Amiodarone with Cyclosporine Interaction Details

Brand Names Associated with Amiodarone

Brand Names Associated with Cyclosporine

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Feb 27, 2024

Interaction Effect

Increased plasma levels of cycloSPORINE

Interaction Summary

The concomitant administration of amiodarone and cycloSPORINE may increase cycloSPORINE levels, leading to elevated creatinine levels despite reductions in the dose of cycloSPORINE[1]. Case reports of patients who were coadministered amiodarone and cycloSPORINE showed increased cycloSPORINE levels compared with baseline (cycloSPORINE administered alone) [2][3][4]. Monitor cycloSPORINE levels and renal function in patients concomitantly administered amiodarone and cycloSPORINE [1].

Severity

Moderate

Onset

Delayed

Evidence

Probable

How To Manage Interaction

The concomitant administration of amiodarone and cycloSPORINE may result in elevated plasma concentrations of cycloSPORINE, which may increase creatinine levels despite dose reductions of cycloSPORINE. Monitor cycloSPORINE levels and renal function in patients concomitantly administered amiodarone and cycloSPORINE[1].

Mechanism Of Interaction

Unknown

Literature Reports

A) A 66-year-old female kidney transplant patient experienced an increase in cycloSPORINE levels from 100 to 150 nanogram/mL (83.2 to 124.7 nanomol/L) to 265 ng/mL (220.4 nanomol/L) three days after the addition of amiodarone 1200 mg daily. CycloSPORINE dosage reduction from 500 mg daily to 360 mg daily resulted in therapeutic cycloSPORINE levels of 125 +/- 50 nanogram/mL (103.9 +/- 41.6 nanomol/L) [5].

B) CycloSPORINE clearance was reduced by 50% after concomitant use of amiodarone for 44 days in a 47-year-old male heart transplant patient. Upon the discontinuation of amiodarone, cycloSPORINE clearance rapidly returned to baseline [4].

C) Concomitant administration of amiodarone and cycloSPORINE to eight heart or heart-lung transplant patients resulted in increased cycloSPORINE levels over baseline [3].

D) Five patients who were receiving amiodarone prior to heart transplantation exhibited increased cycloSPORINE metabolism after the discontinuation of the antiarrhythmic therapy. Seven to 28 days following heart transplantation, total cycloSPORINE metabolites averaged 1210 nanogram/mL in patients previously treated with amiodarone compared to 650 nanogram/mL in patients who were not receiving amiodarone. In two of these patients, the increased cycloSPORINE metabolism lasted for more than five weeks [6].

References

1 ) Product Information: Cordarone(R) oral tablets, amiodarone HCl oral tablets. Wyeth Pharmaceuticals Inc (per FDA), Philadelphia, PA, 2016.

2 ) Chitwood K, Abdul-Haqq A, & Heim-Duthoy K: Cyclosporine-amiodarone interaction. Ann Pharmacother 1993; 27:569-571.

3 ) Mamprin F, Mullins P, Graham T, et al: Amiodarone-cyclosporine interaction in cardiac transplantation. Am Heart J 1992; 123:1725-1726.

4 ) Nicolau D, Uber W, Crumbley A III, et al: Amiodarone-cyclosporine interaction in a heart transplant patient. J Heart Lung Transplant 1992; 11:564-568.

5 ) Chitwood K, Abdul-Haqq A, & Heim-Duthoy K: Cyclosporine- amiodarone interaction. Ann Pharmacother 1993; 27:569-571.

6 ) Preuner JG, Lehle K, Keyser A, et al: Development of severe adverse effects after discontinuing amiodarone therapy in human heart transplant recipients. Transplant Proc 1998; 30:3943-3944.

Amiodarone Overview

• Amiodarone is used to treat and prevent certain types of serious, life-threatening ventricular arrhythmias (a certain type of abnormal heart rhythm when other medications did not help or could not be tolerated. Amiodarone is in a class of medications called antiarrhythmics. It works by relaxing overactive heart muscles.

Cyclosporine Overview

• Cyclosporine and cyclosporine (modified) are used with other medications to prevent transplant rejection (attack of the transplanted organ by the immune system of the person who received the organ) in people who have received kidney, liver, and heart transplants. Cyclosporine (modified) is also used alone or with methotrexate (Rheumatrex) to treat the symptoms of rheumatoid arthritis (arthritis caused by swelling of the lining of the joints) in patients whose symptoms were not relieved by methotrexate alone. Cyclosporine (modified) is also used to treat psoriasis (a skin disease in which red, scaly patches form on some areas of the body) in certain patients who have not been helped by other treatments. Cyclosporine and cyclosporine (modified) are in a class of medications called immunosuppressants. They work by decreasing the activity of the immune system.

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Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.