What are the common drug interactions for cyclosporine and tacrolimus in kidney transplant recipients
Many drugs are known to interact with CNIs (cyclosporine and tacrolimus); some agents are more problematic than others.
Antiepileptic medications such as phenytoin, carbamazepine, and phenobarbital; antituberculosis agents such as rifampin, rifabutin, and isoniazid (INH); and herbal supplements such as St. John’s wort are well-known inducers of the cytochrome P-450 (CYP3A4) pathway and would decrease plasma concentrations of CNIs.
Thus these drug-drug interactions may increase the risk of acute rejection following transplantation. The use of these agents in combination with CNIs requires dose escalation and careful TDM.
Coadministration of CNIs with agents that strongly inhibit the CYP3A4 enzymatic system may conversely result in nephrotoxicity.
Nefazodone, nondihydropyridine calcium channel blockers (verapamil, diltiazem), antibiotics (erythromycin, clarithromycin, telithromycin, but not azithromycin), antifungal agents (ketoconazole, fluconazole, itraconazole, voriconazole), and grapefruit are strong CYP3A4 inhibitors.
Grapefruit and grapefruit juice are known inhibitors of the cytochrome P-450 pathway and should be avoided in transplant patients and patients with CKD taking statins and calcium channel blockers.
