BNF for Children 2011-2012

BNFC 2011–2012 Appendix 1: Interactions 683Ciclosporin. Antibacterials (continued)given with .trimethoprim, also plasma concentrationof ciclosporin reduced by intravenoustrimethoprim. Antidepressants: plasma concentration of ciclosporinreduced by .St John’s wort—avoid concomitant useAntidiabetics: ciclosporin possibly enhances hypoglycaemiceffect of repaglinide. Antiepileptics: metabolism of ciclosporin acceleratedby .carbamazepine, .phenobarbital and .phenytoin(reduced plasma concentration); plasma concentrationof ciclosporin possibly reduced by oxcarbazepine. Antifungals: metabolism of ciclosporin inhibited by.fluconazole, .itraconazole, .ketoconazole,.posaconazole and .voriconazole (increased plasmaconcentration); metabolism of ciclosporin possiblyinhibited by .miconazole (increased plasma concentration);increased risk of nephrotoxicity whenciclosporin given with .amphotericin; ciclosporinincreases plasma concentration of .caspofungin(manufacturer of caspofungin recommends monitoringliver enzymes); plasma concentration of ciclosporinpossibly reduced by griseofulvin andterbinafine; plasma concentration of ciclosporinpossibly increased by micafungin. Antimalarials: plasma concentration of ciclosporinincreased by .chloroquine and hydroxychloroquine(increased risk of toxicity)Antimuscarinics: avoidance of ciclosporin advised bymanufacturer of darifenacin. Antivirals: increased risk of nephrotoxicity whenciclosporin given with aciclovir; plasma concentrationof ciclosporin possibly increased by .atazanavir,.nelfinavir and .ritonavir; plasma concentration ofciclosporin possibly reduced by .efavirenz; plasmaconcentration of ciclosporin increased by.fosamprenavir and .indinavir; plasma concentrationof both drugs increased when ciclosporin given with.saquinavir. Beta-blockers: plasma concentration of ciclosporinincreased by .carvedilol. Bile Acids: absorption of ciclosporin increased by.ursodeoxycholic acid. Bosentan: ciclosporin increases plasma concentrationof .bosentan (also plasma concentration of ciclosporinreduced—avoid concomitant use). Calcium-channel Blockers: combination of ciclosporinwith .lercanidipine may increase plasma concentrationof either drug (or both)—avoid concomitant use;plasma concentration of ciclosporin increased by.diltiazem, .nicardipine and .verapamil; ciclosporinpossibly increases plasma concentration of nifedipine(increased risk of toxicity including gingival hyperplasia). Cardiac Glycosides: ciclosporin increases plasmaconcentration of .digoxin (increased risk of toxicity). Colchicine: possible increased risk of nephrotoxicityand myotoxicity when ciclosporin given with.colchicine—suspend or reduce dose of colchicine(avoid concomitant use in hepatic or renal impairment). Corticosteroids: plasma concentration of ciclosporinincreased by high-dose .methylprednisolone (risk ofconvulsions); ciclosporin increases plasma concentrationof prednisolone. Cytotoxics: increased risk of nephrotoxicity whenciclosporin given with .melphalan; increased risk ofneurotoxicity when ciclosporin given with.doxorubicin; ciclosporin increases plasma concentrationof .epirubicin, .everolimus and .idarubicin;ciclosporin reduces excretion of mitoxantrone(increased plasma concentration); risk of toxicitywhen ciclosporin given with .methotrexate; plasmaconcentration of ciclosporin possibly increased byimatinib; in vitro studies suggest a possible interactionbetween ciclosporin and docetaxel (consultdocetaxel product literature); ciclosporin possiblyCiclosporin. Cytotoxics (continued)increases plasma concentration of etoposide(increased risk of toxicity). Diuretics: plasma concentration of ciclosporin possiblyincreased by .acetazolamide; increased risk ofhyperkalaemia when ciclosporin given with .potassium-sparingdiuretics and aldosterone antagonists;increased risk of nephrotoxicity and possibly hypermagnesaemiawhen ciclosporin given with thiazidesand related diuretics. Grapefruit Juice: plasma concentration of ciclosporinincreased by .grapefruit juice (increased risk oftoxicity). Hormone Antagonists: metabolism of ciclosporininhibited by .danazol (increased plasma concentration);plasma concentration of ciclosporin reduced bylanreotide and .octreotide. Lipid-regulating Drugs: absorption of ciclosporinreduced by .colesevelam; increased risk of renalimpairment when ciclosporin given withbezafibrate or fenofibrate; increased risk of myopathywhen ciclosporin given with .rosuvastatin (avoidconcomitant use); plasma concentration of bothdrugs may increase when ciclosporin given with.ezetimibe; increased risk of myopathy when ciclosporingiven with .statinsMannitol: possible increased risk of nephrotoxicitywhen ciclosporin given with mannitol. Metoclopramide: plasma concentration of ciclosporinincreased by .metoclopramideMifamurtide: avoidance of ciclosporin advised bymanufacturer of mifamurtide. Modafinil: plasma concentration of ciclosporin reducedby .modafinilOestrogens: plasma concentration of ciclosporin possiblyincreased by oestrogens. Orlistat: absorption of ciclosporin possibly reduced by.orlistat. Potassium Salts: increased risk of hyperkalaemiawhen ciclosporin given with .potassium saltsProgestogens: plasma concentration of ciclosporinpossibly increased by progestogensRanolazine: ciclosporin possibly increases plasmaconcentration of ranolazineSevelamer: plasma concentration of ciclosporin possiblyreduced by sevelamerSirolimus: ciclosporin increases plasma concentrationof sirolimus. Sitaxentan: ciclosporin increases plasma concentrationof .sitaxentan—avoid concomitant use. Sulfinpyrazone: plasma concentration of ciclosporinreduced by .sulfinpyrazone. Tacrolimus: plasma concentration of ciclosporinincreased by .tacrolimus (increased risk of nephrotoxicity)—avoidconcomitant use. Ulcer-healing Drugs: plasma concentration of ciclosporinpossibly increased by .cimetidine; plasmaconcentration of ciclosporin possibly affected byomeprazoleVitamins: plasma concentration of ciclosporin possiblyaffected by vitamin ECidofovir. Antivirals: manufacturers advise avoid concomitantuse of cidofovir with .tenofovirCilazapril see ACE InhibitorsCilostazol. Anagrelide: avoidance of cilostazol advised by manufacturerof .anagrelideAntibacterials: plasma concentration of cilostazolincreased by erythromycin (consider reducing doseof cilostazol)Antifungals: plasma concentration of cilostazolincreased by ketoconazole (consider reducing dose ofcilostazol)Calcium-channel Blockers: plasma concentration ofcilostazol increased by diltiazem (consider reducingdose of cilostazol)Appendix 1: Interactions