Methylprednisolone with Cyclosporine Interaction Details
Brand Names Associated with Methylprednisolone
- Medrol®
- Methylprednisolone
Brand Names Associated with Cyclosporine
- Cyclosporine
- Gengraf®
- Neoral®
- Sandimmune® Capsules
- Sandimmune® Oral Solution
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 03, 2023
Interaction Effect
CycloSPORINE toxicity and steroid excess
Interaction Summary
Concomitant administration of methylPREDNISolone and cycloSPORINE has resulted in mutual inhibition of metabolism, thus resulting in increased plasma levels for both drugs. Symptoms of corticosteroid excess have been observed with both methylPREDNISolone and prednisolone. Concurrent use of cycloSPORINE, methylPREDNISolone, and ketoconazole has resulted in grand mal seizures and convulsions.
Severity
Moderate
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Monitor cycloSPORINE levels and adjust cycloSPORINE dosage as necessary. Monitor patients for increased cycloSPORINE toxicity (renal dysfunction, neurotoxicity). Also, monitor patients for corticosteroid excess and adjust methylPREDNISolone dosage as necessary.
Mechanism Of Interaction
Mutual inhibition of metabolism
Literature Reports
A) Three consecutive patients being treated for severe aplastic anemia with cycloSPORINE and high-dose methylPREDNISolone developed grand mal seizures when ketoconazole was added to therapy. Doses which induced the seizures were cycloSPORINE 400 mg/day in divided doses (1 patient received 200 mg/day), methylPREDNISolone 60 mg/day, and ketoconazole 200 mg/day. Ketoconazole was added in order to elevate cycloSPORINE serum levels and to prevent fungal infection. In all cases, the seizures were preceded by nausea, vomiting, dizziness, headache, and hypertension. All patients were able to resume this 3-drug combination when cycloSPORINE was reduced to 100 mg/day. Ketoconazole and methylPREDNISolone may synergistically inhibit the metabolism of cycloSPORINE by the cytochrome P450 system. Clinicians are advised to avoid giving ketoconazole or methylPREDNISolone concomitantly with cycloSPORINE. If ketoconazole is needed, the cycloSPORINE dose should be reduced with monitoring of cycloSPORINE concentrations and hepatic function .
B) Administration of cycloSPORINE with high-dose methylPREDNISolone may predispose patients to seizures; however, the clinical significance of this observation has not been determined .
Methylprednisolone Overview
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Methylprednisolone, a corticosteroid, is similar to a natural hormone produced by your adrenal glands. It is often used to replace this chemical when your body does not make enough of it. It relieves inflammation (swelling, heat, redness, and pain) and is used to treat certain forms of arthritis; skin, blood, kidney, eye, thyroid, and intestinal disorders (e.g., colitis); severe allergies; and asthma. Methylprednisolone is also used to treat certain types of cancer.
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This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.
Cyclosporine Overview
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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:
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.