Ciclosporin serum levels are markedly reduced (in some cases within one day) by the concurrent use of
rifampicin. Transplant rejection can rapidly develop if the
ciclosporin dosage is not increased.
Ciclosporin levels and effects (e.g. on
renal function) should be monitored as a matter of routine, but it is essential to increase monitoring if
rifampicin is started or stopped. The
ciclosporin dose will need to be increased substantially when
rifampicin is added (3- to 5-fold increases have been needed in some cases). It has been suggested that other antituberculars should be used in patients taking
ciclosporin.