Ciclosporin Aminoglycosides

CICLOSPORIN AMINOGLYCOSIDES, COLISTIN t risk of nephrotoxicity Additive nephrotoxic effects Monitor renal function... 

Gentamicin is an aminoglycoside. All aminoglycosides tend to be nephrotoxic and ototoxic. The dose must be reduced and serum concentrations must be monitored in patients with impaired renal function. Concomitant administration of aminoglycosides and other nephrotoxic drugs, such as certain diuretics, ciclosporin, teicoplanin and vancomycin should be avoided. 

Concentration dependent toxicity Aminoglycosides Cytotoxic agents Ciclosporin Digoxin Lithium Tacrolimus Theophylline Warfarin... 

Additive renal toxic effects may occur with immunosuppressants (e.g. azathioprine, ciclosporin, tacrolimus), ACE inhibitors, penicillamine, irinotecan and aminoglycoside antibiotics. A deterioration of renal function may even occur after the topical use of NSAIDs. Guidelines are variable for the use of NSAIDs with differing degrees of renal function, as assessed by creatinine clearance measurements. 

Continuous infusion of amphotericin has been assessed in an open study in six lung transplant recipients with invasive or semi-invasive bronchopulmonary azole-resistant candidal infections who were treated for 40 (17-73) days by 24-hour continuous infusions of amphotericin 1 mg/kg (113). They received at least 1000 ml/day of 0.9% saline intravenously. Apart from ciclosporin, five patients received aminoglycosides for at least 2 weeks, and four received ganciclovir. Calculated creatinine clearance fell from 57 (43-73) ml/minute to a nadir of 35 (28-39) and recovered to 52 (33-60) after the end of therapy. One patient needed temporary hemofiltration for 7 days. Besides three episodes of mild hypokalemia there were no adverse effects attributable to amphotericin. Asymptomatic colonization with Candida persisted for 10 months in one case, but the other five patients were cured. 

ADEFOVIR DIPIVOXIL 1. ANTIBIOTICS-aminoglycosides, vancomycin 2. ANTICANCER AND IMMUNOMODULATING DRUGS-ciclosporin, tacrolimus 3. ANTIFUNGALS-amphotericin, 4. ANTIPROTOZOALS-pentamidine 5. ANTIVIRALS - cidofovir, foscarnet sodium, tenofovir Possible t efficacy and side-effects Competition for renal excretion Monitor renal function weekly... 

Nephrotoxic drugs + Nephrotoxic drugs (e.g. Aminoglycosides, Ciclosporin, Cisplatin, Vancomycin) Increased nephrotoxicity... 

In contrast, a retrospective analysis of the medical records of bone marrow transplant patients suggested that aminoglycosides can be safely given with a continuous infusion of ciclosporin without excessive nephrotoxicity, if the patient is carefully monitored. ... 

Established and clinically important interactions. The concurrent use of ciclosporin and aminoglycosides should be avoided where possible, and only undertaken with care and very close monitoring of renal function. 

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