Ciclosporin(continued)
▶Lanreotideis predicted to decrease the absorption of oral
ciclosporin. Adjust dose.rTheoretical
▶Live vaccinesare predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
ciclosporin. Public Health England advises avoid (refer to
Green Book).rTheoretical
▶Ciclosporinis predicted to increase the exposure tolomitapide.
Separate administration by 12 hours.oTheoretical
▶Lumacaftoris predicted to decrease the exposure to
ciclosporin. Avoid.rTheoretical
▶Macrolides(clarithromycin, erythromycin)increase the
concentration ofciclosporin.rStudy
▶Ciclosporinis predicted to decrease the efficacy of
mifamurtide. Avoid.rTheoretical
▶Mitotanedecreases the concentration ofciclosporin.r
Study
▶Monoclonal antibodies(blinatumomab)are predicted to
transiently increase the exposure tociclosporin. Monitor and
adjust dose.oTheoretical
▶Monoclonal antibodies(sarilumab)potentially affect the
exposure tociclosporin. Monitor and adjust dose.o
Theoretical
▶Monoclonal antibodies(tocilizumab)are predicted to decrease
the exposure tociclosporin. Monitor and adjust dose.o
Theoretical
▶Netupitantincreases the concentration ofciclosporin.r
Study
▶Nevirapineis predicted to decrease the concentration of
ciclosporin.oStudy
▶Nilotinibincreases the concentration ofciclosporin.r
Study
▶Ciclosporinis predicted to increase the exposure tonintedanib.
oStudy
▶Ciclosporinincreases the concentration ofNSAIDs(diclofenac).
rStudy→Also seeTABLE 2p. 847→Also seeTABLE 16p. 851
▶Octreotidedecreases the absorption of oralciclosporin. Adjust
ciclosporindose,p. 519.rAnecdotal
▶Palbociclibis predicted to increase the exposure tociclosporin.
Adjust dose.oTheoretical
▶Ciclosporinis predicted to increase the exposure to
panobinostat. Adjust dose.oTheoretical
▶Pasireotideis predicted to decrease the absorption of oral
ciclosporin. Adjust dose.rTheoretical
▶Ciclosporinincreases the exposure topibrentasvir. Avoid or
monitor.rStudy
▶Pitolisantis predicted to decrease the exposure tociclosporin.
Avoid.rTheoretical
▶Ciclosporinis predicted to increase the concentration of
ranolazineandranolazineis predicted to increase the
concentration ofciclosporin.oTheoretical
▶Ciclosporinmoderately increases the exposure torepaglinide.
oStudy
▶Ribociclibis predicted to increase the exposure tociclosporin.
Use with caution and adjust dose.oTheoretical
▶Rifampicindecreases the concentration ofciclosporin.r
Study
▶Ciclosporinvery markedly increases the exposure torifaximin.
rStudy
▶Ciclosporinis predicted to increase the exposure toriociguat.
oTheoretical
▶Ciclosporinmoderately increases the exposure tosirolimus.
Separate administration by 4 hours.rStudy
▶St John’s Wortdecreases the concentration ofciclosporin.
Avoid.oStudy
▶Ciclosporinvery markedly increases the exposure tostatins
(atorvastatin). Avoid or adjustatorvastatindose,p. 132.r
Study
▶Ciclosporinmoderately increases the exposure tostatins
(fluvastatin).rStudy
▶Ciclosporinmarkedly to very markedly increases the exposure
tostatins(pravastatin). Adjust dose.rStudy
▶Ciclosporinmarkedly increases the exposure tostatins
(rosuvastatin, simvastatin). Avoid.rStudy▶Sulfinpyrazonedecreases the concentration ofciclosporin.
rStudy
▶Ciclosporinincreases the concentration oftacrolimus. Avoid.
rStudy→Also seeTABLE 2p. 847→Also seeTABLE 16p. 851
▶Ciclosporinis predicted to increase the exposure toticagrelor.
Use with caution or avoid.rStudy
▶Ciclosporinincreases the exposure totofacitinib. Avoid.r
Study
▶Ciclosporinis predicted to increase the exposure totopotecan.
rStudy
▶Ciclosporinis predicted to increase the concentration of
trametinib.oTheoretical
▶Ursodeoxycholic acidaffects the concentration ofciclosporin.
Use with caution and adjust dose.rAnecdotal
▶Ciclosporinis predicted to increase the exposure tovenetoclax.
Avoid or monitor for toxicity.rTheoretical
▶Vitamin E substancesaffect the exposure tociclosporin.
oStudy
▶Ciclosporinincreases the concentration ofvoxilaprevir. Avoid.
rStudy
Cilostazol→seeTABLE 4p. 847 (antiplatelet effects)
GENERAL INFORMATIONConcurrent use with 2 or more
antiplatelets or anticoagulants is contra-indicated.
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to alter the effects of
cilostazol.oTheoretical
▶Antifungals, azoles(fluconazole)are predicted to increase the
exposure tocilostazol. Adjustcilostazoldose.o
Theoretical
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to moderately increase the exposure tocilostazol.
Adjustcilostazoldose.oStudy
▶Antifungals, azoles(miconazole)are predicted to increase the
exposure tocilostazol. Use with caution and adjust dose.
oTheoretical
▶Cobicistatis predicted to moderately increase the exposure to
cilostazol. Adjustcilostazoldose.oStudy
▶Enzalutamideis predicted to alter the effects ofcilostazol.
oTheoretical
▶HIV-protease inhibitorsare predicted to moderately increase
the exposure tocilostazol. Adjustcilostazoldose.o
Study
▶Idelalisibis predicted to moderately increase the exposure to
cilostazol. Adjustcilostazoldose.oStudy
▶Cilostazolis predicted to increase the exposure tolomitapide.
Separate administration by 12 hours.oTheoretical
▶Macrolides(clarithromycin)are predicted to moderately
increase the exposure tocilostazol. Adjustcilostazoldose.
oStudy
▶Macrolides(erythromycin)slightly increase the exposure to
cilostazol. Adjustcilostazoldose.oStudy
▶Mitotaneis predicted to alter the effects ofcilostazol.o
Theoretical
▶Moclobemideis predicted to increase the exposure to
cilostazol.oTheoretical
▶Proton pump inhibitors(esomeprazole)are predicted to increase
the exposure tocilostazol.oTheoretical
▶Proton pump inhibitors(omeprazole)are predicted to increase
the exposure tocilostazol. Adjustcilostazoldose.o
Study
▶Rifampicinis predicted to alter the effects ofcilostazol.
oTheoretical
▶SSRIs(fluoxetine, fluvoxamine)are predicted to increase the
exposure tocilostazol. Adjustcilostazoldose.o
Theoretical→Also seeTABLE 4p. 847
▶St John’s Wortis predicted to alter the effects ofcilostazol.
oTheoretical
Cimetidine→see H 2 receptor antagonists
Cinacalcet
FOOD AND LIFESTYLEDose adjustment might be necessary if
smoking started or stopped during treatment.▶Cinacalcetis predicted to increase the exposure to
anticholinesterases, centrally acting(galantamine). Monitor and
adjust dose.oStudy896 Ciclosporin—Cinacalcet BNFC 2018 – 2019
Interactions|Appendix 1A1