Omeprazole and Cyclosporine Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Cyclosporine Injection
Omeprazole
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
Altered cycloSPORINE exposure and an increased omeprazole exposure
Interaction Deep Dive
Coadministration of omeprazole and cycloSPORINE (CYP3A inhibitor) may increase omeprazole exposure and may also alter cycloSPORINE exposure. Monitor patients to determine if it is necessary to adjust the dosage of cycloSPORINE when taken concomitantly with omeprazole1. The effect of omeprazole on cycloSPORINE concentrations is unclear. Controlled studies have reported no significant alterations 5 or increased cycloSPORINE serum concentrations 6. In case reports, both increased and decreased cycloSPORINE levels have been found 34.
Why it happens (mechanism)
Altered cycloSPORINE metabolism; inhibition of CYP3A-mediated metabolism of omeprazole
Literature reports
4 reports — tap to read
a) Clinical reports of interactions between omeprazole and other drugs metabolized by the cytochrome P450 system have been reported 1. Omeprazole may increase the metabolism of cycloSPORINE, causing decreased cycloSPORINE blood levels 2.
b) Whole-blood cycloSPORINE concentrations became substantially elevated in a patient (approximately doubled) when omeprazole was given concurrently. CycloSPORINE levels had remained constant for 6 months prior to omeprazole therapy; following a reduction in cycloSPORINE dose, the cycloSPORINE levels returned to normal range, and remained in that range through 4 months of concurrent therapy 3.
c) A bone marrow transplant patient experienced reduced cycloSPORINE serum concentrations (from 254 ng/mL to 81 ng/mL) when omeprazole IV 40 mg/day was added to cycloSPORINE. Following withdrawal of omeprazole, cycloSPORINE levels returned to 270 ng/mL 4.
d) CycloSPORINE serum concentrations were analyzed in a crossover, placebo-controlled study involving 10 stable renal transplant patients. Mean whole blood trough concentrations of cycloSPORINE were 102 mcg/L during concurrent omeprazole use (20 mg/day) compared with 100 mcg/L when placebo was used. Changes in serum levels of less than 30% were considered insufficient to achieve clinical significance and differences were less than 30% in this study. Although both drugs are metabolized in the liver by the cytochrome P450 system, it was suggested that cycloSPORINE is metabolized substantially by the CYP3A4 enzyme and omeprazole by the CYP2C8 enzyme, so competitive inhibition may not be a factor 5.
Common questions
Can I take Omeprazole and Cyclosporine Injection together?
Altered cycloSPORINE exposure and an increased omeprazole exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Omeprazole 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 "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Omeprazole 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 (6)
- Product Information: KONVOMEP(TM) powder for oral suspension, omeprazole sodium bicarbonate powder for oral suspension. Azurity Pharmaceuticals Inc (per manufacturer), Woburn, MA, 2022. DailyMed
- Lake KD: Management of drug interactions with cyclosporine. Pharmacotherapy 1991; 11:110S-118S. DOI
- Schouler L, Dumas F, & Couzigou P: Omeprazole-cyclosporin interaction. Am J Gastroenterol 1991; 86:1097.
- Arranz R, Yanez E, Franceschi JL, et al: More about omeprazole-cyclosporine interaction. Am J Gastroenterol 1993; 88:154.
- Blohme I, Idstrom JP, & Andersson T: A study of the interaction between omeprazole and cyclosporine in renal transplant patients. Br J Clin Pharmacol 1993; 35:156-160.
- Reichenspurner H, Meiser BM, Muschiol F, et al: The influence of gastrointestinal agents on resorption and metabolism of cyclosporine after heart transplantation: experimental and clinical results. J Heart Lung Transplant 1993; 12:987-992.
Keep reading about Cyclosporine Injection
Keep reading about Omeprazole
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