Ciclosporin / Tacrolimus

• Lupus nephritis or transplant-related autoimmune disease when azathioprine/HCQ insufficient

Inhibit calcineurin → block IL-2 transcription → suppress T-lymphocyte activation.

• Compatible — continue if needed for disease control
• Tacrolimus dose often needs increasing in pregnancy (↑ clearance)
• Monitor BP + renal function every trimester

Ciclosporin

2.5–5 mg/kg/day PO in 2 divided doses, trough-level guided

Tacrolimus

0.1–0.2 mg/kg/day PO in 2 divided doses, trough-level guided — often needs uptitration in pregnancy

• CautionUncontrolled hypertension
• CautionRenal impairment
• AbsoluteVoclosporin specifically avoided in pregnancy/lactation — alcohol-containing formulation (distinct from ciclosporin/tacrolimus)

• Hypertension
• Nephrotoxicity
• Tremor, headache
• Gum hyperplasia / hirsutism (ciclosporin)

• • Compatible in pregnancy; possible association with preterm birth/low birth weight, though hard to separate from underlying maternal disease.
• • Low transfer into breast milk — compatible with breastfeeding.

• Grapefruit juice

  Caution

  ↑ levels via CYP3A4 inhibition

• NSAIDs

  Caution

  ↑ nephrotoxicity risk

• 💡 A useful steroid- and MMF-sparing option that can safely bridge a woman through pregnancy when disease needs more than azathioprine/HCQ alone.