Some
NSAIDs (diclofenac, indometacin,
ketoprofen,
mefenamic acid,
naproxen,
piroxicam and sulindac) sometimes reduce
renal function in individual patients, which is reflected in
serum creatinine level rises and possibly in changes in
ciclosporin levels, but concurrent use can also be uneventful. Diclofenac
serum levels can be doubled by
ciclosporin.
Concurrent use in rheumatoid arthritis need not be avoided but
renal function should be closely monitored. The manufacturers of
ciclosporin also specifically recommend that patients with rheumatoid arthritis taking
ciclosporin and an
NSAID should also have their liver function measured, because hepatotoxicity is a potential adverse effect of both drugs. It is difficult to generalise about what will or will not happen if any particular
NSAID is given, but in the case of diclofenac, it has been recommended that doses at the lower end of the range should be used initially, because its
serum levels can be doubled by
ciclosporin.