Amlodipine with Cyclosporine Interaction Details

Brand Names Associated with Amlodipine

Brand Names Associated with Cyclosporine

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Mar 03, 2024

Interaction Effect

An increased risk of cycloSPORINE toxicity (renal dysfunction, cholestasis, paresthesias)

Interaction Summary

Systemic exposure of cycloSPORINE may be increased when coadministered with amlodipine. In a prospective study of 11 patients undergoing renal transplant and treated with amlodipine and cycloSPORINE concomitantly, trough cycloSPORINE concentrations increased by an average of 40%[1][2]. Monitor trough cycloSPORINE concentrations frequently after starting amlodipine therapy and adjust the cycloSPORINE dosage if appropriate [1].

Severity

Major

Onset

Delayed

Evidence

Theoretical

How To Manage Interaction

Concomitant use of amlodipine and cycloSPORINE may result in increased cycloSPORINE concentrations. Monitor trough cycloSPORINE concentrations frequently after starting amlodipine therapy and adjust the cycloSPORINE dosage if appropriate[1].

Mechanism Of Interaction

Inhibition of cycloSPORINE metabolism by amlodipine

Literature Reports

A) A retrospective analysis involving 19 renal transplant patients showed that amlodipine increases the cycloSPORINE concentration by approximately 25%. All patients were stabilized on cycloSPORINE, azathioprine, and prednisone prior to amlodipine therapy. The mean 12-hour cycloSPORINE concentration prior to amlodipine was 136 mcg/mL (113 mcmol/L), and four weeks after amlodipine 5 mg daily was started, cycloSPORINE levels averaged 170 mcg/mL (141 mcmol/L). Four patients had their cycloSPORINE dose reduced, but no patients experienced an increase in plasma creatinine or showed evidence of cycloSPORINE toxicity. Two other studies found that amlodipine increases the cycloSPORINE levels by 23% and 40%, while one study showed no change in cycloSPORINE pharmacokinetics during amlodipine therapy [3].

References

1 ) Product Information: EXFORGE oral tablets, amlodipine valsartan oral tablets. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2019.

2 ) Product Information: CADUET(R) oral tablets, amlodipine besylate atorvastatin calcium oral tablets. Pfizer Labs (per FDA), New York, NY, 2015.

3 ) McGregor DO, Bailey RR, & Robson RA: Amlodipine has a minor effect on cyclosporine metabolism (letter). Clin Nephrol 1997; 48:336.

Amlodipine Overview

• Amlodipine is used alone or in combination with other medications to treat high blood pressure in adults and children 6 years and older. It is also used to treat certain types of angina (chest pain) and coronary artery disease (narrowing of the blood vessels that supply blood to the heart). Amlodipine is in a class of medications called calcium channel blockers. It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. It controls chest pain by increasing the supply of blood to the heart. If taken regularly, amlodipine controls chest pain, but it does not stop chest pain once it starts. Your doctor may prescribe a different medication to take when you have chest pain.

• High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

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.