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Cyclosporin drug interactions

There are substantial and important drug interactions with cyclosporin:

Drugs that 4 cyclosporin A levels Drugs that 5 cyclosporin levels

Azole antifungals Digoxin

Rifampicin —► major effect Phenytoin —► major effect

Macrolide antibiotics, especially Sulphonamides erythromycin

Carbamazepine

Imipenem/meropenem

Calcium channel blockers

Oral contraceptives

Drugs WORSENING cyclosporin nephrotoxicity

• Aminoglycosides.

• Ciprofloxacin.

• Cotrimoxazole.

J" Note: This is not an exhaustive list. Check cyclosporin levels 48h after any drug addition or cessation.

Tacrolimus

• Calcineurin inhibitor that prevents early T-cell activation; mechanism of action, pharmacology, drug interactions and toxicity similar to cyclosporin.

• Superior to cyclosporin in three randomised trials when used in combination with methotrexate as GvHD prophylaxis.

• Dosage: 0.03mg/kg/day by continuous IV infusion from day -2; taper 20% every 2 weeks from day 180; monitor blood level and toxicities and modify dose accordingly; used with standard dose MTX or mini-MTX (5mg/m2 IV days +1, +3, +6 and +11).

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