Table 6.

Cyclosporine Drug Interactions

Drug	Potentiate Renal Dysfunction	↑ Cyclosporine Levels	↓ Cyclosporine Levels	Other Interactions
Cyclosporine	Antibiotics: ciprofloxacin gentamicin tobramycin vancomycin trimethoprim/sulfamethoxazole Antineoplastic: melphalan Antifungals: amphotericin B ketoconazole Anti-inflammatory drugs: azapropazone colchicine diclofenac naproxen sulindac Histamine-2 blockers: cimetidine ranitidine Immunosuppressant: tacrolimus Fibric acid derivative: fenofibrate	Calcium channel blockers: diltiazem nicardipine verapamil Antifungals: fluconazole itraconazole ketoconazole Antibiotics: azithromycin clarithromycin erythromycin quinupristin/dalfopristin Glucocorticosteroid: methylprednisolone Protease inhibitors: indinavir nelfinavir ritonavir saquinavir Other drugs: allopurinol amiodarone bromocriptine colchicine danazol imatinib metoclopramide oral contraceptives Food: grapefruit juice increases absorption	Antibiotics: nafcillin rifampin Anticonvulsants: carbamazepine phenobarbital phenytoin St. John's Wort: decreases serum concentrations of cyclosporine, resulting in subtherapeutic levels Other drugs: octreotide orlistat sulfinpyrazone terbinafine ticlopidine	Rifabutin: increases the metabolism of drugs metabolized by the cytochrome P-450 system Diclofenac: doubling of blood levels and (reversible) decrease in renal function Methotrexate: concentrations were increased 30% and the concentrations of its metabolite, 7-hydroxy methotrexate, were decreased by approximately 80%. The clinical significance is not known. Decreased clearance of: digoxin colchicines prednisolone 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors (eg, simvastatin, lovastatin) Potentiate hyperkalemia with: potassium-sparing diuretics angiotensin-converting enzyme inhibitors angiotensin II receptor blockers