Ciclosporin levels can be markedly raised by
clarithromycin (commonly 2- to 3-fold),
erythromycin (4- to 5-fold or more,
intravenous use seems to have less effect than oral), josamycin (commonly 2- to 3-fold), midecamycin (2-fold) and pristinamycin (65% in one study). Rokitamycin,
telithromycin and
troleandomycin are predicted to interact similarly. Although major studies have found no interaction with azithro- mycin, there have been several case reports.
Ciclosporin levels and effects (e.g. on
renal function) should be monitored as a matter of routine, but it may be prudent to increase monitoring if
macrolides are started or stopped. With
erythromycin, also consider increased monitoring if the
route of administration is changed. Other
macrolides may also interact, although it seems unlikely that they all will, see
macrolides. There is some evidence to suggest that roxithromycin and spiramycin interact minimally or not at all.