Aminoglycoside
Severe
Textbook
Increased risk of nephrotoxicity.
Avoid concurrent use.
Source: KDT 7e · p746
Drug reference
Ciclosporin
Immunosuppressant
Also known as SANDIMMUNE, NEORAL, Capsorin, Capimune, Deximune
Immunosuppressant
CDSCO approved
EXCRETION
—
not curated
INTERACTIONS
6 major
SEVERE in our sources
PREGNANCY
—
not curated
Top interactionssee all 12 →
- AminoglycosideSevereTextbookKDT 7e · p746
- Amphotericin BSevereDatabaseKimi deep-research + Cla
- CaspofunginSevereDatabaseKimi deep-research + Cla
- EzetimibeSevereDatabaseKimi deep-research + Cla
Mechanism
Ciclosporin binds to cyclophilin, a cytoplasmic-receptor protein present in target cells. This complex binds to calcineurin, inhibiting Ca2+-stimulated dephosphorylation of the cytosolic component of NFAT. This prevents NFAT from entering the nucleus, inhibiting gene transcription and T lymphocyte activation. Cyclosporine also increases expression of transforming growth factor "β" (TGF-"β"), an inhibitor of IL-2 –stimulated T-cell proliferation and generation of cytotoxic T lymphocytes (CTLs).
Indications
Kidney transplantationLiver transplantationHeart transplantationOther organ transplantationRheumatoid arthritisPsoriasis
Dosing
- Renal adjustment
- No adjustments generally are necessary for dialysis or renal failure patients.
- Hepatic adjustment
- In the presence of hepatic dysfunction, dosage adjustments are required.
Pharmacokinetics
Bioavailability
Original soft gelatin capsule: 20-50%. Modified microemulsion formulation (Neoral): more uniform and slightly increased bioavailability.
Metabolism
Extensively metabolized in the liver by CYP3A and to a lesser degree by the GI tract and kidneys. At least 25 metabolites identified.
Excretion
Principally through the bile into the feces, with ~6% being excreted in the urine. Only 0.1% excreted unchanged in urine.
Pregnancy & lactation
Lactation
Cyclosporine is excreted in human milk.
Drug interactions
Amphotericin B
Severe
Database
Additive nephrotoxicity
Monitor renal function and CNI levels
Source: Kimi deep-research + Cla
Caspofungin
Severe
Database
Increased caspofungin AUC + raised transaminases
Use only if benefit outweighs risk; monitor LFTs
Source: Kimi deep-research + Cla
Ezetimibe
Severe
Database
Markedly increased ezetimibe (and ciclosporin) exposure
Monitor ciclosporin levels; use lowest ezetimibe dose, caution
Source: Kimi deep-research + Cla
Modafinil
Severe
Database
CYP3A4 induction → subtherapeutic ciclosporin
Monitor levels; adjust dose
Source: Kimi deep-research + Cla
Octreotide
Severe
Database
Reduced ciclosporin absorption → graft rejection risk
Monitor ciclosporin levels, adjust dose
Source: Kimi deep-research + Cla
Azilsartan Medoxomil
Moderate
Database
Increased risk of hyperkalemia.
Monitor serum potassium levels, especially in patients with risk factors for hyperkalemia.
Source: DDInter
Etoricoxib
Moderate
Database
Increased risk of ciclosporin-induced nephrotoxicity, leading to impaired renal function.
Avoid concomitant use if possible. If unavoidable, monitor renal function (serum creatinine, BUN) closely and ciclosporin levels. Adjust ciclosporin dose as needed.
Lornoxicam
Moderate
Database
Increased risk of renal dysfunction and nephrotoxicity.
Avoid concomitant use. If unavoidable, monitor renal function (serum creatinine, BUN) very closely. Consider alternative analgesics.
Ornidazole
Moderate
Database
Increased ciclosporin levels, leading to increased risk of nephrotoxicity and other ciclosporin-related adverse effects.
Monitor ciclosporin trough levels closely. Adjust ciclosporin dose as needed. Monitor renal function.
Roxithromycin
Moderate
Database
Increased risk of ciclosporin toxicity (nephrotoxicity, neurotoxicity, hepatotoxicity).
Monitor ciclosporin trough levels closely. Adjust ciclosporin dose as needed.
Teicoplanin
Moderate
Database
Increased risk of acute kidney injury.
Monitor renal function (serum creatinine, BUN) closely. Adjust doses of teicoplanin or ciclosporin as needed. Consider therapeutic drug monitoring for both drugs.
Related guidelines
Other Immunosuppressant drugs
Ask House about Ciclosporin
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Sources: BNF·Verified: 2026-05-10 · House clinical team