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Sandimmune Disease Interactions

There are 4 disease interactions with Sandimmune (cyclosporine).

Major

Cyclosporine (applies to Sandimmune) hypertension

Major Potential Hazard, High plausibility.

The use of cyclosporine is contraindicated in patients with rheumatoid arthritis or psoriasis with uncontrolled hypertension. Hypertension, possibly due to renal vasoconstriction, has occurred in 50% of patients receiving cyclosporine. Antihypertensive therapy may be necessary for kidney, liver, and heart transplant recipients treated with cyclosporine. Hypertension may decline with continued used, but has persisted in some patients.

References

  1. (2022) "Product Information. SandIMMUNE (cycloSPORINE)." Apothecon Inc
  2. Textor SC, Canzanello VJ, Taler SJ, Wilson DJ, Schwartz LL, Augustine JE, Raymer JM, Romero JC, Wiesner RH, Krom RAF, B (1994) "Cyclosporine-induced hypertension after transplantation." Mayo Clin Proc, 69, p. 1182-93
  3. "Product Information. Neoral (cycloSPORINE)." Sandoz Pharmaceuticals Corporation
Major

Cyclosporine (applies to Sandimmune) renal dysfunction

Major Potential Hazard, High plausibility.

The use of cyclosporine is contraindicated in patients with rheumatoid arthritis or psoriasis with abnormal renal function. Cyclosporine causes a reversible reduction in renal blood flow and glomerular filtration rate resulting in increased serum creatinine and blood urea nitrogen. Mild nephrotoxicity generally responds to reductions in cyclosporine doses. Persistent, chronic, and progressive nephrotoxicity has occurred. Renal biopsies from these patients can demonstrate interstitial fibrosis, tubular atrophy, global or segmental glomerulosclerosis, or smooth vascular muscle damage. Larger cumulative doses or elevated cyclosporine trough levels may be associated with the development of interstitial fibrosis. Clinical monitoring of renal function is necessary and differentiation between cyclosporine-induced nephrotoxicity, allograft rejection, and other causes of impaired renal function should be determined prior to cyclosporine dosage adjustments.

