The risk of nephrotoxicity appears to be increased if
ciclosporin is given with amphotericin B. Limited evidence suggests that liposomal amphotericin B (AmBisome) does not increase nephrotoxicity or hepatotoxicity when given to infants taking
ciclosporin.
Ciclosporin levels may be increased or decreased by amphotericin B.
It has been suggested that if amphotericin must be given, withholding
ciclosporin until the
serum level is less than about 150 nanograms/mL may be a means of decreasing
renal toxicity without losing the immunosuppressive effect. The reports supporting a lack of significant nephrotoxicity all used liposomal amphotericin, which would seem to suggest that, in patients taking ciclosporin,
A these formulations are advisable. Monitor both
ciclosporin levels and
renal function carefully on concurrent use.