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Cyclosporine - Interactions and Warnings

Possible decrease in the bioavailability of cyclosporin when combined with St John's wort.
- Lancet 2000 Jan 8;355(9198):134-8 -- Herb-drug interactions. -- Fugh-Berman A.

Pharmacokinetic interactions (e.g. increased bioavailability), myositis, and rhabdomyolysis have been reported following concurrent use of atorvastatin, cerivastatin, simvastatin or lovastatin and cyclosporine A, mibefradil or nefazodone. An increase in pravastatin bioavailability has been reported in the presence of cyclosporine A, possibly because of an interaction at the level of biliary excretion. Some statins may have lower adverse drug interaction potential than others, which is an important determinant of safety during long-term therapy.
- Atheroscler Suppl 2002 May;3(1):35-40 -- Pharmacological interactions of statins. -- Paoletti R, Corsini A, Bellosta S.

Patients taking drugs with a narrow therapeutic index such as cyclosporine should be discouraged from using herbal products. All drugs with a narrow therapeutic index may either have increased adverse effects or be less effective when used in conjunction with herbal products.
- Crit Care Nurse 2002 Apr;22(2):22-8, 30, 32; quiz 34-5 -- Herbal remedies: drug-herb interactions. -- Kuhn MA.

Description of a kidney transplant recipient who developed marked reduction of cyclosporine therapeutic activity after the self-initiation of St. John's wort.
- Am J Kidney Dis 2001 Nov;38(5):1105-7 -- Interaction between cyclosporine and Hypericum perforatum (St. John's wort) after organ transplantation. -- Moschella C, Jaber BL.

Report of acute rejection in two transplant patients due to a metabolic interaction of St John's wort and cyclosporin.
- Lancet 2000 Feb 12;355(9203):548-9 -- Acute heart transplant rejection due to Saint John's wort. -- Ruschitzka F, Meier PJ, Turina M, Luscher TF, Noll G.

Grapefruit juice can markedly augment oral drug bioavailability. Clinically relevant interactions seem likely for cyclosporin.
- Br J Clin Pharmacol 1998 Aug;46(2):101-10 -- Grapefruit juice-drug interactions. -- Bailey DG, Malcolm J, Arnold O, Spence JD.

last update: November 2008

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