Cyclosporine (drug interactions)
Cyclosporine is an immunosuppressant medication primarily used to prevent organ rejection in transplant patients and to treat conditions like rheumatoid arthritis and psoriasis. However, it has numerous potential drug interactions that can affect its efficacy and safety. Certain foods and supplements, such as grapefruit juice, citrus aurantium, and berberine, can raise cyclosporine levels in the body, increasing the risk of toxicity. Conversely, herbs like St. John's wort may accelerate the breakdown of cyclosporine, leading to inadequate drug levels and possible organ rejection. Other substances, including peppermint oil and Scutellaria baicalensis, can also impact cyclosporine absorption or blood levels. Additionally, various medications, including certain antibiotics, NSAIDs, and birth control pills, can interact with cyclosporine, making it crucial for patients to consult healthcare providers about their medication regimen. Awareness of these interactions is essential for anyone taking cyclosporine to ensure safe and effective treatment.
Cyclosporine (drug interactions)
TRADE NAMES: Neoral, Sandimmune
DEFINITION: Helps prevent rejection of a transplanted organ by suppressing the immune system. Also used to treat rheumatoid arthritis and psoriasis.
INTERACTIONS: Berberine (found in goldenseal, Oregon grape, and barberry), citrus aurantium, grapefruit juice, ipriflavone, peppermint oil, St. John’s wort, Scutellaria baicalensis, echinacea, chamomile, garlic, ginger, licorice, many medications
Grapefruit Juice
Effect: Possible Harmful Interaction
Grapefruit juice slows the body’s normal breakdown of several drugs, including cyclosporine, allowing it to build up to potentially excessive levels in the blood. A study indicates this effect can last for three days or more following the last glass of juice. If one takes cyclosporine, the safest approach is to avoid grapefruit juice altogether.
Citrus Aurantium
Effect: Possible Harmful Interaction
Like grapefruit juice, bitter orange (citrus aurantium) may raise cyclosporine levels. If one takes cyclosporine, the safest approach is to avoid citrus aurantium altogether.
Berberine
Effect: Possible Harmful Interaction
The substance berberine, found in goldenseal, Oregon grape, and barberry, may increase cyclosporine levels.
St. John’s Wort
Effect: Possible Harmful Interaction
The herb St. John’s wort (Hypericum perforatum) is primarily used to treat mild to moderate depression. St. John’s wort has the potential to accelerate the body’s normal breakdown of certain drugs, including cyclosporine, resulting in lower blood levels of these drugs.
This interaction appears to have occurred in two heart transplant patients taking cyclosporine, leading to heart transplant rejection. These persons had been doing well after transplantation while taking standard immunosuppressive therapy that included cyclosporine. After starting St. John’s wort for depression, however, they began experiencing problems, and their blood levels of cyclosporine were found to have dipped below the therapeutic range. After St. John’s wort was discontinued, cyclosporine levels returned to normal, and no further episodes of rejection occurred.
Numerous cases of transplant rejection episodes involving the heart, kidney, and liver have also been reported in people using the herb. Based on this evidence, if one is taking cyclosporine, one should not take St. John’s wort.
Ipriflavone
Effect: Possible Harmful Interaction
The supplement ipriflavone is used to treat osteoporosis. A three-year, double-blind trial of almost five hundred women and a small study found worrisome evidence that ipriflavone can reduce white blood cell count in some people. For this reason, anyone taking medications that suppress the immune system should avoid taking ipriflavone.
Peppermint
Effect: Possible Harmful Interaction
An animal study indicated that peppermint oil use may increase the body's cyclosporine levels. If one is taking cyclosporine and wishes to use peppermint oil as well, notify a physician in advance so that blood levels of cyclosporine can be monitored, and the dose adjusted if necessary. If one is already taking both peppermint oil and cyclosporine and stops taking the peppermint, the body’s cyclosporine levels may fall. Again, consult a physician to make the necessary dosage adjustment.
Scutellaria baicalensis
Effect: Possible Harmful Interaction
A study in animals found that the herb Scutellaria baicalensis (Chinese skullcap) may impair the absorption of cyclosporine.
Other Interactions
Several other herbs and supplements can interact with cyclosporine, including echinacea, garlic, ginger, and licorice root. Cyclosporine has innumerable drug interactions, and several categories of medications should be avoided. Certain antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDS), antifungal medications, anti-seizure drugs, and acid reflux treatment drugs have been shown to interact with cyclosporine. Additionally, birth control pills, the immunosuppressant drug tacrolimus, and cholesterol-reducing drugs may interact with cyclosporine. Medical experts suggest patients avoid receiving live vaccines when taking cyclosporine. They should also avoid potassium-raising and photosynthesizing drugs. Finally, medications to treat gout, for fluid-reducing, and blood pressure medications should be avoided with taking cyclosporine.
Bibliography
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