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Cafergot PB rectal

Selected Immunosuppressants/Strong CYP3A4 Inducers

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Serious. These medicines may interact and cause very harmful effects. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

Your medicine may speed up how quickly your body processes cyclosporine, everolimus, sirolimus, tacrolimus, and temsirolimus.

What might happen:

The amount of cyclosporine, everolimus, sirolimus, tacrolimus, or temsirolimus in your blood may decrease and it may not work as well.

What you should do about this interaction:

Make sure your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together. Your doctor may want to check the amount of cyclosporine, everolimus, sirolimus, tacrolimus, or temsirolimus in your blood and may need to change the amount of cyclosporine, everolimus, sirolimus, tacrolimus, or temsirolimus you take while you are taking your other medicine.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

References:

1.Afinitor (everolimus) US prescribing information. Novartaris Pharmaceuticals Corporation February, 2014.
2.Rapamune (sirolimus) US prescribing information. Wyeth Pharmaceuticals March, 2013.
3.Torisel (temsirolimus) US prescribing information. Wyeth Pharmaceuticals, Inc. June, 2011.
4.Langhoff E, Madsen S. Rapid metabolism of cyclosporin and prednisone in kidney transplant patient receiving tuberculostatic treatment. Lancet 1983 Oct 29;2(8357):1031.
5.Van Buren D, Wideman CA, Ried M, Gibbons S, Van Buren CT, Jarowenko M, Flechner SM, Frazier OH, Cooley DA, Kahan BD. The antagonistic effect of rifampin upon cyclosporine bioavailability. Transplant Proc 1984 Dec; 16(6):1642-5.
6.Daniels NJ, Dover JS, Schachter RK. Interaction between cyclosporin and rifampicin. Lancet 1984 Sep 15;2(8403):639.
7.Allen RD, Hunnisett AG, Morris PJ. Cyclosporin and rifampicin in renal transplantation. Lancet 1985 Apr 27;1(8435):980.
8.Howard P, Bixler TJ, Gill B. Cyclosporine-rifampin drug interaction. Drug Intell Clin Pharm 1985 Oct;19(10):763-4.
9.Anonymous. Cyclosporin and antituberculous therapy. Lancet 1985 Jun 8; 1(8441):1342-3.
10.Cassidy MJ, Van Zyl-Smit R, Pascoe MD, Swanepoel CR, Jacobson JE. Effect of rifampicin on cyclosporin A blood levels in a renal transplant recipient. Nephron 1985;41(2):207-8.
11.Offermann G, Keller F, Molzahn M. Low cyclosporin A blood levels and acute graft rejection in a renal transplant recipient during rifampin treatment. Am J Nephrol 1985;5(5):385-7.
12.al-Sulaiman MH, Dhar JM, al-Khader AA. Successful use of rifampicin in the treatment of tuberculosis in renal transplant patients immunosuppressed with cyclosporine. Transplantation 1990 Oct;50(4):597-8.
13.Vandevelde C, Chang A, Andrews D, Riggs W, Jewesson P. Rifampin and ansamycin interactions with cyclosporine after renal transplantation. Pharmacotherapy 1991;11(1):88-9.
14.Hebert MF, Roberts JP, Prueksaritanont T, Benet LZ. Bioavailability of cyclosporine with concomitant rifampin administration is markedly less than predicted by hepatic enzyme induction. Clin Pharmacol Ther 1992 Nov; 52(5):453-7.
15.Keown PA, Stiller CR, Laupacis AL, Howson W, Coles R, Stawecki M, Koegler J, Carruthers G, McKenzie N, Sinclair NR. The effects and side effects of cyclosporine: relationship to drug pharmacokinetics. Transplant Proc 1982 Dec;14(4):659-61.
16.Freeman DJ, Laupacis A, Keown PA, Stiller CR, Carruthers SG. Evaluation of cyclosporin-phenytoin interaction with observations on cyclosporin metabolites. Br J Clin Pharmacol 1984 Dec;18(6):887-93.
17.Keown PA, Laupacis A, Carruthers G, Stawecki M, Koegler J, McKenzie FN, Wall W, Stiller CR. Interaction between phenytoin and cyclosporine following organ transplantation. Transplantation 1984 Sep;38(3):304-6.
18.Rowland M, Gupta SK. Cyclosporin-phenytoin interaction: re-evaluation using metabolite data. Br J Clin Pharmacol 1987 Sep;24(3):329-34.
19.Ptachcinski RJ, Venkataramanan R, Rosenthal JT, Burckart GJ, Taylor RJ, Hakala TR. Cyclosporine kinetics in renal transplantation. Clin Pharmacol Ther 1985 Sep;38(3):296-300.
