Isolated cases of nephrotoxicity have been described in patients taking
ciclosporin with either amiloride/hydrochlorothiazide or
metolazone. The concurrent use of
ciclosporin with thiazides may increase
serum magnesium levels, and the concurrent use of
ciclosporin with potassium-sparing
diuretics may cause hyperkalaemia. The concurrent use of
ciclosporin and
eplerenone may increase potassium levels and lead to
renal impairment.
The general importance of these adverse interactions is not clear, but some caution is clearly prudent. Consider monitoring potassium levels if a potassium-sparing
C diureticisgiven.Themanufacturersofeplerenoneadviseavoidingconcurrentuse
wherever possible. If concurrent use is necessary, monitor
ciclosporin levels, potassium and
renal function frequently until stable.