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Gengraf Capsules and Zithromax (Azithromycin Single-Dose Packet)

Determining the interaction of Gengraf Capsules and Zithromax (Azithromycin Single-Dose Packet) and the possibility of their joint administration.

Check result:
Gengraf Capsules <> Zithromax (Azithromycin Single-Dose Packet)
Relevance: 22.08.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Azithromycin may rarely increase the blood levels and effects of cycloSPORINE. Contact your doctor if your condition changes or if you experience increased side effects such as nausea, vomiting, diarrhea, abdominal pain, dizziness, fatigue, headache, tremors, seizures, fever, sore throat, unusual bruising or bleeding, and increased or decreased urination. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

MONITOR: Available data suggest that azithromycin may rarely increase the blood concentrations of cyclosporine. The mechanism of interaction has not been established. Other macrolide antibiotics such as clarithromycin and erythromycin interfere with the clearance of cyclosporine by inhibiting CYP450 3A4 metabolism and P-glycoprotein efflux, but azithromycin is not known to inhibit either. Pharmacokinetic studies in healthy volunteers and kidney transplant patients have also found no evidence of a clinically significant interaction, and azithromycin has been studied extensively in the treatment of cyclosporine-induced gingival hyperplasia without reports of interaction. Nevertheless, there have been isolated case reports of markedly increased cyclosporine blood levels during coadministration with azithromycin. In one report, cyclosporine trough level increased from 178 ng/mL (taken two weeks before and on the first day of hospitalization) to 400 ng/mL three days after initiation of ceftriaxone (1 gram IV every 12 hours) and azithromycin (500 mg IV once a day) to treat probable pneumonia in a 42-year-old kidney transplant patient who had been stabilized on cyclosporine 100 mg twice a day for two years. His cyclosporine dosage was reduced by 50%, and trough level returned to normal on hospital day 6 and remained normal three days later when azithromycin was discontinued. However, on hospital day 13, cyclosporine trough level dropped to 76 ng/mL, which led to a dosage increase back to 100 mg twice a day. Three days later, cyclosporine trough level was at 170 ng/mL and remained within target when measured on day 19 and at follow-up three weeks after discharge. Confounding factors in the case include active infection and fever, which can alter the level and activity of CYP isoenzymes, as well as the concomitant administration of ceftriaxone, which has been associated with increased cyclosporine levels by approximately 2-fold in isolated case reports. However, the temporal relationship between discontinuation of azithromycin and decreased cyclosporine levels would implicate azithromycin rather than ceftriaxone, which was not stopped until hospital day 17. Other, unpublished reports of adverse events attributed to potential interaction between azithromycin and cyclosporine include tinnitus, elevations in blood urea nitrogen and serum creatinine, and leukopenia.

MANAGEMENT: Caution and closer monitoring of cyclosporine blood levels and renal function may be advisable during coadministration with azithromycin, particularly in patients who are elderly or critically ill. Patients should be advised to notify their physician if they experience possible signs and symptoms of cyclosporine toxicity such as nausea, vomiting, diarrhea, abdominal pain, dizziness, fatigue, headache, tremors, and convulsions.

References
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Gengraf Capsules

Generic Name: cyclosporine

Brand name: Gengraf, Neoral, Sandimmune, Sandimmune

Synonyms: Gengraf (Capsules, Modified), Gengraf

Zithromax (Azithromycin Single-Dose Packet)

Generic Name: azithromycin

Brand name: Zithromax, Zmax, AzaSite, Azithromycin 3 Day Dose Pack, Azithromycin 5 Day Dose Pack, Zithromax Tri-Pak, Zithromax Z-Pak, Zithromax IV

Synonyms: Zithromax

In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.