Cyclosporine drug interactions

Martin JE, Daoud AJ, Schroeder TJ, First MR. The clinical and economic potential of cyclosporin drug interactions. Pharmacoeconomics 1999 15(4) 317-37. 

Wadhwa NK, Schroeder TJ, Pesce AJ, et al. Cyclosporin drug interactions a review. Ther Drug Monit 1987 9 399-406. 

LiU J, Bauer LA, Horn JR, Hansten PD. Cyclosporine-drug interactions and the influence of patient age. Am J Health Syst Pharm 2000 57(17) 1579-84. 

Mai I, Bauer S, Perloff ES, Johne A, Uehleke B, Frank B, Budde K, Roots I. Hyperforin content determines the magnitude of St. John s wort-cyclosporine drug interactions. Clin Pharmacol Ther 2004 76 330-340. 

Mai, L, Bauer, S., Perloff, E., Johne, A., Uehleke, B., Frank, B., et al. (2004). Hyperforin content determines the magnitude of the St John s wort-cyclosporine drug interaction. Clinical Pharmacology and Therapeutics, 76, 330—340. 

Cohen E, Kramer MR, Maoz C, Ben-Dayan D, Gaity M Cyclosporin drug-interaction-induced rhabdomyolysis A report of two cases in lui tran lant recipients. Transplantati[Pg.1024]

Sirolimus is currently the only FDA-approved ToR inhibitor. One of its derivatives, everolimus, is in phase III clinical trials and has been approved for use in some European countries.30 Sirolimus is a macrolide antibiotic that has no effect on cal-cineurin phosphatase.11,31,32 Sirolimus inhibits T cell activation and proliferation by binding to and inhibiting the activation of the mammalian ToR, which suppresses cellular response to IL-2 and other cytokines (i.e., IL-4 and IL-15J.11,31 Studies have shown that sirolimus may be used safely and effectively with either cyclosporine or tacrolimus as a replacement for either azathioprine or mycophenolate mofetil.33 However, when using both sirolimus and cyclosporine as part of a patient s immunosuppressant therapy, because of a drug interaction between the two resulting in a marked increase in sirolimus concentrations, it is recommended to separate the sirolimus and cyclosporine doses by at least 4 hours. Sirolimus also can be used as an alternative agent for patients who do not tolerate calcineurin inhibitors due to nephrotoxicity or other adverse events.34... 

Drug interactions Metabolized by CYP450 3A4 (e.g., cyclosporine, erythromycin, itraconazole, phenytoin, St. John s wort)... 

Although many patients believe that dietary supplements will not interact with medications, recent literature suggests otherwise. Recently, many St. John s wort-drug interactions have been reported in the literature. Cases of patients developing symptoms of serotonin syndrome have been reported with St. John s wort alone and in concomitant therapy with other antidepressants such as monoamine oxidase inhibitors, serotonin reuptake inhibitors, and venlafaxine. St. John s wort may exacerbate the sedative effects of benzodiazepines, alcohol, narcotics, and other sedatives. St. John s wort may decrease the levels of protease inhibitors, cyclosporine, digoxin, and theophylline. 

Azithromycin Drugs that may interact with azithromycin include antacids, cyclosporine, HMG-CoA reductase inhibitors, pimozide, tacrolimus, theophyllines, and warfarin. Also consider all drug interactions with erythromycin. 

The following drug interactions were reported for metronidazole, a chemically related nitroimidazole. Therefore, these drug interactions may occur with tinidazole. Drugs that may affect tinidazole include cholestyramine, CYP3A4 inducers and inhibitors and oxytetracycline. Drugs that may be affected by tinidazole include alcohols, anticoagulants, cyclosporine, tacrolimus, disulfiram, fluorouracil, hydantoins, and lithium. 

The potential for drug interactions, particularly with other drugs that are actively secreted by the proximal tubules, should be considered. Probenecid has been shown to inhibit the renal clearance of acyclovir. Cyclosporine and other nephrotoxic agents may increase the risk of renal toxicity of acyclovir. 

Significant drug interactions include cyclosporins (increased cyclosporine levels), phenytoin, rifampin, and rifabutin (decreased voriconazole levels). Because of its low toxicity profile, this drug may gain importance in the chronic treatment of infections with invasive dimorphic fungi and resistant Candida spp. 

Breidenbach T, Hoffmann MW, Becker T, et al Drug interaction of St John s wort with cyclosporin (letter). Lancet 355 1912, 2000... 

Greenblatt DJ, von Moltke LL, Harmatz JS, et al Human cytochromes and some newer antidepressants kinetics, metabolism, and drug interactions. J Clin Psychopharmacol 19 23S-35S, 1999 Karliova M, Treichel U, Malago M, et al Interaction of Hypericum perforatum (St. John s wort) with cyclosporin A metabolism in a patient after liver transplantation. J Hepatol 33 853-855, 2000 Michalets EL Update clinically significant cytochrome P-450 drug interactions. Pharmacotherapy 18 84-112, 1998... 

Drug interactions Sandostatin has been associated with changes in nutrient absorption, so it may effect the absorption of orally administered drugs. Concomitant administration of Sandostatin with cyclosporine may decrease blood levels of cyclosporine and result in transplant rejection. Patients receiving insulin, oral hypoglycemic agents, beta blockers. 

Drug interactions In a randomized, double-blind study, Zenapax or placebo was added to an immunosuppressive regimen of cyclosporine, mycophenolate mofetil, and steroids to assess tolerability, pharmacokinetics, and drug interactions. The addition of Zenapax did not result in an increased incidence of adverse events or a change in the types of adverse events reported. The following medications have been administered in clinical trials with Zenapax with no incremental increase in adverse reactions cyclosporine, mycophenolate mofetil, ganciclovir, acyclovir, azathioprine, and corticosteroids. 

Drug interactions No formal drug-drug interaction studies have been conducted. The following medications have been administered in clinical trials with Simulect with no incremental increase in adverse reactions azathioprine, corticosteroids, cyclosporine, mycophenolate mofetil, and muromonab-CD3. 

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