Ciclosporin levels may be increased by some azole antifungals. The effects seem variable and may be affected by dose, ethnicity and gender. The
azoles implicated are
fluconazole (up to 2-fold increase in
ciclosporin levels),
itraconazole (ciclosporin dose reductions of about 80% needed),
ketoconazole (ciclosporin dose reductions of up to 85% needed), and miconazole (65% rise in
ciclosporin levels). However, many patients may not be affected.
Ciclosporin levels and/or effects (e.g. on
renal function) should be monitored as a matter of routine, but it may be prudent to increase monitoring if these
azoles are stopped, started, or if the doses are altered.