Clindamycin Ciclosporin

In two lung-transplant patients aged 39 and 48 years, blood ciclosporin concentrations fell after the addition of oral clindamycin (1.8 g/day), and both patients required temporary increases in daily ciclosporin dose until clindamycin withdrawal (237). 

In two patients who had lung transplants and were taking an immunosuppressive regimen that included ciclosporin, the addition of clindamycin (600 mg tds) resulted in a significant reduction in ciclosporin concentrations (68). 

Two patients had a marked reduction in their serum ciclosporin levels when they took clindamycin. 

A lung transplant patient receiving ciclosporin in a dose to maintain levels of 100 to 150 nanograms/mL required dose increases to achieve this level when clindamycin 600 mg three times daily was given. Initially the levels were almost halved by the addition of clindamycin. Ciclosporin was reduced to the original dose when the clindamycin was stopped. ... 

In a second lung transplant patient, the use of clindamycin 600 mg three times daily necessitated ciclosporin dose increases from 325 mg daily to 1.1 g daily over 4 weeks to maintain serum levels of about 200 nanograms/mL. The reasons for the interaction are not understood, but the authors suggest close monitoring of ciclosporin levels to prevent underdosing if clindamycin is given however, this seems exceptionally cautious as these two cases appear to be all that have been reported. 

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