Warfarin Ciclosporin

Interactions Antacids ciclosporin colestipol druas metabolized bv cytochrome P450 3A4 fibrates oral-contraceptiyes warfarin niacin erythromycin diaoxin azole-antifunaals... 

Concentration dependent toxicity Aminoglycosides Cytotoxic agents Ciclosporin Digoxin Lithium Tacrolimus Theophylline Warfarin... 

The absorption of some drugs may also be reduced if they are given with adsorbents such as charcoal or kaolin, or anionic exchange resins such as colestyramine or colestipol. The absorption of propranolol, digoxin, warfarin, tricyclic antidepressants, ciclosporin and levothyroxine is reduced by colestyramine. 

Cholestasis Oral contraceptives, ciclosporin, tamoxifen, warfarin, azathioprine, carbimazole... 

CICLOSPORIN ANTICOAGULANTS-ORAL 1. J ciclosporin levels when co-administered with warfarin or acenocoumarol 2.1 anticoagulant effect with warfarin and variable effect with acenocoumarol Competitive metabolism by CYP3A4 1. Watch for i efficacy of ciclosporin 2. Monitor INR at least weekly until stable... 

Interactions of St. John s wort with prescribed drugs are due to its ability to induce the activity of both CYP3A4 and the P glycoprotein transporter system (16). Prescribed drugs that interact with St. John s wort include ciclosporin, digoxin, HIV protease inhibitors, oral contraceptives, serotonin re-uptake inhibitors, theophyUine, and warfarin (17). 

Single-dose ciclosporin slightly increased the absorption of sitagliptin, although this was not considered clinically relevant. Sitagliptin does not have a clinically relevant effect on the pharmacokinetics of digoxin, oral contraceptives, simvastatin or warfarin. 

Imatinib increases serum tacrolimus levels and is therefore predicted to increase ciclosporin levels. Imatinib may also increases the levels of some benzodiazepines (e.g. midazolam), some calcium-channel blockers (e.g. nifedipine), oestrogens, paracetamol, pimozide, and warfarin. In one case lansoprazole was suspected to have raised imatinib levels. 

Caution is recommended when eplerenone is used with alpha blockers, antipsychotics, amifostine, baclofen, corticosteroids, tetracosactide and tricyclic antidepressants. Lithium, ciclosporin, and tacrolimus should generally not be used with eplerenone. Antacids, cisapride, midazolam and simvastatin had no effect on eplerenone pharmacokinetics. Eplerenone had no important effect on cisapride, midazolam, warfarin or contraceptive steroid pharmacokinetics, but caused a slight increase in digoxin levels. 

The ciclosporin levels of a patient were reduced when warfarin was given. When the ciclosporin dosage was raised an increase in the warfarin dosage was needed. The INR of another patient taking warfarin was reduced when she was given ciclosporin. A further report describes a rise in serum ciclosporin levels when an unnamed anticoagulant was given. Other reports describe increased or decreased acenocoumarol effects and decreased ciclosporin levels in two patients. 

Acenocoumarol, warfarin and ciclosporin are all metabolised, at least in part, by the cytochrome P450 isoenzyme CYP3A4. It is possible that some competition occurs for metabolism, leading to increased or decreased effects of the anticoagulants and decreased ciclosporin levels. 

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