Clindamycin and Cyclosporine: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 1, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Cyclosporine
Clindamycin
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Let's talk about taking cyclosporine and clindamycin together. Cyclosporine is an important medicine that helps keep your immune system calm, often after a transplant. It works best when the amount in your blood stays in a certain range.
When clindamycin (an antibiotic) is added, the amount of cyclosporine in your blood can drop lower than it should. If it falls too low, your cyclosporine may not protect you the way it needs to. The good news is that this is very manageable. Your care team can check your cyclosporine blood levels and adjust your dose while you are on the antibiotic. Please don't change anything on your own, just keep taking both as prescribed and let your team know.
Effect: Concurrent clindamycin reduces cycloSPORINE bioavailability, lowering blood concentrations and risking subtherapeutic exposure (loss of immunosuppression).
- Direction: Reduced cycloSPORINE effect. Neither agent is affected as a prodrug here; the concern is falling trough levels.
- Mechanism: Unknown.
- Evidence: Probable, based on two lung transplant case reports where cycloSPORINE doses required substantial increases (one nearly doubled, another from 325 mg to 1100 mg daily) to maintain target troughs; levels normalized on clindamycin discontinuation.
- Onset: Delayed.
- Management: Monitor cycloSPORINE trough concentrations closely. Dose may need upward titration during co-therapy and reduction when clindamycin is stopped. Narrow therapeutic index warrants vigilance.
What happens
Decreased cycloSPORINE bioavailability
Interaction Deep Dive
A marked decline in cycloSPORINE blood levels occurred in two lung transplant patients on cycloSPORINE when clindamycin was introduced to their regimens. In the first case, a 48-year-old woman was being maintained on cycloSPORINE with a target range of 100 mcg/L to 150 mcg/L. When oral clindamycin 600 mg three times daily was initiated to treat a bronchopulmonary infection, her cycloSPORINE concentrations dropped below the target despite the cycloSPORINE dose being nearly doubled. Once clindamycin was stopped, the cycloSPORINE dose was reduced back to its earlier level. The second case involved a 39-year-old woman with cystic fibrosis who developed bilateral pneumonia. She was given oral clindamycin 600 mg three times daily, and across four weeks her cycloSPORINE dose required escalation from 325 mg daily to 1100 mg daily in order to keep a serum concentration near 200 mcg/L. Following discontinuation of clindamycin, her cycloSPORINE dose was brought back down to 325 mg daily1.
Why it happens (mechanism)
Unknown
How to manage this interaction
This interaction is manageable with monitoring. Here is what typically happens and what you can do:
- Your team will monitor closely. Expect more frequent cyclosporine blood level checks while you are on clindamycin.
- Your dose may be adjusted. Your cyclosporine dose may need to be increased during the antibiotic course, then lowered again once clindamycin is finished. This is individualized by your care team.
- Keep taking both as prescribed. Do not start, stop, or change either medicine on your own.
- Speak up. Tell your pharmacist or prescriber that you take both, and report any new symptoms.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Clindamycin and Cyclosporine together?
Adding clindamycin can lower your cyclosporine blood levels and weaken its effect, so your care team will monitor your levels and may raise your cyclosporine dose while you are on the antibiotic. Keep taking both as prescribed and don't adjust anything yourself. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Clindamycin and Cyclosporine interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How is the Clindamycin and Cyclosporine interaction managed?
This interaction is manageable with monitoring. Here is what typically happens and what you can do: Your team will monitor closely. Expect more frequent cyclosporine blood level checks while you are on clindamycin. Your dose may be adjusted. Your cyclosporine dose may need to be increased during the antibiotic course, then lowered again once clindamycin is finished. This is individualized by your… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Clindamycin or Cyclosporine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there anything you'd monitor while I'm on both?
References (1)
- Thurnheer R, Laube I, & Speich R: Possible interaction between clindamycin and cyclosporin (letter). Br Med J 1999; 319:163.
Keep reading about Cyclosporine
Keep reading about Clindamycin
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