CICLOSPORIN (CYCLOSPORINE) AND MACROLIDES
Ciclosporin levels can be markedly raised by clarithromycin (commonly 2- to 3-fold), erythromycin (4- to 5-fold or more, intravenous use seems to have less effect than oral), josamycin (commonly 2- to 3-fold), midecamycin (2-fold) and pristinamycin (65% in one study). Rokitamycin, telithromycin and troleandomycin are predicted to interact similarly. Although major studies have found no interaction with azithro- mycin, there have been several case reports.
Ciclosporin levels and effects (e.g. on renal function) should be monitored as a matter of routine, but it may be prudent to increase monitoring if macrolides are started or stopped. With erythromycin, also consider increased monitoring if the route of administration is changed. Other macrolides may also interact, although it seems unlikely that they all will, see macrolides. There is some evidence to suggest that roxithromycin and spiramycin interact minimally or not at all.
Ciclosporin levels and effects (e.g. on renal function) should be monitored as a matter of routine, but it may be prudent to increase monitoring if macrolides are started or stopped. With erythromycin, also consider increased monitoring if the route of administration is changed. Other macrolides may also interact, although it seems unlikely that they all will, see macrolides. There is some evidence to suggest that roxithromycin and spiramycin interact minimally or not at all.