Drug interactions
Cyclosporin + Nirmatrelvir / ritonavir
Severity: Major
Cyclosporin and Nirmatrelvir / ritonavir: 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
The ritonavir component potently inhibits CYP3A and P-gp, which can greatly increase cyclosporine exposure. Toxicity such as acute kidney injury and neurotoxicity has been reported in transplant recipients.
What this interaction means in plain words
Cyclosporin and Nirmatrelvir / ritonavir 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.
Why it happens
Strong CYP3A4 and P-gp inhibition by ritonavir (with nirmatrelvir) reduces cyclosporine clearance.
What to do
Prefer an alternative COVID-19 therapy. If used, reduce or hold cyclosporine doses and monitor trough levels and renal function during and after the course.
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
Frequently asked questions
Can I take Cyclosporin with Nirmatrelvir / ritonavir?
MediHelp rates the interaction as major. Cyclosporin and Nirmatrelvir / ritonavir 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. The ritonavir component potently inhibits CYP3A and P-gp, which can greatly increase cyclosporine exposure. Toxicity such as acute kidney injury and neurotoxicity has been reported in transplant recipients.
How serious is the interaction between Cyclosporin and Nirmatrelvir / ritonavir?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Prefer an alternative COVID-19 therapy. If used, reduce or hold cyclosporine doses and monitor trough levels and renal function during and after the course.
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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