Ciclosporin

MEDICATION TYPE

Immunosuppressant

INDICATIONS

Immunosuppression. Prevention of transplanted organ rejection.

DRUG INTERACTIONS

ACE inhibitors
Increase risk of Hyperkalaemia.

Allopurinol
Plasma concentration of Ciclosporin increased.

Amiloride
Increased risk of Hyperkalaemia.

Aminoglycosides
Increase risk of Nephrotoxicity.

Amphotericin
Increase risk of nephrotoxicity.

Cimetidine
Increases Ciclosporin level.

Ciprofloxacin, Colistin, Co-trimoxazole, Vancomycin
Increase risk of nephrotoxicity.

Diclofenac
Plasma level of diclofenac is doubled – half diclofenac dose.

Digoxin
Plasma concentration of digoxin increases, risk of digxin toxicity.

Erythromycin, Clarithromycin
Increase cyclosporin level.

Fluconazole, Itraconazole, Ketoconazole, Voriconazole
Increase Ciclosporin level.

Grapefruit juice
Increases Ciclosporin concentration.

Methotrexate
Increased toxicity.

Methyl Prednisolone
Increases Ciclosporin level.

NSAID
increased risk of nephrotoxicity.

Prednisolone
prednisolone level increased.

Progestogens
increase Ciclosporin levels.

Rifampicin
Reduces ciclosporin plasma concentration.

Tacrolimus
Plasma Ciclosporin concentration increased – increased risk of toxicity, avoid concomitant use.

Trimethoprim
Plasma concentration of Ciclosporin reduced by intravenous trimethoprim.

Ursodeoxycholic Acid
Increases Ciclosporin absorption.

Vaccines
Do not give live vaccines to patients on immunosuppression. Other vaccines may give reduced host response.

NOTES

TDM essential; multiple drug interactions (azoles, macrolides).