Drug search by name

IsonaRif and Neoral

Determining the interaction of IsonaRif and Neoral and the possibility of their joint administration.

Check result:

IsonaRif <> Neoral

Relevance: 14.08.2022 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:

Using cycloSPORINE and rifAMPin together can make cycloSPORINE less effective. Given the risk of organ rejection associated with low cycloSPORINE levels, caution is advised if cycloSPORINE must be taken with rifAMPin. You may need a dose adjustment or special test if you take both medications. 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 CLOSELY: The coadministration with rifamycins, particularly rifampin, may decrease the blood concentrations and pharmacologic effects of cyclosporine. The mechanism probably involves reduced absorption as well as accelerated clearance of cyclosporine due to induction of both intestinal P-glycoprotein drug efflux pumps and hepatic/intestinal CYP450 3A4 isoenzymes by rifamycins. In a study of six healthy volunteers, rifampin (600 mg orally at bedtime for 11 days) increased the average blood clearance of cyclosporine (10 mg/kg orally and 3 mg/kg intravenously) by 40% and decreased its oral bioavailability from 27% to 10%. There have also been case reports of transplant patients whose cyclosporine blood levels dropped significantly, often below assay detection limits, as early as two days following the initiation of rifampin. The decreases were associated with acute rejection episodes in many cases, subsequently requiring discontinuation of rifampin or substantial increases in cyclosporine dosage. This interaction is likely to occur with other rifamycins but to a lesser extent. In vitro and in vivo enzyme studies have suggested rifapentine induction potential to be less than that of rifampin but greater than that of rifabutin.

MANAGEMENT: Given the risk of organ rejection associated with inadequate immunosuppressant levels, caution is advised if cyclosporine must be coadministered with rifamycins, particularly rifampin. Cyclosporine blood levels should be closely monitored and the dosage adjusted accordingly, particularly following initiation or discontinuation of rifamycin therapy in patients who are stabilized on their anti-rejection regimen.

References

"Product Information. Sandimmune (cyclosporine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
Al-Sulaiman MH, Dhar JM, Al-Khader AA "Successful use of rifampicin in the treatment of tuberculosis in renal transplant patients immunosuppressed with cyclosporine." Transplantation 50 (1990): 597-8
Koselj M, Bren A, Kandus A, Kovac D "Drug interactions between cyclosporine and rifampicin, erythromycin, and azoles in kidney recipients with opportunistic infections." Transplant Proc 26 (1994): 2823-4
Van Buren D, Wideman CA, Ried M, et al. "The antagonistic effect of rifampin upon cyclosporin bioavailability." Transplant Proc 16 (1984): 1642-5
Modry DL, Stinson EB, Oyer PE, Jamieson SW, Baldwin JC, Shumway NE "Acute rejection and massive cyclosporin requirements in heart transplant recipients treated with rifampin." Transplantation 39 (1985): 313-4
Allen RD, Hunnisett AG, Morris PJ "Cyclosporin and rifampicin in renal transplantation." Lancet 1 (1985): 980
Offermann G, Keller F, Molzahn M "Low cyclosporine A blood levels and acute graft rejection in a renal transplant recipient during rifampin treatment." Am J Nephrol 5 (1985): 385-7
Yee GC, McGuire TR "Pharmacokinetic drug interactions with cyclosporin (Part I)." Clin Pharmacokinet 19 (1990): 319-32
Hebert MF, Roberts JP, Prueksaritanont T, Benet LZ "Bioavailability of cyclosporine with concomitant rifampin administration is markedly less than predicted by hepatic enzyme induction." Clin Pharmacol Ther 52 (1992): 453-7
Strayhorn VA, Baciewicz AM, Self TH "Update on rifampin drug interactions, III." Arch Intern Med 157 (1997): 2453-8
Daniels NJ, Dover JS, Schachter RK "Interaction between cyclosporin and rifampicin." Lancet 1 (1984): 639
Watkins PB "Drug metabolism by cytochromes P450 in the liver and small bowel." Gastroenterol Clin North Am 21 (1992): 511-26
Zylber-Katz E "Multiple drug interactions with cyclosporine in a heart transplant patient." Ann Pharmacother 29 (1995): 127-31
Langhoff E, Madsen S "Rapid metabolism of cyclosporin and prednisone in kidney transplant patient receiving tuberculostatic treatment." Lancet 2 (1983): 1031
Vandevelde C, Chang A, Andrews D, et al "Rifampin and ansamycin interaction with cyclosporine after renal transplantation." Pharmacotherapy 11 (1991): 88-9
Calne RY, White DJG, Thiru S, Rolles K, Drakopoulos S, Jamieson NV "Cyclosporin and antituberculous therapy." Lancet 1 (1985): 1342-3
Howard P, Bixler TJ, Gill B "Cyclosporine-rifampin drug interaction." Drug Intell Clin Pharm 19 (1985): 763-4
Cassidy MJ, Zyl-Smit RV, Pascoe MD, et al "Effect of rifampicin on cyclosporin A blood levels in a renal transplant recipient." Nephron 41 (1985): 207-8

IsonaRif

Generic Name: isoniazid / rifampin

Brand name: IsonaRif, Rifamate

Synonyms: n.a.

What is IsonaRif?

Neoral

Generic Name: cyclosporine

Brand name: Gengraf, Neoral, Sandimmune, Sandimmune

Synonyms: Neoral (Capsules, Modified)

What is Neoral?

+ Add a drug Remove all

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.

The list of popular interactions