Pyrazinamide Ciclosporin

This topic has been re-analysed in a systematic review of published papers, in which relevant information from a total of 34 patients was identified (163). AU but two patients were also taking concomitant drugs known to affect the muscles, among which glucocorticoids, simvastatin, lovastatin, colchicine, and pyrazinamide were the most frequently cited. Ciclosporin is therefore difficult to implicate in most patients, but at least one case with positive ciclosporin re-administration supported a causative role. The clinical picture was non-specific, with myalgia, cramps, and muscle weakness, sometimes associated with raised serum creatine kinase activity, and heterogeneous histopathology. FinaUy, skeletal muscle abnormalities have rarely been described in patients without muscle symptoms. 

Isonlazld and ethambutol do not normally interact with ciclosporin. However, there is one case report describing a patient who had a gradual rise in serum ciclosporin levels when isoniazid and ethambutol were stopped, and another which attributed a marked rise in ciclosporin levels to the use of isoniazid." There have been several other case reports of successful treatment of tuberculosis in heart and kidney transplant patients using isoniazid, ethambutoi, pyrazinamide with ofloxacin, or streptomycin.Consider also pyrazinamide , (p.l044), and quinolones , (p.1018). 

Pyrazinamide does not normally appear to interact with ciclosporin but one isolated report suggests that it may possibly have contributed to the effects of rifampicin in one patient, which resulted in lowered ciclosporin levels. Another patient developed toxic myopathy attributed to the use of pyrazinamide with ciclosporin. 

There would therefore seem to he no reason for avoiding pyrazinamide in patients taking ciclosporin, hut he aware of these rare complications. 

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