Propafenone Ciclosporin

PROPAFENONE ANTICANCER AND IMMUNOMODULATING DRUGS-CICLOSPORIN Possible t cidosporin levels Uncertain Watch for signs of cidosporin toxicity... 

Mibefradil inhibits CYP3A4 (2). Other drugs that are metabolized by this pathway accumulate as a result. Drugs that were commonly affected included amiodarone, astemizole, ciclosporin, cisapride, erythromycin, imi-pramine, lovastatin, propafenone, quinidine, simvastatin (9), tacrohmus (10), tamoxifen, terfenadine, thioridazine, and drugs that impair sinoatrial node function (for example beta-blockers) (6). 

I. ANTIARRHYTHMICS - disopyramide, propafenone 2. ANTIBIOTICS-chloramphenicol, doxycycline, metronidazole, rifampicin, telithromycin 3. ANTICANCER AND IMMUNOMODULATING DRUGS - carmustine, ciclosporin, corticosteroids, doxorubicin, etoposide, ima-tinib, lomustine, paclitaxel, tacrolimus, tamoxifen, toremifene, vinca alkaloids... 

A heart transplant patient taking eielosporin, azathioprine and prednisolone developed ventrieular tachyeardia 9 months after transplantation, for whieh he was given propafenone 600 or 750 mg daily. After the first day, his ciclosporin level had risen from about 160 to 190 nanograms/mL, and after 5 days the levels had reaehed around 260 nanograms/mL. Over the same time period his serum ereatinine rose from 168 to 212 micromol/L. His ciclosporin dose was redueed from 240 mg daily to a final dose of 200 mg daily after whieh his renal function and ciclosporin levels were reestablished at about the level before propafenone was started. ... 

The authors suggest that propafenone interferes with the metabolism of ciclosporin by affecting hepatic cytochrome P450, or that propafenone may enhance the absorption of ciclosporin. 

Spes CH, Angermann CE, Horn K, Strasser T, Mudra H, Landgraf R, Theisen K. Ciclosporin-propafenone interaction. Klin Wochenschr 99(S) 68, 872. 

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