20.Carstensen H, Jacobsen N, Dieperink H. Interaction between cyclosporin A and phenobarbitone. Br J Clin Pharmacol 1986 May;21(5):550-1.
21.Noguchi M, Kiuchi C, Akiyama H, Sakamaki H, Onozawa Y. Interaction between cyclosporin A and anticonvulsants. Bone Marrow Transplantation Team. Bone Marrow Transplant 1992 May;9(5):391.
22.Schofield OM, Camp RD, Levene GM. Cyclosporin A in psoriasis: interaction with carbamazepine. Br J Dermatol 1990 Mar;122(3):425-6.
23.Lele P, Peterson P, Yang S, Jarrell B, Burke JF Jr. Cyclosporine and tegretrol -- another drug interaction. Kidney Int 1985;27(1):344.
24.Soto Alvarez J, Sacristan Del Castillo JA, Alsar Ortiz MJ. Effect of carbamazepine on cyclosporin blood level. Nephron 1991;58(2):235-6.
25.Cooney GF, Mochon M, Kaiser B, Dunn SP, Goldsmith B. Effects of carbamazepine on cyclosporine metabolism in pediatric renal transplant recipients. Pharmacotherapy 1995 May-Jun;15(3):353-6.
26.Kovarik JM, Hartmann S, Figueiredo J, Rouilly M, Port A, Rordorf C. Effect of rifampin on apparent clearance of everolimus. Ann Pharmacother 2002 Jun;36(6):981-5.
27.Hebert MF, Fisher RM, Marsh CL, Dressler D, Bekersky I. Effects of rifampin on tacrolimus pharmacokinetics in healthy volunteers. J Clin Pharmacol 1999 Jan;39(1):91-6.
28.Kiuchi T, Tanaka K, Inomata Y, Uemoto S, Satomura K, Egawa H, Uyama S, Sano K, Okajima H, Yamaoka Y. Experience of tacrolimus-based immunosuppression in living-related liver transplantation complicated with graft tuberculosis: interaction with rifampicin and side effects. Transplant Proc 1996 Dec;28(6):3171-2.
29.Furlan V, Perello L, Jacquemin E, Debray D, Taburet AM. Interactions between FK506 and rifampicin or erythromycin in pediatric liver recipients. Transplantation 1995 Apr 27;59(8):1217-8.
30.Bhaloo S, Prasad GV. Severe reduction in tacrolimus levels with rifampin despite multiple cytochrome P450 inhibitors: a case report. Transplant Proc 2003 Nov;35(7):2449-51.
31.Chenhsu RY, Loong CC, Chou MH, Lin MF, Yang WC. Renal allograft dysfunction associated with rifampin-tacrolimus interaction. Ann Pharmacother 2000 Jan;34(1):27-31.
32.Ngo BT, Pascoe M, Kahn D. Drug interaction between rifampicin and sirolimus in transplant patients. Saudi J Kidney Dis Transpl 2011 Jan-Feb;22(1):112-5.
33.Stroh M, Palcza J, McCrea J, Marsilio S, Breidinger S, Panebianco D, Johnson-Levonas A, Kraft WK, Orford K, Murphy G, Agrawal N, Trucksis M, Wagner JA, Iwamoto M. The effect of multiple doses of rifampin and ketoconazole on the single-dose pharmacokinetics of ridaforolimus. Cancer Chemother Pharmacol 2012 May;69(5):1247-53.
34.Lopez-Montes A, Gallego E, Lopez E, Perez J, Lorenzo I, Llamas F, Serrano A, Andres E, Illescas L, Gomez C. Treatment of tuberculosis with rifabutin in a renal transplant recipient. Am J Kidney Dis 2004 Oct; 44(4):e59-63.
35.Bauer S, Stormer E, Johne A, Kruger H, Budde K, Neumayer HH, Roots I, Mai I. Alterations in cyclosporin A pharmacokinetics and metabolism during treatment with St John's wort in renal transplant patients. Br J Clin Pharmacol 2003 Feb;55(2):203-11.
36.Hebert MF, Park JM, Chen YL, Akhtar S, Larson AM. Effects of St. John's wort (Hypericum perforatum) on tacrolimus pharmacokinetics in healthy volunteers. J Clin Pharmacol 2004 Jan;44(1):89-94.
37.Mai I, Stormer E, Bauer S, Kruger H, Budde K, Roots I. Impact of St John's wort treatment on the pharmacokinetics of tacrolimus and mycophenolic acid in renal transplant patients. Nephrol Dial Transplant 2003 Apr;18(4):819-22.
38.Alscher DM, Klotz U. Drug interaction of herbal tea containing St. John's wort with cyclosporine. Transpl Int 2003 Jul;16(7):543-4.
39.Turton-Weeks SM, Barone GW, Gurley BJ, Ketel BL, Lightfoot ML, Abul-Ezz SR. St John's wort: a hidden risk for transplant patients. Prog Transplant 2001 Jun;11(2):116-20.
40.Moschella C, Jaber BL. Interaction between cyclosporine and Hypericum perforatum (St. John's wort) after organ transplantation. Am J Kidney Dis 2001 Nov;38(5):1105-7.
