Enalapril Ciclosporin

A 52-year-old male renal transplant recipient on stable therapy (4.5 months) with ciclosporin, myco-phenolate mofetil, and co-trimoxazole developed erythrocytosis and hypertension. His leukocyte count fell 19 days after he started to take enalapril. Enalapril was withdrawn, the dose of co-trimoxazole was halved, and the dose of mycophenolate was first reduced and then withdrawn on day 25. On day 28 the leukocyte and neutrophil counts were so low that granulocyte-stimulating factor had to be used. The leukocyte count normalized during continued treatment with ciclosporin and co-trimoxazole. CMV tests were negative. 

A 40-year-old woman with a lung transplant (taking ciclosporin, azathio-prine, prednisolone, enalapril, gentamicin inhalation, salbutamol and acetylcysteine) developed life-threatening hyperkalaemia of 6.8 mmol/L... 

Two kidney transplant patients on ciclosporin developed acute renal failure 10 to 42 days after starting to take enalapril 5 to 10 mg twice daily. Recovery was complete when the enalapril was stopped in one of the patients, and when both enalapril and ciclosporin were stopped in the other. The latter patient had no problems when the ciclosporin was restarted. Both recovered renal function after 10 to 30 days. Neither had any previous evidence of renal artery stenosis or chronic rejection, which are conditions known to predispose to renal failure during ACE inhibitor treatment. Two other patients appeared to tolerate concurrent use well. Two further kidney transplant patients developed acute renal failure when given enalapril. Neither had renal arterial stenosis or acute rejection. The manufacturer briefly mentions that transient oliguria was seen in a kidney transplant patient given ciclosporin and captopril. ... 

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