Etretinate Ciclosporin

Secondary hyperlipidaemias results from liver and biliary disease, obesity, hypothyroidism, diabetes, diet, alcohol excess, renal disease (nephrotic syndrome) and drugs (including etretinate, HIV protease ir hibitors, thiazide diuretics, oral contraceptive steroids, glucorticosteroids, (3-adrenoceptor antagonists, ciclosporin). 

An increase in ciclosporin blood levels occurred in one patient given etretinate, but studies have not found this effect. In two patients taking isotretinoin and ciclosporin, rises in ciclosporin levels occurred, although another patient taking both drugs had no alteration in ciclosporin levels. 

Uncertain. An in vitro study using human liver microsomes found that concentrations of 100 micromol of acitretin, etretinate and isotretinoin inhibited the total ciclosporin metaholism and total primary ciclosporin metabolite production to the same extent (32 to 45%). These figures suggest that the retinoids may inhibit ciclosporin metabolism. However, another in vitro study using human liver microsomes did not find that etretinate inhibits the metabolism of ciclosporin. ... 

The overall picture seems to be that etretinate has only a modest effect, or no effect at all, on ciclosporin blood levels in most patients. Nevertheless, this possible interaction is worth bearing in mind because of the possibility of isolated cases of raised ciclosporin levels. There seems to be no marked therapeutic advantage in using both drugs together for psoriasis. From the cases presented, it is unclear if isotretinoin alters ciclosporin levels. In addition, it has been suggested that serum lipids should be monitored be-... 

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