Diltiazem, nicardipine and
verapamil markedly raise
serum ciclosporin levels but also appear to possess kidney protective effects. Amlodipine has modestly increased
ciclosporin levels in some studies, but not in others, and it may also have kidney protective properties. A single case describes elevated
ciclosporin levels caused by
nisoldipine. Nifedipine normally appears not to interact, but rises and falls in
ciclosporin levels have been seen in a few patients.
Ciclosporin levels should be well monitored (especially with
diltiazem, nicardipine and verapamil) and dosage reductions made as necessary. With
diltiazem and
verapamil the
ciclosporin dosage can apparently be reduced by about 25 to 50% and even greater reductions may be necessary with nicardipine.