Clonixin and Cyclosporine Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Cyclosporine Injection
Clonixin
No brand names on record
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.
What happens
An increased risk of cycloSPORINE nephrotoxicity
Interaction Deep Dive
Concomitant use of cycloSPORINE with an NSAID may potentiate renal dysfunction, especially in dehydrated patients. Pharmacodynamic interactions between cycloSPORINE and both naproxen and sulindac have been associated with worsening of renal function. Additionally, the AUC of diclofenac was increased significantly when it was coadministered with cycloSPORINE in patients with rheumatoid arthritis. Reversible declines in renal function have occasionally been reported with concomitant use of cycloSPORINE and diclofenac. Use caution when coadministering an NSAID with cycloSPORINE and closely monitor renal function, including serum creatinine. In patients with rheumatoid arthritis, monitoring of serum creatinine and blood pressure is recommended after initiation of a new NSAID or when an NSAID dose increase. Use lower doses of a NSAID, such as diclofenac, if concomitant administration with cycloSPORINE is necessary1. NSAIDs can affect renal prostaglandins, potentially increasing the risk of cycloSPORINE-related nephrotoxicity due to decreased synthesis of renal prostacyclin 2.
Why it happens (mechanism)
Reduced synthesis of renal prostacyclin
Literature reports
5 reports — tap to read
a) Intact renal prostacyclin synthesis is important in maintaining glomerular filtration rate and renal blood flow in patients treated with cycloSPORINE, and the use of cyclooxygenase inhibitors, such as NSAIDs, may enhance the toxic effects of cycloSPORINE 5. Interactions leading to renal impairment have been reported with a number of NSAIDs, including diclofenac, mefenamic acid, sulindac, and naproxen. It should be assumed that such interactions may occur with any combination of NSAID and cycloSPORINE 6785.
b) The effects of NSAIDs and cycloSPORINE administration on renal function were studied in 11 patients with rheumatoid arthritis 7. The combination resulted in more pronounced reductions in glomerular filtration rate and effective renal plasma flow than either drug alone, but this did not reach statistical significance. Similarly, in a study involving patients with rheumatoid arthritis stabilized on cycloSPORINE therapy, the coadministration of ketoprofen, indomethacin, or sulindac did not cause a clinically significant difference in the calculated creatinine clearance 9.
c) Concomitant administration of sulindac and cycloSPORINE resulted in elevations in cycloSPORINE serum levels in a 47-year-old renal transplant recipient 10. The trough cycloSPORINE serum levels increased from 525 nanograms/milliliter (ng/mL) to 1218 ng/mL following 3 days of oral sulindac 150 mg twice daily. The levels decreased following withdrawal of sulindac. Increased cycloSPORINE concentrations have also been reported following the use of mefenamic acid 8. Studies with diclofenac have not demonstrated an increase in cycloSPORINE concentrations, although the bioavailability of diclofenac was approximately doubled 6.
d) Ten healthy male volunteers were included in a placebo-controlled, randomized crossover study to determine how an imbalance in intrarenal prostaglandins plays a part in cycloSPORINE-induced nephrotoxicity. CycloSPORINE (10 mg/kg twice daily) for 4 days had no effect on glomerular filtration rate (GFR) and effective renal plasma flow (ERPF). However, when the same dose of cycloSPORINE was combined with indomethacin (50 mg twice daily), the GFR was decreased by 37% and the ERPF fell by 32%. Therefore, it appears that cycloSPORINE-induced renal vasoconstriction is influenced by prostaglandins 11.
e) The combination of cycloSPORINE and an NSAID resulted in colitis in an 8-year-old female with rheumatoid arthritis. During the third month of treatment with cycloSPORINE 7 mg/kg, prednisoLONE 15 mg daily, and indomethacin 75 mg daily, she experienced the onset of abdominal pain and 10 to 14 bloody stools per day. Discontinuing the cycloSPORINE resolved her symptoms within 5 days. She was rechallenged approximately 3 weeks later, and her symptoms again appeared within 4 days. Her cycloSPORINE blood level at this time was 100 nanograms/milliliter (ng/mL). Colonoscopy revealed a nonspecific colitis, and indomethacin was stopped, with a resolution of symptoms within a week. However, because of exacerbation of rheumatoid arthritis, diclofenac was substituted for indomethacin. Over the next week, she again developed bloody stools, and her cycloSPORINE level was 120 ng/mL. Her disease was finally controlled with cycloSPORINE, methotrexate, and prednisoLONE without the recurrence of colitis 12.
Common questions
Can I take Clonixin and Cyclosporine Injection together?
An increased risk of cycloSPORINE nephrotoxicity Always confirm with your pharmacist or prescriber before making any change.
How serious is the Clonixin and Cyclosporine Injection interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
Questions for your pharmacist
- Does my dose of Clonixin or Cyclosporine Injection 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 a safer alternative to one of these medications for me?
References (12)
- Product Information: SANDIMMUNE(R) oral capsules, oral solution, intravenous injection, cyclosporine oral capsules, oral solution, intravenous injection. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2023. DailyMed
- Product Information: Mobic(R) oral tablets, oral suspension, meloxicam oral tablets, oral suspension. Boehringer Ingelheim Pharmaceuticals, Inc. (per FDA), Ridgefield, CT, 2012.
- Product Information: Voltaren(R)-XR oral extended-release tablets, diclofenac sodium oral extended-release tablets. Novartis Pharmaceuticals Corporation, East Hanover, NJ, 2011. DailyMed
- Product Information: CLINORIL(R) oral tablets, sulindac oral tablets. Merck & CO. Inc. Whitehouse Station, NJ, 2010. DailyMed
- Harris KP, Jenkins D, & Walls J: Nonsteroidal antiinflammatory drugs and cyclosporine: a potentially serious adverse interaction. Transplantation 1988; 46:598-599. PubMed
- Kovarik JM, Kurki P, Mueller E, et al: Diclofenac combined with cyclosporine in treatment refractory rheumatoid arthritis: longitudinal safety assessment and evidence of a pharmacokinetic/dynamic interaction. J Rheumatol 1996; 23:2033-2038.
- Altman RD, Perez GO, & Sfakianakis GN: Interaction of cyclosporine A and nonsteroidal anti-inflammatory drugs on renal function in patients with rheumatoid arthritis. Am J Med 1992; 93:396-402. DOI
- Agar JW: Cyclosporine A and mefenamic acid in a renal transplant patient. Aust N Z J Med 1991; 21:784-785.
- Tugwell P, Ludwin D, Gent M, et al: Interaction between cyclosporin A and nonsteroidal antiinflammatory drugs. J Rheumatol 1997; 24:1122-1125.
- Sesin GP, O'Keefe E, & Roberto P: Sulindac-induced elevation of serum cyclosporine concentration. Clin Pharm 1989; 8(6):445-446.
- Sturrock NDC, Lang CC, & Struthers AD: Indomethacin and cyclosporin together produce marked renal vasoconstriction in humans. J Hypertens 1994; 12:919-924. DOI
- Constantopoulos A: Colitis induced by interaction of cyclosporine A and non-steroidal anti-inflammatory drugs. Pediatr Intl 1999; 41:184-186. PubMed
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