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Cyclosporine; Sirolimus; Tacrolimus/NSAIDs

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:

Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

Both your immunosuppressant and NSAIDs can affect your kidneys.

What might happen:

You may experience a decrease in kidney function.

What you should do about this interaction:

Let your healthcare professional (e.g. doctor or pharmacist) know that you are taking these medicines together. If you experience mental confusion, blurred vision, fever, sore throat, stomach pain, hearing problems, chest pain, changes in the amount of urine, fatigue, or unusual bleeding or bruising, contact your doctor. It may be necessary to change you to a different 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.Deray G, Le Hoang P, Aupetit B, Achour A, Rottembourg J, Baumelou A. Enhancement of cyclosporine A nephrotoxicity by diclofenac. Clin Nephrol 1987 Apr;27(4):213-4.
2.Harris KP, Jenkins D, Walls J. Nonsteroidal antiinflammatory drugs and cyclosporine. A potentially serious adverse interaction. Transplantation 1988 Oct;46(4):598-9.
3.Mueller EA, Kovarik JM, Koelle EU, Merdjan H, Johnston A, Hitzenberger G. Pharmacokinetics of cyclosporine and multiple-dose diclofenac during coadministration. J Clin Pharmacol 1993 Oct;33(10):936-43.
4.Sesin GP, O'Keefe E, Roberto P. Sulindac-induced elevation of serum cyclosporine concentration. Clin Pharm 1989 Jun;8(6):445-6.
5.Agar JW. Cyclosporin A and mefenamic acid in a renal transplant patient. Aust N Z J Med 1991 Oct;21(5):784-5.
6.Ludwin D, Bennett KJ, Grace EM, Buchanan WW, Bensen W, Bombardier C, Tugwell PX. Nephrotoxicity in patients with rheumatoid arthritis treated with cyclosporine. Transplant Proc 1988 Jun;20(3 Suppl 4):367-70.
7.Altman RD, Perez GO, Sfakianakis GN. Interaction of cyclosporine A and nonsteroidal anti-inflammatory drugs on renal function in patients with rheumatoid arthritis. Am J Med 1992 Oct;93(4):396-402.
8.Prograf (tacrolimus) UK summary of product characteristics. Fujisawa Limited November 14, 2002.
9.Prograf (tacrolimus) Canadian prescribing information. Astellas April 27, 2011.
10.Prograf (tacrolimus) US prescribing information. Fujisawa Healthcare, Inc. September, 2004.
11.Rapamune (sirolimus) US prescribing information. Wyeth Pharmaceuticals March, 2013.

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