References

  1. Harris KP, Jenkins D, Walls J (1988) "Nonsteroidal antiinflammatory drugs and cyclosporine: a potentially serious adverse interaction." Transplantation, 46, p. 598-9
  2. Bertani T, Ferrazzi P, Schieppati A, et al. (1991) "Nature and extent of glomerular injury induced by cyclosporine in heart transplant patients." Kidney Int, 40, p. 243-50
  3. Madhok R, Torley HI, Capell HA (1991) "A study of the longterm efficacy and toxicity of cyclosporine A in rheumatoid arthritis." J Rheumatol, 18, p. 1485-9
  4. Ballardie FW, Edwards BD, Hows J, et al. (1992) "Disturbance in renal haemodynamics and physiology in bone marrow transplant recipients treated with ciclosporin A." Nephron, 60, p. 17-24
  5. Butkus DE, Herrera GA, Raju SS (1992) "Successful renal transplantation after cyclosporine-associated hemolytic-uremic syndrome following bilateral lung transplantation." Transplantation, 54, p. 159-62
  6. Margolis DJ, Guzzo C, Johnson J, Lazarus GS (1992) "Alterations in renal function in psoriasis patients treated with cyclosporine, 5 mg/kg/day." J Am Acad Dermatol, 26, p. 195-7
  7. Zachariae H, Hansen HE, Kragballe K, Olsen S (1992) "Morphologic renal changes during cyclosporine treatment of psoriasis." J Am Acad Dermatol, 26, p. 415-9
  8. Burack DA, Griffith BP, Thompson ME, Kahl LE (1992) "Hyperuricemia and gout among heart transplant recipients receiving cyclosporine." Am J Med, 92, p. 141-6
  9. Venkataramanan R, Ptachcinski RJ, Burckart GJ, et al. (1984) "The clearance of cyclosporine by hemodialysis." J Clin Pharmacol, 24, p. 528-31
  10. Albrecht K, Niebel W, Marggraf G, Eigler FW (1987) "Cyclosporine pharmacokinetics in the early course of renal transplantation." Transplant Proc, 19, p. 17-9
  11. Dische FE, Neuberger J, Keating J, et al. (1988) "Kidney pathology in liver allograft recipients after long-term treatment with cyclosporin A." Lab Invest, 58, p. 395-402
  12. Awni WM, Kasiske BL, Heim-Duthoy K, Rao KV (1989) "Long-term cyclosporine pharmacokinetic changes in renal transplant recipients: effects of binding and metabolism." Clin Pharmacol Ther, 45, p. 41-8
  13. Vernillet L, Moulin B, Dadoun C, et al. (1988) "Pharmacokinetics of cyclosporine A in patients with nephrotic syndrome." Transplant Proc, 20, p. 529-35
  14. Morales JM, Andres A, Hernandez E, et al. (1990) "Fractional excretion of sodium is an early predictor of cyclosporine nephrotoxicity after renal transplantation." Transplant Proc, 22, p. 1728-9
  15. Bach JF, Feutren G, Noel LH, et al. (1990) "Factors predictive of cyclosporine-induced nephrotoxicity: the role of cyclosporine blood levels." Transplant Proc, 22, p. 1296-8
  16. Frey FJ (1991) "Pharmacokinetic determinants of cyclosporine and prednisone in renal transplant patients." Kidney Int, 39, p. 1034-50
  17. Cantarell MC, Capdevila L, Morlans M, Piera L (1991) "Uric acid calculus in renal transplant patients treated with cyclosporine." Clin Nephrol, 35, p. 288
  18. Dijkmans BA, van Rijthoven AW, The HS, et al. (1987) "Effect of cyclosporin on serum creatinine in patients with rheumatoid arthritis." Eur J Clin Pharmacol, 31, p. 541-5
  19. Follath F, Wenk M, Vozeh S, et al. (1983) "Intravenous cyclosporine kinetics in renal failure." Clin Pharmacol Ther, 34, p. 638-43
  20. Boers M, van Rijthoven AW, The HS, et al. (1988) "Serum creatinine levels two years later: follow-up of a placebo-controlled trial of cyclosporine in rheumatoid patients." Transplant Proc, 20, p. 371-5
  21. Ludwin D, Bennett KJ, Grace EM, et al. (1988) "Nephrotoxicity in patients with rheumatoid arthritis treated with cyclosporine." Transplant Proc, 20, p. 367-70
  22. Messana JM, Rocher LL, Ellis CN, et al. (1990) "Effects of cyclosporine on renal function in psoriasis patients." J Am Acad Dermatol, 23, p. 1288-93
  23. Ptachcinski RJ, Venkataramanan R, Rosenthal JT, Burckart GJ, Taylor RJ, Hakala TR (1985) "Cyclosporine kinetics in renal transplantation." Clin Pharmacol Ther, 38, p. 296-300
  24. (2022) "Product Information. SandIMMUNE (cycloSPORINE)." Apothecon Inc
  25. Landewe RBM, The HSG, Vanrijthoven AWAM, Rietveld JR, Breedveld FC, Dijkmans BAC (1994) "Cyclosporine in common clinical practice: an estimation of the benefit/risk ratio in patients with rheumatoid arthritis." J Rheumatol, 21, p. 1631-6
  26. Forre O, Bjerkhoel F, Kjeldsenkragh J, Ostensen H, Astor T, Boe E, Lekven C, Sorensen JU, Karoliussen O, Dehli O, Glennas A, Kv (1994) "Radiologic evidence of disease modification in rheumatoid arthritis patients treated with cyclosporine - results of a 48-week multicenter study comparing low-dose cyclosporine with placebo." Arthritis Rheum, 37, p. 1506-12
  27. Bensen W, Tugwell P, Roberts RM, Ludwin D, Ross H, Grace E, Gent M (1994) "Combination therapy of cyclosporine with methotrexate and gold in rheumatoid arthritis (2 pilot studies)." J Rheumatol, 21, p. 2034-8
  28. "Product Information. Neoral (cycloSPORINE)." Sandoz Pharmaceuticals Corporation
  29. Neumayer HH, Budde K, Farber L, Haller P, Kohnen R, Maibucher A, Schuster A, Vollmar J, Waiser J, Luft FC (1996) "Conversion to microemulsion cyclosporine in stable renal transplant patients: results after one year." Clin Nephrol, 45, p. 326-31
View all 29 references
Moderate

