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 9 →
- 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
Lacidipine
Moderate
Database
Possible increased ciclosporin levels
Monitor ciclosporin level
Source: Kimi deep-research + Cla
Ursodeoxycholic Acid
Moderate
Database
UDCA may increase ciclosporin absorption
Monitor ciclosporin levels when co-prescribing
Source: Kimi deep-research + Cla
3 additional unreviewed or low-confidence interactions hidden because their provenance or source detail is insufficient.
Related guidelines
Other Immunosuppressant drugs
Ask House about Ciclosporin
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Textbook-sourced·Sources: BNF·Updated: 2026-05-10