Drug interactions
Cyclosporin + Ketoconazole
Severity: Major
Cyclosporin and Ketoconazole: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Ketoconazole markedly increases cyclosporine concentrations, with a risk of nephrotoxicity and other cyclosporine toxicity. The interaction is well established and has even been used to reduce cyclosporine dose requirements.
What this interaction means in plain words
Cyclosporin and Ketoconazole can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Cyclosporin belongs to Miscellaneous; Ketoconazole belongs to Anti Fungals.
Why it happens
Ketoconazole potently inhibits CYP3A4 and P-glycoprotein, decreasing cyclosporine metabolism and efflux.
What to do
Empirically reduce the cyclosporine dose and monitor trough levels and renal function closely. Readjust the dose when ketoconazole is stopped.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Cyclosporin
- Adenovirus types 4 and 7 live + Cyclosporin Contraindicated
- Aliskiren + Cyclosporin Contraindicated
- Bcg vaccine live + Cyclosporin Contraindicated
- Bosentan + Cyclosporin Contraindicated
- Cidofovir + Cyclosporin Contraindicated
- Cyclosporin + Dengue vaccine Contraindicated
Other interactions of Ketoconazole
- Alfuzosin + Ketoconazole Contraindicated
- Alprazolam + Ketoconazole Contraindicated
- Avanafil + Ketoconazole Contraindicated
- Conivaptan + Ketoconazole Contraindicated
- Dihydroergotamine intranasal + Ketoconazole Contraindicated
- Dihydroergotamine + Ketoconazole Contraindicated
Frequently asked questions
Can I take Cyclosporin with Ketoconazole?
MediHelp rates the interaction as major. Cyclosporin and Ketoconazole can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Ketoconazole markedly increases cyclosporine concentrations, with a risk of nephrotoxicity and other cyclosporine toxicity. The interaction is well established and has even been used to reduce cyclosporine dose requirements.
How serious is the interaction between Cyclosporin and Ketoconazole?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Empirically reduce the cyclosporine dose and monitor trough levels and renal function closely. Readjust the dose when ketoconazole is stopped.
What other medicines interact with Cyclosporin?
MediHelp also lists interactions of Cyclosporin with, for example, Adenovirus types 4 and 7 live, Aliskiren, Bcg vaccine live. The full list is on the Cyclosporin page.
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