Cyclosporine (applies to Sandimmune) hepatic dysfunction

Moderate Potential Hazard, High plausibility. Applicable conditions: Liver Disease

Cyclosporine is extensively metabolized by CYP450 3A enzymes in the liver (some GI and renal metabolism) and primarily eliminated in the bile and feces. Cyclosporine can induce dose-related nephrotoxicity and hepatotoxicity. Hepatotoxicity, usually noted during the first month of therapy (high dosages) is characterized by elevations of hepatic enzymes and bilirubin. Reduction in chemistry levels usually results with dosage reduction. Therapy with cyclosporine should be administered cautiously and dosages modifications considered in patients with or predisposed to hepatic dysfunction. Clinical monitoring of hepatic function, particularly during administration of high dosages, is recommended.

References

  1. Christians U, Kohlhaw K, Budniak J, et al. (1991) "Ciclosporin metabolite pattern in blood and urine of liver graft recipients." Eur J Clin Pharmacol, 41, p. 285-90
  2. Takaya S, Zaghloul I, Iwatsuki S, et al. (1987) "Effect of liver dysfunction on cyclosporine pharmacokinetics." Transplant Proc, 19, p. 1246-7
  3. Awni WM, Kasiske BL, Heim-Duthoy K, Rao KV (1989) "Long-term cyclosporine pharmacokinetic changes in renal transplant recipients: effects of binding and metabolism." Clin Pharmacol Ther, 45, p. 41-8
  4. de Groen PC, McCallum DK, Moyer TP, Wiesner RH (1988) "Pharmacokinetics of cyclosporine in patients with primary biliary cirrhosis." Transplant Proc, 20, p. 509-11
  5. Vernillet L, Moulin B, Dadoun C, et al. (1988) "Pharmacokinetics of cyclosporine A in patients with nephrotic syndrome." Transplant Proc, 20, p. 529-35
  6. Kassianides C, Nussenblatt R, Palestine AG, et al. (1990) "Liver injury from cyclosporine A." Dig Dis Sci, 35, p. 693-7
  7. Sewing K-F, Christians U, Kohlhaw K, et al. (1990) "Biologic activity of cyclosporine metabolites." Transplant Proc, 22, p. 1129-34
  8. (2022) "Product Information. SandIMMUNE (cycloSPORINE)." Apothecon Inc
  9. "Product Information. Neoral (cycloSPORINE)." Sandoz Pharmaceuticals Corporation
  10. Tredger JM (1995) "Using cyclosporine neoral immediately after liver transplantation." Ther Drug Monit, 17, p. 638-41
View all 10 references
Moderate

Cyclosporine (applies to Sandimmune) malabsorption syndrome

Moderate Potential Hazard, High plausibility.

Patients with malabsorption syndromes may have difficulty achieving therapeutic serum concentrations with the Sandimmune formulations (capsules or solution) of cyclosporine. An alternative formulation, Neoral (capsule or solution for microemulsion), has increased bioavailability compared to Sandimmune. Sandimmune and Neoral are not bioequivalent and should not be used interchangeably without physician supervision.

References

  1. Albrecht K, Niebel W, Marggraf G, Eigler FW (1987) "Cyclosporine pharmacokinetics in the early course of renal transplantation." Transplant Proc, 19, p. 17-9
  2. de Groen PC, McCallum DK, Moyer TP, Wiesner RH (1988) "Pharmacokinetics of cyclosporine in patients with primary biliary cirrhosis." Transplant Proc, 20, p. 509-11
  3. Vernillet L, Moulin B, Dadoun C, et al. (1988) "Pharmacokinetics of cyclosporine A in patients with nephrotic syndrome." Transplant Proc, 20, p. 529-35
  4. (2022) "Product Information. SandIMMUNE (cycloSPORINE)." Apothecon Inc
  5. "Product Information. Neoral (cycloSPORINE)." Sandoz Pharmaceuticals Corporation
  6. "Product Information. Neoral (cycloSPORINE)." Sandoz Pharmaceuticals Corporation
View all 6 references

Sandimmune drug interactions

There are 780 drug interactions with Sandimmune (cyclosporine).

Sandimmune alcohol/food interactions

There are 2 alcohol/food interactions with Sandimmune (cyclosporine).

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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