Verapamil and Cyclosporine Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Verapamil
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
An increased risk of cycloSPORINE toxicity (renal dysfunction, cholestasis, paresthesias)
Interaction Deep Dive
Coadministration of cycloSPORINE (a P-gp and CYP3A4 substrate) with verapamil (a P-gp and CYP3A4 inhibitor) may increase the plasma concentrations of cycloSPORINE. Adjust cycloSPORINE dosage to achieve the desired cycloSPORINE concentrations when these drugs are administered concomitantly12. Concomitant use of verapamil and cycloSPORINE has been shown to result in increased cycloSPORINE blood levels 891011.
Why it happens (mechanism)
Reduced cycloSPORINE metabolism
Literature reports
3 reports — tap to read
a) DilTIAZem, verapamil, and niCARdipine have been shown to increase cycloSPORINE blood levels. The mechanism of this interaction is not known. However, it may relate to decreased cycloSPORINE metabolism or increased bioavailability. The significance of increased cycloSPORINE levels with dilTIAZem is not known because dilTIAZem has been shown to have a renal protective effect. In contrast, NIFEdipine, isradipine and nitrendipine have been shown to have no effect on cycloSPORINE blood levels. When a calcium channel blocker is used in combination with cycloSPORINE, blood levels and renal function should be monitored carefully, especially when using a calcium channel blocker that is known to increase cycloSPORINE levels 435.
b) A randomized, prospective study examined the effects of verapamil, isradipine, and felodipine on cycloSPORINE levels and renal function. Twenty-two renal transplant recipients with good allograft function who were stabilized on verapamil and cycloSPORINE were selected. Verapamil was discontinued for three weeks, and patients were then randomized to received either isradipine 5 mg daily or felodipine 10 mg daily. The cycloSPORINE dose was not changed during the study. Serum levels of cycloSPORINE during verapamil, isradipine, felodipine, and washout were 130.5 ng/mL, 73.5 ng/mL, 71.3 ng/mL, and 83.0 ng/mL, respectively. The glomerular filtration rates during verapamil, isradipine, felodipine, and washout were 84.2 mL/min, 98.0 mL/min, 87.5 mL/min, and 77.9 mL/min, respectively 6.
c) In a retrospective chart review involving 103 patients receiving cycloSPORINE in capsule form, the effect of verapamil and dilTIAZem on cycloSPORINE levels appeared to be independent of the dosage. All patients were receiving a long-acting form of the calcium channel blocker and had been stabilized on their cycloSPORINE dose for two or more weeks. Doses of verapamil ranging from 240 mg daily to 480 mg daily did not affect the cycloSPORINE plasma level index. These results suggest that once the dose of cycloSPORINE is adjusted when a patient is started on verapamil, further dosage adjustments of cycloSPORINE are not necessary as long as the dose of verapamil is only altered but not discontinued 7.
Common questions
Can I take Verapamil and Cyclosporine Injection together?
An increased risk of cycloSPORINE toxicity (renal dysfunction, cholestasis, paresthesias) Always confirm with your pharmacist or prescriber before making any change.
How serious is the Verapamil 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.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Verapamil 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 (11)
- 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
- Baciewicz AM & Baciewicz FA Jr: Cyclosporine pharmacokinetic drug interactions. Am J Surg 1989; 157:264-271. PubMed
- Yee GC & McGuire TR: Pharmacokinetic drug interactions with cyclosporin (Part II). Clin Pharmacokinet 1990; 19:400-415. PubMed
- Martinez F, Pirson Y, Wallemaca P, et al: No clinically significant interaction between cyclosporin and isradipine. Nephron 1991; 59:658-659.
- Yildiz A, Sever MS, Turkmen A, et al: Interaction between cyclosporine A and verapamil, felodipine, and isradipine. Nephron 1999; 81:117-118. PubMed
- Jacob LP, Malhotra D, Chan L, et al: Absence of a dose-response of cyclosporine levels to clinically used doses of diltiazem and verapamil. Am J Kidney Dis 1999; 33:301-303. DOI
- Product Information: Covera HS(R), verapamil. Pharmacia Corporation, Chicago, IL, 2003. DailyMed
- Lindholm A & Henricsson S: Verapamil inhibits cyclosporin metabolism (letter). Lancet 1987; 1:1262. PubMed
- Maggio TG & Bartels DW: Increased cyclosporine blood concentrations due to verapamil administration. Drug Intell Clin Pharm 1988; 22:705-707. DOI
- Sabate I, Grino J, Castelao JM, et al: Evaluation of cyclosporin-verapamil interaction, with observations on parent cyclosporin and metabolites. Clin Chem 1988; 34:2151. DOI
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Keep reading about Cyclosporine Injection
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