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Sandimmune Drug Interactions
If colchicine, digoxin, methotrexate, live vaccinations, or other drugs are taken with Sandimmune, interactions are possible. These can be quite serious -- they can increase your risk of seizures, kidney problems, shallow breathing, and other problems. To avoid complications, your doses may be adjusted or you may be given a different medication altogether.
Sandimmune® (cyclosporine) can potentially react with a number of other medications -- far too many to list in this article. Some of the drugs that can interact with Sandimmune include but are not limited to:
- Aliskiren (Tekamlo™, Tekturna®, Tekturna HCT®, Valturna®)
- Allopurinol (Zyloprim®)
- Certain blood pressure medicines, such as ACE inhibitors and calcium channel blockers
- Colchicine (Colcrys®)
- CYP 3A4 inducer medications, such as:
- Aminoglutethimide (Cytadren®)
- Bosentan (Tracleer®)
- Carbamazepine (Carbatrol®, Epitol®, Equetro®, Tegretol®)
- Dexamethasone (Decadron®, Dexpak®, Maxidex®)
- Efavirenz (Sustiva®)
- Efavirenz, emtricitabine, and tenofovir (Atripla®)
- Etravirine (Intelence™)
- Fosphenytoin (Cerebyx®)
- Nafcillin
- Nevirapine (Viramune®)
- Oxcarbazepine (Trileptal®)
- Pentobarbital (Nembutal®)
- Phenobarbital (Luminal®)
- Phenytoin (Dilantin®, Phenytek®)
- Primidone (Mysoline®)
- Rifabutin (Mycobutin®)
- Rifampin (Rifadin®)
- Rifapentine (Priftin®)
- St. John's wort
- CYP 3A4 inhibitor medications, such as:
- Amprenavir (Agenerase®)
- Atazanavir (Reyataz®)
- Clarithromycin (Biaxin®)
- Conivaptan (Vaprisol®)
- Darunavir (Prezista®)
- Delavirdine (Rescriptor®)
- Erythromycin
- Fluconazole (Diflucan®)
- Fosamprenavir (Lexiva®)
- Imatinib (Gleevec®)
- Indinavir (Crixivan®)
- Isoniazid
- Itraconazole (Sporanox®)
- Ketoconazole (Nizoral®)
- Lopinavir and ritonavir (Kaletra®)
- Miconazole
- Nefazodone (Serzone®)
- Nelfinavir (Viracept®)
- Nicardipine (Cardene®)
- Posaconazole (Noxafil®)
- Quinidine
- Ritonavir (Norvir®)
- Saquinavir (Fortovase®, Invirase®)
- Telaprevir (INCIVEK™)
- Telithromycin (Ketek®)
- Voriconazole (VFEND®)
- Dabigatran (Pradaxa®)
- Digoxin (Lanoxin®)
- Echinacea
- Fentanyl (Abstral®, Actiq®, Duragesic®, Fentora®, Lazanda®, Onsolis®, Subsys®)
- Grapefruit juice
- "Live" vaccinations, such as:
- Chickenpox vaccine (varicella vaccine)
- FluMist® (the nasal vaccine for influenza; the injected vaccine is not live)
- MMR vaccine (measles, mumps, rubella vaccine)
- Polio vaccine
- Rotavirus vaccine
- Smallpox vaccine
- Yellow fever vaccine
- BCG vaccine (used in some countries for tuberculosis)
- Methylprednisolone (A-Methapred®, Depo-Medrol®, Medrol®, Solu-Medrol®)
- Natalizumab (Tysabri®)
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as:
- Celecoxib (Celebrex®)
- Diclofenac (Cataflam®, Voltaren®)
- Etodolac (Lodine®)
- Ibuprofen (Motrin®, Advil®)
- Indomethacin (Indocin®)
- Ketoprofen (Orudis®)
- Ketorolac (Toradol®)
- Meloxicam (Mobic®)
- Nabumetone (Relafen®)
- Naproxen (Naprosyn®) or naproxen sodium (Aleve®, Anaprox®, Naprelan®)
- Oxaprozin (Daypro®)
- Others (see List of NSAIDs for a more complete list of these medications)
- Orlistat (Alli™, Xenical®)
- P-glycoprotein inducers, such as:
- Carbamazepine (Carbatrol®, Epitol®, Equetro®, Tegretol®)
- Dexamethasone (Decadron®)
- Doxorubicin (Adriamycin®, Doxil®)
- Nefazodone (Serzone®)
- Prazosin (Minipress®)
- Rifampin (Rifadin®)
- St. John's wort
- Tipranavir (Aptivus®)
- Trazodone (Desyrel®) and trazodone ER (Oleptro™)
- Vinblastine
- P-glycoprotein inhibitors, such as:
- Amiodarone (Cordarone®, Pacerone®)
- Atorvastatin (Lipitor®, also found in Caduet®)
- Carvedilol (Coreg®, Coreg CR®)
- Clarithromycin (Biaxin®)
- Darunavir (Prezista®)
- Dipyridamole (Persantine®, also found in Aggrenox®)
- Dronedarone (Multaq®)
- Erythromycin
- Grapefruit juice
- Itraconazole (Sporanox®)
- Ketoconazole (Nizoral®)
- Lapatinib (Tykerb®)
- Lopinavir and ritonavir (Kaletra®)
- Mefloquine (Lariam®)
- Nelfinavir (Viracept®)
- Nicardipine (Cardene®)
- Nilotinib (Tasigna®)
- Progesterone
- Propranolol (Inderal®, Inderal LA®, InnoPran XL®, also found in Inderide®)
- Quinidine
- Ranolazine (Ranexa®)
- Reserpine
- Ritonavir (Norvir®, also found in Kaletra®)
- Saquinavir (Invirase®)
- Sunitinib (Sutent®)
- Tacrolimus (Prograf®, Protopic®)
- Tamoxifen (Nolvadex®)
- Telaprevir (INCIVEK™)
- Verapamil (Calan®, Calan SR®, Covera-HS®, Isoptin SR®, Verelan®, Verelan PM®)
- Pimecrolimus (Elidel®)
- Potassium-sparing diuretics, such as:
- Amiloride (Midamor®) or amiloride-HCTZ (Moduretic®)
- Spironolactone (Aldactone®) or spironolactone-HCTZ (Aldactazide®)
- Triamterene (Dyrenium®) or triamterene/HCTZ (Dyazide®, Maxzide®)
- Silodosin (Rapaflo®)
- Statin medications, such as:
- Atorvastatin (Lipitor®) or combination medications that contain atorvastatin (Caduet®)
- Fluvastatin (Lescol®, Lescol® XL)
- Lovastatin (Altoprev®, Mevacor®) or combination medications that contain lovastatin (Advicor®)
- Pitavastatin (Livalo®)
- Pravastatin (Pravachol®)
- Rosuvastatin (Crestor®)
- Simvastatin (Zocor®) or combination medications that contain simvastatin (Juvisync®, Simcor®, Vytorin®)
Written by/reviewed by: Susan Lakey, PharmD, MPH, BCPP
Last reviewed by: Kristi Monson, PharmD