Drug interactions ciclosporin

Drug-drug interactions Ciclosporin Acute kidney damage has been reported in association with aciclovir and ciclosporin [19" ]. 

Q35 Cli nically significant drug interactions with ciclosporin could occur... 

Most drug interactions associated with rhabdomyolysis occur when ciclosporin is combined with simvastatin or lovastatin. It has been suggested that if a statin is to be combined with ciclosporin, pravastatin or fluvastatin should be chosen instead (80). 

Lampen A, Christians U, Bader A, et al. Drug interactions and interindividual variability of ciclosporin metabolism in the small intestine. Pharmacology 1996 52 (3) 159-168. 

ACEBUTOLOL, ATENOLOL, BETAXOLOL, BISOPROLOL, METOPROLOL, PROPANOLOL CICLOSPORIN t risk of hyperkalaemia Beta-blockers cause an efflux of potassium from cells, and side-effect has been observed during cidosporin therapy Monitor serum potassium levels during co-administration > For signs and symptoms of hyperkalaemia, see Clinical Features of Some Adverse Drug Interactions, Hyperkalaemia... 

POTASSIUM-SPARING DIURETICS CICLOSPORIN t risk of hyperkalaemia Additive effect >- For signs and symptoms of hyperkalaemia, see Clinical Features of Some Adverse Drug Interactions, Hyperkalaemia... 

CICLOSPORIN DOXORUBICIN High doses of cidosporin T AUC of doxorubicin by 48% and of a metabolite by 443%. Risk of severe myelosuppression and neurotoxicity Cidosporin inhibits P-gp and cytochrome P450, which results in 1 clearance of doxorubicin Advise patients to report symptoms such as sore throat, fever, bleeding and bruising - For signs and symptoms of immunosuppression, see Clinical Features of Some Adverse Drug Interactions, Immunosuppression and blood dyscrasias... 

CICLOSPORIN BZDs-ALPRAZOLAM, MIDAZOLAM, DIAZEPAM Likely t plasma concentrations and risk of t sedation These BZDs are metabolized primarily by CYP3A4, which is moderately inhibited by cidosporin Warn patients about t sedation. Consider using alternative drugs, e.g. flurazepam, quazepam. Warn about activities requiring attention - For signs and symptoms of CNS depression, see Clinical Features of Some Adverse Drug Interactions, Central nervous system depression... 

Drug interactions with ciclosporin have been comprehensively reviewed (5). 

Table 1 lists drugs that have proven or possible clinically relevant drug interactions with ciclosporin. 

The FDA has received six reports of subtherapeutic blood ciclosporin concentrations soon after transplant recipients started to take orlistat (285). Reduced absorption of ciclosporin is the most likely mechanism (286,287) by reduction in fat absorption rather than by a direct drug-drug interaction. 

Potential drug-drug interactions of ciclosporin with methylphenidate and amfebutamone (bupropion) have been described (43). 

Breidenbach TH, Hoffmann MW, Becker TH, Schlitt H, Klempnauer J. Drug interaction of St. John s wort with ciclosporin. Lancet 2000 355 1912. 

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