Ciclosporin Acenocoumarol

CICLOSPORIN ANTICOAGULANTS-ORAL 1. J ciclosporin levels when co-administered with warfarin or acenocoumarol 2.1 anticoagulant effect with warfarin and variable effect with acenocoumarol Competitive metabolism by CYP3A4 1. Watch for i efficacy of ciclosporin 2. Monitor INR at least weekly until stable... 

The ciclosporin levels of a patient were reduced when warfarin was given. When the ciclosporin dosage was raised an increase in the warfarin dosage was needed. The INR of another patient taking warfarin was reduced when she was given ciclosporin. A further report describes a rise in serum ciclosporin levels when an unnamed anticoagulant was given. Other reports describe increased or decreased acenocoumarol effects and decreased ciclosporin levels in two patients. 

Acenocoumarol, warfarin and ciclosporin are all metabolised, at least in part, by the cytochrome P450 isoenzyme CYP3A4. It is possible that some competition occurs for metabolism, leading to increased or decreased effects of the anticoagulants and decreased ciclosporin levels. 

---