The combination of cyclosporine with potassium medicines or potassium-sparing diuretics increases the likelihood of the patient experiencing hyperkalemia.
As a result of simultaneous use with antibiotics from the aminoglycoside category, as well as melphalan with amphotericin B and colchicine, and in addition to ciprofloxacin and trimethoprim, the likelihood of nephrotoxicity increases.
Combination with NSAIDs increases the risk of side effects from the kidneys.
A combination with colchicine or lovastatin increases the risk of weakness or pain in the muscles.
A variety of drugs can increase or lower plasma cyclosporine levels by inducing or inhibiting hepatic enzymes involved in the metabolism and elimination of this substance.
Among the drugs that increase the plasma level of cyclosporine: josamycin with erythromycin, doxycycline with clarithromycin, and in addition midekamycin with roxithromycin and chloramphenicol and ketoconazole with fluconazole (probably in a large dose). Also included in this list are diltiazem, verapamil, itraconazole and nicardipine with amiodarone and propafenone, and in addition metoclopramide with carvedilol. Increases in concentrations are observed when combined with danazol, oral contraceptives, methylprednisolone (in high dosages), allopurinol, and cholic acid and its derivatives.
Drugs that lower the plasma level of cyclosporine: carbamazepine, nafcillin, phenytoin with barbiturates, as well as metamizole, rifampicin and sulfadimidine (intravenous administration). In addition, terbinafine with probucol and griseofulvin, orlistat with octreotide, troglitazone and LS, which contain St. John's wort.
There is evidence that cyclosporine reduces the clearance of prednisolone, and in the treatment with prednisolone in high doses, an increase in the blood values of cyclosporin is possible.
Glibenclamide is capable of raising equilibrium plasma values of cyclosporine.
As a result of a combination of drugs with diuretics, the probability of renal function disorders increases.
The combination with doxorubicin leads to an increase in its plasma parameters, and with it its toxic properties.
Methotrexate enhances the plasma values of cyclosporine, and besides it increases episodes of increasing blood pressure and the development of nephrotoxic effect.
The substance melphalan (injected in large doses intravenously) can cause the development of kidney failure in severe form.
As a result of simultaneous use with teniposide, a decrease in the clearance of this substance is observed, along with an increase in its toxic properties and an elongation of the half-life.
In the case of combination with warfarin, the mutual effect of both active substances is reduced.
The combination of cyclosporine and potassium drugs, ACE inhibitors, and besides this potassium-sparing diuretic increases the likelihood of hyperkalemia.
Combination with enalapril may cause an acute form of kidney failure, and a combination with nifedipine may increase gingival hyperplasia.
In people taking cyclosporine, there is a marked increase in the level of bioavailability of diclofenac, which can lead to a reversible disorder in the kidneys. An increase in the bioavailability of this component is most likely due to a slowdown in its metabolic processes as a result of the "first pass" process within the liver.
Simultaneous reception of cyclosporine together with prednisolone lowers the level of clearance of the latter. In the case of using large dosages of prednisolone, the cyclosporin level in the blood can increase. The level of cyclosporin increases and the substance methylprednisolone.
The use of cisapride by people taking cyclosporine can increase the peak plasma level and the absorption rate of the latter.
Combination with cyclosporine may cause a decrease in clearance rates of substances such as colchicine and pravastatin with digoxin, as well as prednisolone and lovastatin with simvastatin. This, in turn, can provoke an increase in the toxic effect: glycoside poisoning (digoxin) and toxic effect on muscles (pravastatin with lovastatin and simvastatin with colchicine), which manifests itself in the form of muscle weakness or pain as well as myositis. Occasionally, the development of rhabdomyolysis.
Aminoglycoside antibiotics, antiviral drugs, ACE inhibitors, as well as trimethoprim, cephalosporins, ciprofloxacin and amphotericin B with melphalan and co-trimoxazole enhance nephrotoxic properties of cyclosporine.
The combination of cyclosporin with quinidine and its derivatives, as well as theophylline and its derivatives, can enhance the effect of these substances on the body.
Combined with imipenem cilastatin can increase the rate of cyclosporine, resulting in the development of manifestations of neurotoxicity (such as increased excitability and trembling).
Combined use of the drug with other immunosuppressants increases the likelihood of infectious processes and lymphoproliferative pathologies.
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