Cyclosporin and miscellaneous drugs
Posted on September 28, 2009
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Isolated and unconfirmed interactions have been reported with acetazolamide, acyclovir, captopril, cephalosporins, disopyramide, doxycycline, imipenem/cilastatin, nafcillin and sulphinpyrazone.
Clinical evidence, mechanism, importance and management
The Drug Monitoring Centre of Sandoz (the manufacturers of cydosponn) in Basel has on record a number of previously unpublished spontaneous and isolated reports of interactions between cyclosporin and other drugs. There are also other isolated case reports of interactions involving cyclosporin.
A man with a heart transplant demonstrated increased serum cyclosporin levels, marked renal impairment and neurotox-lcity when given oral acetazolamide for raised intra-ocular pressure secondary to panuveitis. An increase in serum creatirune levels and in acyclovir levels accompanied by reversible acute tubular necrosis has been noted during the concurrent use of cyclosponn and acyclovir. Transient oliguna was seen in a patient given cyclosporin and captopril. Increased serum cyclosponn levels have been reported with moxalactam (latamoxef). A woman treated with cyclosponn with a year old kidney transplant rapidly developed nephrotoxicity shortly after starting to take 100 mg disopyramide three times daily. She also experienced the an ticholinergic side-effects of disopyramide (mouth dryness, dysuna). A patient showed an increase in serum creatmine levels when treated with doxycycline. A woman with a kidney transplant and on cyclosponn developed a urinary tract infection for which 500 mg. lmipenem/cilastatin intravenously 12-hourly was given 20 mg after the second dose she became confused, disorientated, and agitated and developed motor aphasia and intense tremor. This was interpreted as being a combination of the adverse central nervous effects of both drugs. The lmipenem/cilastatin was not given again and these adverse effects subsided over the next few days However it was noted that the cyclosponn serum levels climbed over the next four days from about 400 to 1000 ng/ml. Reduced serum cyclosponn levels following the use of lmipenem/cilastin have been seen in rats 6 A kidney transplant patient on cyclosponn and predrusone expenenced a marked fall in her serum cyclosponn levels on two occasions when treated with nafcillin (2 g 6-hourly). Trough serum levels fell from 229 to 119 and then to 68 ng/ml after three and seven days of nafcillm, before climbing again when the nafcillm was stopped On the second occasion levels fell from 272 to 42 ng/ml after nine days treatment with naf cillm. Increased serum cyclosponn levels have been reported with sulphinpyrazone, although there is the possibility that this may be an artefact due to interference with the assay method.
All of these reports need to be viewed in perspective because most of them are isolated and unconfirmed, and m some instances both drugs have been used uneventfully on a number of occasions. However it should also be appreciated that many now well recognized interactions first came to light because someone took the trouble to make a report, even though it involved only one patient. Monitor the concurrent use of any of these drugs carefully.
Tags: Doxycycline
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