The absorption of
ciclosporin is significantly reduced by
orlistat (by more than 50% in some cases). In one case,
orlistat appeared to have less effect on the microemulsion formulation (Neoral) of
ciclosporin than the older formulation (Sandimmun). Never- theless, a non-significant episode of acute graft rejection has been reported with the microemulsion formulation.
Ciclosporin levels and effects (e.g. on
renal function) should be monitored as a matter of routine, but it would be prudent to increase monitoring if
orlistat is started or stopped. Adjust the dose of
ciclosporin as necessary.