Oxycodone and Cyclosporine Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Oxycodone
Cyclosporine Injection
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
Increased oxyCODONE exposure
Interaction Deep Dive
Concomitant use of oxyCODONE with a CYP3A4 inhibitor can increase the plasma concentrations of oxyCODONE, resulting in increased or prolonged opioid effects. These effects could be more pronounced when an inhibitor is added after a stable dose of oxyCODONE is achieved. If concomitant use with a CYP3A4 inhibitor is clinically required, monitor patients frequently for signs of sedation or respiratory depression and consider dosage reduction of oxyCODONE until stable plasma concentrations are achieved. If the inhibitor is discontinued, monitor for signs of opioid withdrawal and consider increasing the oxyCODONE dosage until stable drug effects are achieved1234. A published study showed that the coadministration of voriconazole, increased oxyCODONE AUC and Cmax by 3.6 and 1.7 fold respectively 4. OxyCODONE AUC and Cmax values increased by 170% and 100%, respectively, when added to the CYP3A4 inhibitor, ketoconazole at 400 mg/day 3.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated oxyCODONE metabolism
Literature reports
4 reports — tap to read
a) Voriconazole significantly increased oxyCODONE plasma concentrations and decreased clearance according to a randomized, placebo-controlled, crossover study in 12 healthy volunteers. Adults (age range, 19 to 25 years) were randomized to either placebo (control phase) or to voriconazole (400 mg orally twice daily on day 1, followed by 200 mg orally every 12 hours for 5 more doses). On day 3, all subjects received a single oral dose of oxyCODONE 10 mg. The washout interval between the phases was 4 weeks. During the voriconazole phase, compared to placebo, there was a mean 3.6-fold (range 2.7- to 5.6-fold, p less than 0.001) increase in oxyCODONE AUC, a mean 1.7-fold (range 1.4- to 2.2-fold, p less than 0.001) increase in oxyCODONE Cmax, and a mean 2-fold (range 1.4- to 2.5-fold, p less than 0.001) increase in oxyCODONE half-life. Compared with placebo, concomitant administration of voriconazole decreased the clearance/bioavailability ratio of oxyCODONE by 71% (p less than 0.001). The oxyCODONE metabolite-to-parent drug AUC ratio was increased by 88% for oxyMORphone (p less than 0.01) and decreased by 92% for noroxyCODONE (p less than 0.001). Compared to placebo, voriconazole increased oxyCODONE-induced miosis (p less than 0.001); however, analgesic effects were not altered 5.
b) OxyCODONE AUC and Cmax values increased by 170% and 100%, respectively, when added to the CYP3A4 inhibitor, ketoconazole at 400 mg/day 3.
c) A published study showed that the coadministration of voriconazole (a CYP3A4 inhibitor), increased oxyCODONE AUC and Cmax by 3.6 and 1.7 fold respectively 4.
d) Concomitant use of aprepitant, a moderate CYP3A4 inhibitor, and oxyCODONE resulted in respiratory depression in a 72-year-old man admitted to the hospital for pain control after being stable on transdermal fentaNYL 37.5 mcg/hr and rapid-release oxyCODONE as rescue medication for perianal pain associated with rectal invasion of prostate cancer. After admission, the pain medication was switched to oxyCODONE 48 mg/day continuous infusion plus bolus of 1 hour quantity as a rescue dose and was increased appropriately over 42 days to 108 mg/day before pain decreased enough to begin chemotherapy. Antiemetics (dexAMETHasone [9.9 mg], palonosetron [0.75 mg], and fosaprepitant [150 mg]) were administered. Approximately 3 hours after administration of antiemetics and before the administration of chemotherapy, oversedation and respiratory depression was noted (6 breaths/minute). He responded to verbal stimuli and was able to communicate. Chemotherapy was administered as planned. Two hours later, the oxyCODONE infusion was decreased to 48 mg/day. Drowsiness persisted but respiratory depression improved. The next morning, the patient was able to communicate, was drowsy, but breathing was stable, and his pain was controlled on oxyCODONE 48 mg/day. The next 2 days dexAMETHasone was the only antiemetic administered with no further respiratory depression. Estimated glomerular filtrate rate was 35 to 40 mL/min; no other comorbidities were noted 6.
Common questions
Can I take Oxycodone and Cyclosporine Injection together?
Increased oxyCODONE exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Oxycodone 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 "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.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Oxycodone 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: Oxycodone HCl oral solution, oxycodone HCl oral solution. Genus Lifesciences (per FDA), Allentown, PA, 2023. DailyMed
- Product Information: Oxycodone HCl oral capsules, oxycodone HCl oral capsules. Genus Lifesciences (per FDA), Allentown, PA, 2023. DailyMed
- Product Information: OXYCONTIN(R) oral extended-release tablets, oxycodone HCl oral extended-release tablets. Purdue Pharma LP (per FDA), Stamford, CT, 2023. DailyMed
- Product Information: PERCODAN(R) oral tablets, oxycodone aspirin oral tablets. Endo Pharmaceuticals Inc. (per FDA), Malvern, PA, 2023.
- Hagelberg NM, Nieminen TH, Saari TI, et al: Voriconazole drastically increases exposure to oral oxycodone. Eur J Clin Pharmacol 2009; 65(3):263-271. PubMed
- Hamada H, Suzuki E, Endo M, et al: Opioid-induced respiratory depression suspected of drug interaction in a prostate cancer patient: a case report. Ann Palliat Med 2024; 13(2):428-432. PubMed
Keep reading about Oxycodone
Keep reading about Cyclosporine Injection
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.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist