin treatment imposes no increased risk of adverse effects on the course or outcome of pregnancy, however there is an increased risk of premature birth. Exposure to ciclosporin does not justify termination of pregnancy. A detailed foetal ultrasound examination should be offered to confirm normal morphologic development in the case of first-trimester exposure.


    Ciclosporin is contraindicated during breastfeeding.

    The manufacturer advises that at therapeutic doses of ciclosporin in eye drops, it is unlikely that sufficient amounts would be present in breastmilk. However, a decision must be made whether to discontinue breastfeeding or to discontinue/abstain from this medication, taking into account the benefit of breastfeeding for the child and the benefit of therapy for the woman. Ciclosporin is excreted into breastmilk, although the concentrations are relatively low. A risk to neonates cannot be excluded. Schaefer considers that this drug should pose no obstacle to breastfeeding, as long as breastfeeding did not take place for at least four hours after ciclosporin administration so as to avoid peak ciclosporin levels in milk.

    Side Effects

    Application site reaction
    Blurred vision (transient)
    Conjunctival hyperaemia
    Conjunctival irritation
    Conjunctival oedema
    Corneal decompensation
    Corneal deposits
    Corneal infiltrates
    Corneal scar
    Eyelid erythema
    Eyelid oedema
    Eyelid pruritus
    Increased lacrimation
    Lacrimal gland disorder
    Ocular discharge
    Ocular discomfort
    Ocular hyperaemia
    Ocular irritation
    Ocular pain
    Ocular pruritus
    Ophthalmic herpes zoster
    Sensation of foreign body in eye
    Upper respiratory tract infection


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: October 2018

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    Summary of Product Characteristics: Ikervis 1 mg/ml eye drops, emulsion. Santen Oy. Revised July 2019.

    Summary of Product Characteristics: Verkazia 1mg/ml eye drops, emulsion. Santen Oy. Revised July 2019.

    NICE Evidence Services Available at: Last accessed: 24 October 2018

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