Ciclosporin Chloroquine

Guiserix J, Aizel A. Interactions ciclosporine-chloroquine. [Cyclosporine-chloroquine interactions.] Presse Med 1996 25(26) 1214. 

CICLOSPORIN ANTIMALARIALS -(HYDROXY)CHLOROQUINE t plasma concentrations of ciclosporin Likely inhibition of ciclosporin Monitor renal function weekly... 

These include mesalazine, metformin, NSAIDs, tetracyclines (except doxycycline and minocycline), chloramphenicol, lithium, methotrexate, chloroquine, fibrates, chlorpropamide and glibenclamide, Clinically, it is useful to measure urine output per hour or per 24 hours as a fall in urine output in the presence of adequate fluid intake often indicates or warns of some impairment of renal function. Furthermore, it is neither expensive nor time-consuming to perform a quick test for albumin, casts and red cells in the urine, and to measure pH. Creatinine clearance values are often used to determine the safe doses for several drugs (e.g. NSAIDs, ciclosporin). 

Three patients had rapid rises in serum ciclosporin levels, with evidence of nephrotoxicity in two of them, when they were given chloroquine. Some loss of renal function has even been seen with low doses of ciclosporin used with chloroquine for rheumatoid arthritis. Hydroxychloroquine is expected to interact similarly... 

A kidney transplant patient taking ciclosporin, azathioprine and prednisolone had a threefold rise in ciclosporin blood levels, from 148 to 420 nanograms/mL, accompanied by a rise in serum creatinine levels within 48 hours of starting chloroquine 900 mg daily for suspected malarial fever. On days 2 and 3 the ehloroquine dosage was reduced to 300 mg daily. The eielosporin and ereatinine returned to their former levels 7 days... 

When another kidney transplant patient taking ciclosporin, azathioprine and prednisolone was given chloroquine 100 mg daily for 6 days, his ciclosporin serum levels rose from 105 to 470 nanograms/mL and his serum creatinine levels rose from 200 to 234 micromol/L, accompanied by a rise in blood pressure from 130/80 to 160/100 mmHg. These changes reversed when the chloroquine was stopped, and occurred again when chloroquine was restarted. The ciclosporin serum levels of another patient were doubled by chloroquine 100 mg daily. ... 

A randomised, controlled study in 88 patients with recent onset rheumatoid arthritis found that the addition of ciclosporin (1.25 or 2.5 mg/kg daily) to chloroquine 100 mg daily was moderately effective, but changes in serum creatinine levels occurred. In the presence of chloroquine the creatinine was not significantly altered by placebo or ciclosporin 1.25 mg/kg, but was raised by 10 micromol/L by ciclosporin2.5 mg/kg, indicating that some renal effects can occur. ... 

Not understood. Both chloroquine and ciclosporin can impair renal function. ... 

Nampoory MRN, Nessim J, Gupta RK, Johny KV. Drag interacticn of chloroquine and ciclosporin. Nephron (1992) 62,108-9. 

Chloramphenicol, children, 15.267 Chloroquine, 15.286 Chondroprotective agents, 14.439 Chymopapain, 11.279, 14.264 Ciclesonide, 30.196 Ciclosporin, urinary system, 19.348 Clozapine, 15.50 agranulocytosis, 22.1359 Cocaine... 

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