Verapamil with Cyclosporine Interaction Details

Brand Names Associated with Verapamil

Brand Names Associated with Cyclosporine

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Dec 03, 2023

Interaction Effect

An increased risk of cycloSPORINE toxicity (renal dysfunction, cholestasis, paresthesias)

Interaction Summary

Concomitant use of verapamil and cycloSPORINE has been shown to result in increased cycloSPORINE blood levels.

Severity

Moderate

Onset

Delayed

Evidence

Probable

How To Manage Interaction

If clinically possible, avoid this combination; an alternate calcium channel blocker such as isradipine, which has minimal impact on cycloSPORINE levels, may be used. If these two drugs are given concomitantly, monitor circulating cycloSPORINE levels and adjust cycloSPORINE dosage as necessary; also, monitor patients for increased cycloSPORINE toxicity (renal dysfunction, neurotoxicity). However, this drug interaction may be used intentionally to reduce the effective dose of cycloSPORINE as a cost saving measure.

Mechanism Of Interaction

Decreased cycloSPORINE metabolism

Literature Reports

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 .

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 .

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 .

Verapamil Overview

• Verapamil is used to treat high blood pressure and to control angina (chest pain). The immediate-release tablets are also used alone or with other medications to prevent and treat irregular heartbeats. Verapamil is in a class of medications called calcium-channel blockers. It works by relaxing the blood vessels so the heart does not have to pump as hard. It also increases the supply of blood and oxygen to the heart and slows electrical activity in the heart to control the heart rate.

• High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

Cyclosporine Overview

• Cyclosporine and cyclosporine (modified) are used with other medications to prevent transplant rejection (attack of the transplanted organ by the immune system of the person who received the organ) in people who have received kidney, liver, and heart transplants. Cyclosporine (modified) is also used alone or with methotrexate (Rheumatrex) to treat the symptoms of rheumatoid arthritis (arthritis caused by swelling of the lining of the joints) in patients whose symptoms were not relieved by methotrexate alone. Cyclosporine (modified) is also used to treat psoriasis (a skin disease in which red, scaly patches form on some areas of the body) in certain patients who have not been helped by other treatments. Cyclosporine and cyclosporine (modified) are in a class of medications called immunosuppressants. They work by decreasing the activity of the immune system.

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Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.