Ticlopidine 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
Ticlopidine
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 exposure and reduced efficacy of cycloSPORINE
Interaction Deep Dive
CycloSPORINE and ticlopidine coadministration may result in a reduction of cycloSPORINE levels31. Adjust cycloSPORINE dosage to achieve the desired cycloSPORINE concentrations when these drugs are administered concomitantly 12. Ticlopidine may cause an induction of the cytochrome P450 3A4 system, resulting in an increase in the rate of cycloSPORINE metabolism 4.
Why it happens (mechanism)
Induction of cycloSPORINE metabolism
Literature reports
3 reports — tap to read
a) An 18-year-old patient with nephrotic syndrome was placed on cycloSPORINE with success; therapeutic serum concentrations were achieved. Ticlopidine 500 mg daily was added for its anti-thrombotic effect, resulting in a marked reduction in cycloSPORINE concentrations. No other interactions possibly altering cycloSPORINE pharmacokinetics were reported. Upon rechallenge after a positive dechallenge with ticlopidine, cycloSPORINE levels again fell with concomitant dosing 3.
b) Twenty heart transplant recipients were studied in a randomized, double-blind, placebo-controlled fashion to determine the effects of ticlopidine administration on cycloSPORINE levels. All patients had been stabilized on cycloSPORINE therapy for at least six weeks, and received ticlopidine 250 mg daily or placebo for 14 days. The researchers elected to use ticlopidine 250 mg daily, which is half of the recommended daily dose, to minimize any risk of graft rejection resulting from an abrupt decrease in the cycloSPORINE blood concentration. One patient was withdrawn from the study on the third day because his trough cycloSPORINE level had decreased by 60%. However, because this study was conducted on an out-patient basis, poor compliance can not be ruled out as the cause of the reduced cycloSPORINE level. The ratios of maximum concentration (Cmax), minimum concentration (Cmin), and area under the concentration-time curve (AUC 0-12 hours) showed increased Cmax and lower Cmin values when cycloSPORINE and ticlopidine were coadministered as compared to cycloSPORINE and placebo. Ticlopidine significantly reduced ADP-induced platelet aggregation, as expected. Urinary excretion of 6-beta-hydroxycortisol, an indirect method of detecting drug metabolism induction, was augmented in the ticlopidine group, suggesting that induction of drug metabolism via the cytochrome P450 3A4 system may have occurred. Although cycloSPORINE bioavailability was not clearly altered by ticlopidine 250 mg daily in this study, cycloSPORINE blood levels should still be closely monitored when co-prescribing ticlopidine 4.
c) A case report of a 64-year-old renal transplant patient was receiving cyclosporin A 2.81-4.39 mg/kg/day following renal transplant. After developing left third nerve cranial palsy two years posttransplantation, the patient was administered ticlopidine 250 mg/day. Other concurrent medications were digoxin, furosemide, insulin, predniSONE, and azaTHIOprine. A change in the median trough cycloSPORINE concentration: dose ratio was 36 before ticlopidine therapy and had decreased to 25 after ticlopidine was added to her drug regimen. Ticlopidine therapy was subsequently discontinued after ten months and the median cycloSPORINE concentration: dose ratio increased to 38. Ticlopidine was reinitiated three months later and the cycloSPORINE concentration: dose ratio decreased to 26. Ticlopidine 250 mg daily decreased the concentration of cyclosporin A in the blood. The author concludes that when initiating ticlopidine in a patient taking cyclosporin A, the concentration of cycloSPORINE in the blood should be closely monitored 5.
Common questions
Can I take Ticlopidine and Cyclosporine Injection together?
Reduced cycloSPORINE exposure and reduced efficacy of cycloSPORINE Always confirm with your pharmacist or prescriber before making any change.
How serious is the Ticlopidine 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 "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Ticlopidine 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 (5)
- Product Information: NEORAL(R) oral soft gelatin capsules oral solution, cyclosporine modified oral soft gelatin capsules oral solution. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2023. DailyMed
- Product Information: SANDIMMUNE(R) oral capsules, oral solution, intravenous injection, cyclosporine oral capsules, oral solution, intravenous injection. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2023. DailyMed
- Birmele B, Tebrancher Y, Bagros P, et al: Interaction of cyclosporin and ticlopidine. Nephrol Dial Transplant 1991; 6:150-151. PubMed
- Boissonnat P, de Lorgeril M, Perroux V, et al: A drug interaction study between ticlopidine and cyclosporin in heart transplant recipients. Eur J Clin Pharmacol 1997; 53:39-45. PubMed
- Verdejo A, de Cos M, & Zubimendi J: Probable interaction between cyclosporin A and low dose ticlopidine. BMJ 2000; 320:1037.
Keep reading about Cyclosporine Injection
Keep reading about Ticlopidine
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