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.
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