Netilmicin and Cyclosporine Ophthalmic: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Cyclosporine Ophthalmic
Netilmicin
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
Renal dysfunction or nephrotoxicity
Interaction Deep Dive
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)73.
Why it happens (mechanism)
Additive toxicity
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 123. However, two retrospective studies did not find increased nephrotoxicity when cycloSPORINE was used with aminoglycosides 45.
b) There are no data that demonstrate 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 6. Thus, it does not directly influence the renal clearance of aminoglycosides.
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 4. Another analyzed records of allogenic and autologous bone marrow transplant patients who received cycloSPORINE plus an aminoglycoside and only an aminoglycoside, respectively 5. Both studies indicate that the combination of drugs appears to be safe if the blood levels of cycloSPORINE and the aminoglycoside are monitored carefully.
Common questions
Can I take Netilmicin and Cyclosporine Ophthalmic together?
Renal dysfunction or nephrotoxicity Always confirm with your pharmacist or prescriber before making any change.
How serious is the Netilmicin and Cyclosporine Ophthalmic 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 Netilmicin 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 anything you'd monitor while I'm on both?
References (7)
- 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.
- 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.
- 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.
- 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
- Chandrasekar PH & Cronin SM: Nephrotoxicity in bone marrow transplant recipients receiving aminoglycoside plus cyclosporine or aminoglycoside alone. J Antimicrob Chemother 1991; 27:845-849.
- Ptachinski RJ, Venkataramanan R, & Burckart GJ: Clinical pharmacokinetics of cyclosporine. Clin Pharmacokinet 1986; 11:107-132. DOI
- 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.
Keep reading about Cyclosporine Ophthalmic
Keep reading about Netilmicin
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