Drug interactions
Cyclosporin + Ramipril
Severity: Major
Cyclosporin and Ramipril: major interaction.
Last updated Sources: Health Canada product monograph
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
Cyclosporine constricts the afferent arteriole while ACE inhibitors dilate the efferent arteriole, which can reduce glomerular filtration and cause acute kidney injury. Both agents can also cause hyperkalemia, so the combination raises the risk of dangerously high potassium.
What this interaction means in plain words
Cyclosporin and Ramipril 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; Ramipril belongs to Cardiovascular.
Why it happens
Additive hemodynamic renal effects and reduced aldosterone-mediated potassium excretion, causing impaired renal function and hyperkalemia.
What to do
Monitor serum creatinine and potassium closely after starting or changing doses, and avoid potassium supplements or other potassium-raising drugs. Reduce or stop the ACE inhibitor if renal function worsens or hyperkalemia develops.
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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References
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 Ramipril
- Aliskiren + Ramipril Contraindicated
- Protein a column + Ramipril Contraindicated
- Ramipril + Sacubitril / valsartan Contraindicated
- Ramipril + Sacubitril-valsartan Contraindicated
- Amifostine + Ramipril Major
- Amiloride + Ramipril Major
Frequently asked questions
Can I take Cyclosporin with Ramipril?
MediHelp rates the interaction as major. Cyclosporin and Ramipril 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. Cyclosporine constricts the afferent arteriole while ACE inhibitors dilate the efferent arteriole, which can reduce glomerular filtration and cause acute kidney injury. Both agents can also cause hyperkalemia, so the combination raises the risk of dangerously high potassium.
How serious is the interaction between Cyclosporin and Ramipril?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor serum creatinine and potassium closely after starting or changing doses, and avoid potassium supplements or other potassium-raising drugs. Reduce or stop the ACE inhibitor if renal function worsens or hyperkalemia develops.
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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