TOPIC DISCUSSION: Drugs and Cyclosporine

Cyclosporine is metabolized by the  hepatic cytochrome P450 family of enzymes and excreted into the bile.  
Drugs that induce CYP3A4 decrease the levels of cyclosporine.  Examples of these include carbamazepine, nafcillin, nevirapine, phenobarbital, and phenytoin. Drugs that inhibit CYP3A4 may increase the levels of cyclosporine.  Examples of these include antifungals( azoles), doxycycline, erythromycin, isoniazid, nicardipine, propofol, protease inhibitors, quinidine, and verapamil. 
Cyclosporine may increase the levels of CVP3A4 substrates.  Examples of substrates include benzodiazepines, calcium channel blockers, mirtazapine, sildenafil, venlafaxine and believe it or not- tacrolimus.


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