Omeprazole and Cyclosporine: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Cyclosporine
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.
You've been prescribed cyclosporine (a medicine that calms your immune system) along with omeprazole (a common stomach acid reducer). When these are taken together, your cyclosporine level in the blood can shift. It might go up or down, and honestly the studies don't all agree on which way it goes for any one person.
Cyclosporine is a drug where the right amount really matters, so even a small change is worth watching. The good news is this is easy to handle. Your care team can check your cyclosporine blood levels and fine-tune your dose if needed. Keep taking both as prescribed, and just let your pharmacist or doctor know you're on both.
Effect: Variable, unpredictable changes in cycloSPORINE concentrations, plus increased omeprazole exposure.
Mechanism: Altered cycloSPORINE metabolism; cycloSPORINE (a CYP3A4 inhibitor) can reduce CYP3A-mediated clearance of omeprazole, raising omeprazole exposure. Neither is a prodrug requiring activation here.
Direction/magnitude: Inconsistent. Controlled studies show no significant change or increased cycloSPORINE levels; case reports describe both increases and decreases.
- Onset: Delayed
- Evidence: Theoretical
- NTI drug: CycloSPORINE, so small shifts matter
Management: Monitor cycloSPORINE trough levels and adjust dose as clinically indicated; watch renal function.
What happens
Altered cycloSPORINE concentrations and increased omeprazole exposure
Interaction Deep Dive
When omeprazole is given alongside cycloSPORINE, patients should be monitored to assess whether a cycloSPORINE dose adjustment is warranted1. It remains uncertain how omeprazole influences cycloSPORINE concentrations. In controlled studies, findings have included either no meaningful changes6 or elevated cycloSPORINE serum concentrations7. Case reports have documented cycloSPORINE levels that were both raised and lowered45.
Why it happens (mechanism)
Altered cycloSPORINE metabolism; inhibition of CYP3A-mediated metabolism of omeprazole
How to manage this interaction
This interaction is manageable with monitoring. Here's what typically happens:
- Your care team may check your cyclosporine blood levels more closely after starting, stopping, or changing your omeprazole.
- Your cyclosporine dose may be adjusted and individualized based on those levels.
What you should do:
- Keep taking both medications exactly as prescribed unless your doctor tells you otherwise.
- Tell your pharmacist and prescriber you take both so they can plan any level checks.
- Report anything unusual, such as changes in urination, swelling, tremor, or feeling unwell.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
4 reports — tap to read
a) Reports have described interactions between cycloSPORINE and omeprazole; monitoring of patients along with appropriate dose adjustments is advised 2. Omeprazole can enhance the metabolism of cycloSPORINE, resulting in lower cycloSPORINE blood concentrations 3.
b) In one patient, whole-blood cycloSPORINE concentrations rose considerably (roughly doubling) when omeprazole was administered at the same time 4. The cycloSPORINE levels had been stable for 6 months before omeprazole was started; after the cycloSPORINE dose was lowered, the cycloSPORINE levels came back to the normal range and stayed within that range over 4 months of concurrent treatment.
c) A bone marrow transplant patient had decreased cycloSPORINE serum concentrations (falling from 254 ng/mL to 81 ng/mL) when omeprazole IV 40 mg/day was added to cycloSPORINE 5. After omeprazole was stopped, cycloSPORINE levels rose back to 270 ng/mL.
d) CycloSPORINE serum concentrations were assessed in a crossover, placebo-controlled study of 10 stable renal transplant patients 6. The mean whole blood trough concentrations of cycloSPORINE were 102 mcg/L during concurrent omeprazole administration (20 mg/day) versus 100 mcg/L with placebo. Serum level changes below 30% were regarded as too small to be clinically significant, and the differences in this study were less than 30%. Even though both drugs undergo hepatic metabolism via the cytochrome P450 system, it was proposed that cycloSPORINE is largely metabolized by the P4503A4 enzyme while omeprazole is metabolized by the P4502C18 enzyme, so competitive inhibition may not play a role.
Common questions
Can I take Omeprazole and Cyclosporine together?
Taking omeprazole with cyclosporine can shift your cyclosporine levels up or down, so your care team may check blood levels and adjust the dose. Keep taking both as prescribed and let your pharmacist or doctor know you're on both. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Omeprazole 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 is the Omeprazole and Cyclosporine interaction managed?
This interaction is manageable with monitoring. Here's what typically happens: Your care team may check your cyclosporine blood levels more closely after starting, stopping, or changing your omeprazole. Your cyclosporine dose may be adjusted and individualized based on those levels. What you should do: Keep taking both medications exactly as prescribed unless your doctor tells you otherwise. Tell… Management is individual — always follow your own care team's guidance.
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 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)
- Product Information: KONVOMEP(TM) powder for oral suspension, omeprazole sodium bicarbonate powder for oral suspension. Azurity Pharmaceuticals Inc (per manufacturer), Woburn, MA, 2022. DailyMed
- Product Information: Prilosec(R), omeprazole delayed release capsules. AstraZeneca LP, Wilmington, DE, 2003. 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
Keep reading about Omeprazole
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