Dirithromycin 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
Dirithromycin
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 toxicity (renal dysfunction, cholestasis, paresthesias)
Interaction Deep Dive
Concurrent use of dirithromycin and cycloSPORINE may result in increased serum concentrations of cycloSPORINE and associated cycloSPORINE toxicity (renal dysfunction, cholestasis, paresthesias)1.
Why it happens (mechanism)
Inhibition by dirithromycin of cycloSPORINE metabolism
Literature reports
1 report — tap to read
a) In one study, eight healthy men received cycloSPORINE 5 mg/kg orally in three single doses before a 14-day regimen of oral dirithromycin (500 mg daily), at the end of the fourteen days, and two weeks after ceasing the dirithromycin. While not statistically significant, mean apparent clearance of cycloSPORINE increased 15% during treatment compared with the pre-treatment phase, and 12% compared with the post-treatment phase 1. In contrast, erythromycin decreased cycloSPORINE clearance by 51% and increased the AUC by 122% 2. In addition to healthy volunteers, cycloSPORINE was given chronically to fifteen stable kidney transplant patients. CycloSPORINE plasma levels were determined before, at the end, and two weeks after discontinuation of a fourteen day course of oral dirithromycin 500 mg daily. The addition of dirithromycin produced a statistically significant increase of 16.3% in the average steady state cycloSPORINE concentration. The authors were unable to determine why the clearance of cycloSPORINE differed between kidney transplant patients and healthy volunteers. Until this issue is resolved, dirithromycin should be used with caution in patients on cycloSPORINE 1.
Common questions
Can I take Dirithromycin and Cyclosporine Injection together?
An increased risk of cycloSPORINE toxicity (renal dysfunction, cholestasis, paresthesias) Always confirm with your pharmacist or prescriber before making any change.
How serious is the Dirithromycin and Cyclosporine Injection 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 strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Dirithromycin 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 anything you'd monitor while I'm on both?
References (2)
- Bachmann K, Sullivan TJ, Reese JH, et al: The influence of dirithromycin on the pharmacokinetics of cyclosporine in healthy subjects and in renal transplant patients. Am J Ther 1995; 2:490-498. PubMed
- Freeman DJ, Martell R, Carruthers SG, et al: Cyclosporin-erythromycin interaction in normal subjects. Br J Clin Pharmacol 1987; 23:776-778.
Keep reading about Cyclosporine Injection
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