Pyrazinamide and Cyclosporine Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Pyrazinamide
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
Reduced cycloSPORINE serum concentrations and potentially reduced immunosuppressive efficacy
Interaction Deep Dive
One case has been reported suggesting that pyrazinamide may induce cycloSPORINE metabolism resulting in reduced serum concentrations of cycloSPORINE and potential loss of immunosuppressive efficacy1. Pyrazinamide has been recommended as an alternative to rifampin therapy in patients on cycloSPORINE 23. However, the possibility that pyrazinamide may also induce cycloSPORINE metabolism, as do rifampin and rifabutin, also needs to be considered.
Why it happens (mechanism)
Induction by pyrazinamide of cycloSPORINE metabolism
Literature reports
1 report — tap to read
a) A 28-year-old man who received a kidney transplant was given prednisone, azathioprine, and cycloSPORINE for two months followed by maintenance therapy of prednisone 10 mg daily and cycloSPORINE 5 mg/kg/day. He was well until the thirteenth month when he was found to be positive for Mycobacterium tuberculosis. The patient was treated daily with isoniazid 300 mg, rifampin 600 mg, and ethambutol 1200 mg. CycloSPORINE was gradually increased to 8.3 mg/kg/day. Because the patient did not improve, pyrazinamide was added to therapy at a dose of 15 mg/kg/day. At that time, his cycloSPORINE serum concentration was 90 ng/mL. Two days after he began pyrazinamide, his cycloSPORINE serum concentration had fallen to 53 ng/mL. CycloSPORINE dosing was increased to 9.3 mg/kg/day, after which his serum level was 94 ng/mL. The dose of pyrazinamide was progressively raised to 30 mg/kg/day, where it stayed for the remainder of 14 weeks of treatment. At that point, the patient was receiving 10 mg/kg/day of cycloSPORINE and had a serum concentration of 322 ng/mL. Pyrazinamide was stopped and cycloSPORINE reduced to 8.2 mg/kg/day. Four days later, his trough cycloSPORINE concentration was 159 ng/mL. It was concluded that both isoniazid and rifampin had decreased the cycloSPORINE concentration, and that pyrazinamide had decreased it further 1 .
Common questions
Can I take Pyrazinamide and Cyclosporine Injection together?
Reduced cycloSPORINE serum concentrations and potentially reduced immunosuppressive efficacy Always confirm with your pharmacist or prescriber before making any change.
How serious is the Pyrazinamide 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.
Questions for your pharmacist
- Does my dose of Pyrazinamide 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 (3)
- Jimenez del Cerro LA & Hernandez FR: Effect of pyrazinamide on ciclosporin levels (letter). Nephron 1992; 62:113.
- Coward RA, Raftery AT, & Brown CB: Cyclosporin and antituberculosis therapy (letter). Lancet 1985; 1:1343.
- Sinnott JT & Emmanuel PJ: Mycobacterial infections in the transplant patient. Semin Respir Infect 1990; 5:65-73.
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