Drug Interaction Report

Gentamicin and Cyclosporine Injection: Interaction Details

A pharmacist-reviewed analysis of the Gentamicin and Cyclosporine Injection interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Cyclosporine Injection

Atopica Cequa Cyclavance Gengraf Modulis Neoral Optimmune Restasis
+

Gentamicin

No brand names on record
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
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Interaction severity
Major
Potentially serious — often needs a change or close monitoring.
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.

Of 19 documented Gentamicin interactions, 11 are rated major — including this one.
Worried about symptoms right now? Contact your pharmacist or prescriber, or call Poison Control at 1-800-222-1222 (US). Call 911 for an emergency.
Onset
delayed
Evidence
probable
Severity
Major

What happens

An increased risk of nephrotoxicity and increased risk of renal dysfunction

Interaction Deep Dive

Use caution when using cycloSPORINE with other drugs which are known to impair renal function like gentamicin. During the concomitant use of a drug that may exhibit additive or synergistic renal impairment with cycloSPORINE, close monitoring of renal function (serum creatinine) should be performed. If a significant impairment of renal function occurs, reduce the dosage of the cycloSPORINE and/or coadministered drug or consider an alternative treatment12. The concurrent use of aminoglycosides and cycloSPORINE in renal transplant patients has resulted in decreased renal function (ie, decreased fractional sodium excretion and a decline in diuresis) and increased toxicity (tubular necrosis) 95.

Why it happens (mechanism)

Additive nephrotoxic effects; additive or synergistic renal impairment

Literature reports

3 reports — tap to read

a) CycloSPORINE does not seem to directly affect the pharmacology of aminoglycosides. However, using the two agents together may be more nephrotoxic than either one used alone 345. Two retrospective studies did not find increased nephrotoxicity when cycloSPORINE was used with aminoglycosides 67.

b) There are no data to demonstrate that cycloSPORINE has a direct effect on the pharmacokinetics of aminoglycosides. CycloSPORINE does not appear to interfere with the aminoglycoside assay in the laboratory. The physical and pharmacokinetic properties of the two drugs are completely different. CycloSPORINE, a very lipophilic drug, undergoes extensive hepatic metabolism with only 6% of the drug excreted renally 8.

c) Two retrospective studies have not found additive nephrotoxicity when aminoglycosides are used concomitantly with cycloSPORINE. One studied records of 26 children who were treated with an aminoglycoside and cycloSPORINE after liver transplantation 6. Another analyzed records of allogenic and autologous bone marrow transplant patients who received cycloSPORINE plus an aminoglycoside and only an aminoglycoside, respectively 7.

Common questions

Can I take Gentamicin and Cyclosporine Injection together?

An increased risk of nephrotoxicity and increased risk of renal dysfunction Always confirm with your pharmacist or prescriber before making any change.

How serious is the Gentamicin 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 "probable". Good supporting evidence, though not definitively proven.

Questions for your pharmacist

  • Does my dose of Gentamicin 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 (9)

  1. Product Information: NEORAL(R) oral soft gelatin capsules oral solution, cyclosporine modified oral soft gelatin capsules oral solution. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2023. DailyMed
  2. 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
  3. Hows JM, Chipping PM, Fairhead S, et al: Nephrotoxicity in bone marrow transplant recipients treated with cyclosporine A. Br J Haematol 1983; 54:69-78.
  4. Keown PA, Stiller CR, Wallace AC, et al: Cyclosporine nephrotoxicity: exploration of the risk factors and prognosis of the renal injury. Transplant Proc 1985; 17:247-253.
  5. Termeer A, Hoitsma AJ, & Koene RAP: Severe nephrotoxicity caused by the combined use of gentamicin and cyclosporine in renal allograft recipients. Transplantation 1986; 42:220-221.
  6. Leach CT, Kuhls TL, Brill JE, et al: Use of aminoglycosides during cyclosporine A immunosuppression after liver transplantation in children. Pediatr Infect Dis J 1989; 8:354-357. PubMed
  7. Chandrasekar PH & Cronin SM: Nephrotoxicity in bone marrow transplant recipients receiving aminoglycoside plus cyclosporine or aminoglycoside alone. J Antimicrob Chemother 1991; 27:845-849.
  8. Ptachinski RJ, Venkataramanan R, & Burckart GJ: Clinical pharmacokinetics of cyclosporine. Clin Pharmacokinet 1986; 11:107-132. PubMed
  9. Morales JM, Andres A, Prieto C, et al: Reversible acute renal toxicity by toxic sinergic effect between gentamicin and cyclosporine (letter). Clin Nephrol 1988; 29:272.
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