Drug Interaction Report

Neratinib and Cyclosporine Ophthalmic: Interaction Details

A pharmacist-reviewed analysis of the Neratinib and Cyclosporine Ophthalmic 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 Ophthalmic

Cequa Cequa® Restasis® Vevye
+

Neratinib

Nerlynx Nerlynx®
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 157 documented Neratinib interactions, 139 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
unspecified
Evidence
probable
Severity
Major

What happens

Increased neratinib exposure, an increased risk of neratinib toxicity and an increased cycloSPORINE exposure

Interaction Deep Dive

Avoid concomitant use of neratinib (a CYP3A4 substrate) with cycloSPORINE (a dual moderate CYP3A4 and P-gp inhibitor) due to increases in neratinib exposure and risk of toxicity. Simulations using physiologically based pharmacokinetic models suggested that concomitant use of a moderate CYP3A4 and P-gp dual inhibitor (verapamil) with neratinib may increase neratinib Cmax by 203% and AUC by 299%3. Also, coadministration of cycloSPORINE (a P-gp substrate) with neratinib (a P-gp inhibitor) may increase the concentrations of cycloSPORINE. Adjust cycloSPORINE dosage to achieve the desired cycloSPORINE concentrations when these drugs are administered concomitantly 12.

Why it happens (mechanism)

Inhibition of CYP3A4-mediated metabolism of neratinib; inhibition of P-gp-mediated efflux transport of cycloSPORINE

Literature reports

1 report — tap to read

a) Simulations using physiologically based pharmacokinetic models suggested that concomitant use of a moderate CYP3A4 and P-gp dual inhibitor (verapamil) with neratinib may increase neratinib Cmax by 203% and AUC by 299% 3.

Common questions

Can I take Neratinib and Cyclosporine Ophthalmic together?

Increased neratinib exposure, an increased risk of neratinib toxicity and an increased cycloSPORINE exposure Always confirm with your pharmacist or prescriber before making any change.

How serious is the Neratinib and Cyclosporine Ophthalmic interaction?

It is rated major. Potentially serious — often needs a change or close monitoring.

How quickly could this interaction happen?

The documented onset is "unspecified". The timing of this interaction is not well characterized.

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 Neratinib or Cyclosporine Ophthalmic 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 (3)

  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. Product Information: NERLYNX(R) oral tablets, neratinib oral tablets. Puma Biotechnology Inc (per manufacturer), Los Angeles, CA, 2020. DailyMed
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Cyclosporine Ophthalmic

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All Cyclosporine Ophthalmic interactions (545) Cyclosporine Ophthalmic drug information
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Neratinib

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All Neratinib interactions (157) Neratinib drug information
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