Various drugs can increase or decrease the concentration of cyclosporine in a whole blood or plasma, typically by inhibition or testosterone cypionate cycle induction of enzymes involved in the metabolism of cyclosporin, in particular cytochrome isoenzymes.
Drugs that reduce the concentration of cyclosporine: barbiturates, carbamazepine, oxcarbazepine, phenytoin; nafcillin, sulfadimidine when / in the introduction; rifampin; octreotide; probucol; orlistat;preparations containing St. John’s wort (Hypericum perforatum); ticlopidine, terbinafine, sulfinpyrazone, bosentan.
Drugs that increase the concentration of cyclosporin: some antibiotics, macrolides (mostly erythromycin, azithromycin and clarithromycin); Ketoconazole, fluconazole, itraconazole, voriconazole; diltiazem, nicardipine, verapamil; metoclopramide; oral contraceptives; danazol; methylprednisolone (high dose); allopurinol; amiodarone; cholic acid and derivatives thereof; protease inhibitors, imatinib, colchicine.
Other relevant drug interactions
Care should be taken while the application Sandimmun and drugs with nephrotoxic effect: aminoglycosides (including gentamicin, tobramycin), amphotericin B, ciprofloxacin, vancomycin, trimethoprim (+ sulfamethoxazole); (including diclofenac, naproxen, sulindac); melphalan, antagonists of H 2 histamine receptors (e.g. cimetidine, ranitidine), methotrexate.
joint use of cyclosporine with tacrolimus should be avoided, because this can lead to an increased risk of nephrotoxicity.
The combined use of cyclosporin and nifedipine may lead to more severe gingival hyperplasia than cyclosporine monotherapy.
When concomitant administration of cyclosporine and lercanidipine marked increase in of lercanidipine 3 times and cyclosporine. Caution must be exercised with the concomitant use of cyclosporin and lercanidipine.
It was found that the combined use of diclofenac and cyclosporin can significantly increase the bioavailability of diclofenac, with the possible development of reversible renal function impairment. The increase in the bioavailability of diclofenac is likely due to a decrease of its metabolism in the “first pass” through the liver. When used in conjunction with cyclosporine with less pronounced effect of “first pass” (for example, acetylsalicylic acid) to increase their bioavailability is expected.
Cyclosporine may reduce the clearance testosterone cypionate cycle of digoxin, colchicine, prednisolone and HMG-CoA reductase inhibitors (statins).
A few cases of severe glycoside intoxication within a few days after initiation of treatment with cyclosporine in patients receiving digoxin. There are also reports that cyclosporine may enhance the toxic effects of colchicine such as myopathy and neuropathy, especially in patients with impaired renal function. With simultaneous use of cyclosporine with digoxin or colchicine should be carefully clinical surveillance for early detection of the toxic effects of these drugs and to address the issue of reducing the dose or withdrawal of treatment.
In the application of cyclosporine in clinical practice, and according to the literature, it reported cases of muscle toxicity development, including muscle aches, weakness, myositis and rhabdomyolysis on the background of the simultaneous application of cyclosporine with lovastatin, simvastatin, atorvastatin, pravastatin, and, in rare cases, with fluvastatin . If necessary, the application of the above drugs together with cyclosporine is necessary to reduce their dose. Statin therapy should be suspended or canceled altogether in patients with symptomatic myopathy, as well as in patients with factors predisposing to severe renal impairment, including renal failure, secondary to rhabdomyolysis.
An increase in creatinine concentration was observed in studies that examined the combined use of sirolimus or everolimus with high doses of cyclosporin in microemulsion form. This effect is often reversible after lowering the dose of cyclosporine. Everolimus and sirolimus have little effect on the pharmacokinetic parameters of cyclosporine. The combined use of cyclosporine with everolimus or sirolimus leads to a significant increase in the last concentration in blood plasma. Caution must be exercised in the appointment of cyclosporine with potassium-sparing drugs (potassium-sparing diuretics, testosterone cypionate cycle inhibitors, angiotensin II) or potassium preparations, so while the use of cyclosporine with the above drugs may develop severe hyperkalemia. anabolic steroids