Miconazole and Cyclosporine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Cyclosporine
Miconazole
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
Administration of cycloSPORINE with miconazole1, ketoconazole, fluconazole, or itraconazole 234 has been reported to increase cycloSPORINE blood levels, resulting in increased toxicity. The mechanism of this interaction is not known, but it may be due to decreased metabolism or increased absorption of cycloSPORINE. The severity of the increase in cycloSPORINE blood levels is variable, yielding dramatically increased levels in some patients with only minimal increases in others.
Why it happens (mechanism)
Decreased cycloSPORINE metabolism
Common questions
Can I take Miconazole and Cyclosporine 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 Miconazole 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 strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Miconazole 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 (4)
- Horton CM, Freeman CD, Nolan PE, et al: Cyclosporine interactions with miconazole and other azole-antimycotics: a case report and review of the literature. J Heart Lung Transplant 1992; 11:1127-1132.
- Yee GC & McGuire TR: Pharmacokinetic drug interactions with cyclosporin (Part I). Clin Pharmacokinet 1990; 19:319-332.
- Kramer MR, Marshall SE, Denning DW, et al: Cyclosporine and itraconazole interaction in heart and lung transplant recipients. Ann Intern Med 1990; 113:327-329. PubMed
- Frey FJ: Concomitant cyclosporin and ketoconazole (letter). Lancet 1990; 335:109-110. PubMed
Keep reading about Cyclosporine
Keep reading about Miconazole
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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