41.Beer AM, Ostermann T. St. John's wort: interaction with cyclosporine increases risk of rejection for the kidney transplant and raises daily cost of medication. Med Klin (Munich) 2001 Aug 15;96(8):480-3.
42.Ahmed SM, Banner NR, Dubrey SW. Low cyclosporin-A level due to Saint-John's-wort in heart transplant patients. J Heart Lung Transplant 2001 Jul;20(7):795.
43.Karliova M, Treichel U, Malago M, Frilling A, Gerken G, Broelsch CE. Interaction of Hypericum perforatum (St. John's wort) with cyclosporin A metabolism in a patient after liver transplantation. J Hepatol 2000 Nov; 33(5):853-5.
44.Barone GW, Gurley BJ, Ketel BL, Lightfoot ML, Abul-Ezz SR. Drug interaction between St. John's wort and cyclosporine. Ann Pharmacother 2000 Sep;34(9):1013-6.
45.Mandelbaum A, Pertzborn F, Martin-Facklam M, Wiesel M. Unexplained decrease of cyclosporin trough levels in a compliant renal transplant patient. Nephrol Dial Transplant 2000 Sep;15(9):1473-4.
46.Breidenbach T, Kliem V, Burg M, Radermacher J, Hoffmann MW, Klempnauer J. Profound drop of cyclosporin A whole blood trough levels caused by St. John's wort (Hypericum perforatum). Transplantation 2000 May 27; 69(10):2229-30.
47.Ruschitzka F, Meier PJ, Turina M, Luscher TF, Noll G. Acute heart transplant rejection due to Saint John's wort. Lancet 2000 Feb 12; 355(9203):548-9.
48.Bolley R, Zulke C, Kammerl M, Fischereder M, Kramer BK. Tacrolimus-induced nephrotoxicity unmasked by induction of the CYP3A4 system with St John's wort. Transplantation 2002 Mar 27;73(6):1009.
49.Fridell JA, Jain AK, Patel K, Virji M, Rao KN, Fung JJ, Venkataramanan R. Phenytoin decreases the blood concentrations of sirolimus in a liver transplant recipient: a case report. Ther Drug Monit 2003 Feb; 25(1):117-9.
50.Wada K, Takada M, Ueda T, Ochi H, Kotake T, Morishita H, Hanatani A, Nakatani T. Drug interactions between tacrolimus and phenytoin in Japanese heart transplant recipients: 2 case reports. Int J Clin Pharmacol Ther 2007 Sep;45(9):524-8.
51.Formea CM, Evans CG, Karlix JL. Altered cytochrome p450 metabolism of calcineurin inhibitors: case report and review of the literature. Pharmacotherapy 2005 Jul;25(7):1021-9.
52.Karasu Z, Gurakar A, Carlson J, Pennington S, Kerwin B, Wright H, Nour B, Sebastian A. Acute tacrolimus overdose and treatment with phenytoin in liver transplant recipients. J Okla State Med Assoc 2001 Apr;94(4):121-3.
53.Bates D, Burak KW, Coffin CS, Ying T, Enns EM. Phenytoin-induced reduction in sirolimus levels. Can J Hosp Pharm 2011 Jul;64(4):271-4.
54.Siddiqi N, Marfo K. Clinically significant drug-drug interaction between tacrolimus and phenobarbital: the price we pay. J Pharm Pract 2010 Dec; 23(6):585-9.
55.Coriat R, Mir O, Ropert S, Loulergue P, Billemont B, Goldwasser F. Reactivation of tuberculosis during temsirolimus therapy. Invest New Drugs 2011 Dec;29(6):1494-6.
56.Abdel Halim M, Al-Otaibi T, Gheith O, El-Kholy O, Abdel Tawab K, Said T, Nair P, Nampoory MR. Toxic tacrolimus blood levels with rifampin administration in a renal transplant recipient. Ann Transplant 2010 Jan-Mar;15(1):57-60.
57.Wada K, Takada M, Sakai M, Ochi H, Kotake T, Okada H, Morishita H, Oda N, Mano A, Kato TS, Komamura K, Nakatani T. Drug interaction between tacrolimus and carbamazepine in a Japanese heart transplant recipient: a case report. J Heart Lung Transplant 2009 Apr;28(4):409-11.
58.Quiros-Tejeira RE, Chang IF, Bristow LJ, Karpen SJ, Goss JA. Treatment of acute tacrolimus whole-blood elevation with phenobarbital in the pediatric liver transplant recipient. Pediatr Transplant 2005 Dec; 9(6):792-6.
59.McLaughlin GE, Rossique-Gonzalez M, Gelman B, Kato T. Use of phenobarbital in the management of acute tacrolimus toxicity: a case report. Transplant Proc 2000 May;32(3):665-8.
60.Jahansouz F, Kriett JM, Smith CM, Jamieson SW. Potentiation of cyclosporine nephrotoxicity by nafcillin in lung transplant recipients. Transplantation 1993 May;55(5):1045-8.
61.Veremis SA, Maddux MS, Pollak R, Mozes MF. Subtherapeutic cyclosporine concentrations during nafcillin therapy. Transplantation 1987 Jun; 43(6):913-5.

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