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Cyclosporine Disease Interactions

There are 4 disease interactions with cyclosporine:

Major

Cyclosporine (applies to cyclosporine) 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. "Product Information. Sandimmune (cyclosporine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  2. Textor SC, Canzanello VJ, Taler SJ, Wilson DJ, Schwartz LL, Augustine JE, Raymer JM, Romero JC, Wiesner RH, Krom RAF, B "Cyclosporine-induced hypertension after transplantation." Mayo Clin Proc 69 (1994): 1182-93
  3. "Product Information. Neoral Oral Solution (cyclosporine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
Major

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

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

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

Cyclosporine drug interactions

There are 680 drug interactions with cyclosporine

Cyclosporine alcohol/food interactions

There are 2 alcohol/food interactions with cyclosporine

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.