Cyclosporine + fluconazole

[B-OK]

Hello.

My wife was prescribed with Sandimmune.
4 days ago she was prescribed with Diflucan due to candidosis.

Yesterday she showed high temperature and fatigue. This symptoms were like she had when her cyclosporine concentration was very high. She does not show any symptom of infection.

Cyclosporine and fluconazole are metabolized through cytochrome P450, so combined usage increases concentration of each drug.

How did you managed such cases? What do you think?

Thank you.
All the best to you.

[Hopeful]

Hi,

I don't have personal experience with these drug interactions, nor am I a doctor.

However, I found this abstract which talks about how Cyclosporine availability increases significantly with fluconazole, peaking at day 4. It also says that trough levels may not be sensitive enough to pick up the interaction. You may want to show this abstract to her doctor quickly so that you can adjust her Cyclosporine dosage down while on fluconazole.

http://ndt.oxfordjournals.org/cgi/co...ract/14/7/1698

Hope this helps. It's good that you are so observant.

[B-OK]

Originally Posted by Hopeful

Hi,

I don't have personal experience with these drug interactions, nor am I a doctor.

However, I found this abstract which talks about how Cyclosporine availability increases significantly with fluconazole, peaking at day 4. It also says that trough levels may not be sensitive enough to pick up the interaction. You may want to show this abstract to her doctor quickly so that you can adjust her Cyclosporine dosage down while on fluconazole.

http://ndt.oxfordjournals.org/cgi/co...ract/14/7/1698

Hope this helps. It's good that you are so observant.

Hopeful, hi!
Thank you very much! I am glad that I found this site and that I am able to et answers to my questions.

As far as I understood from the article, adverse effects of diclucan and Sandimmune will be less severe after 7th day. It will be tomorrow

[Hopeful]

Hi B-OK,

You probably still want to discuss this with her doctor.
In the abstract, on day 8 the patients decreased their Cyclosporine dosage 50%. So, that resulted in the great reduction in availability.

Although the worse probably occurred on day 4, your wife could still be getting higher than desired amounts of Cyclopsorine.

Unfortunately, my doctors weren't able to tell me what an alarming number for Cmax would be. I don't think as much research has been done on this as on the trough level. However, the trough isn't always telling, as this article indicates. Please let me know if your doctors have any insight on this.

How long does she need to take fluconazole?

[sandra]

Hi B-OK,

We have been exactly in the same situation as your wife. Our son was treated with fluconazole (diflucan) and his CsA level went through the roof. The doctor stopped the CsA for one day completely, and then restarted at a much lower dose. Does your wife's doctor monitor her CsA level? It is a special blood test, where you collect a blood sample right before the administration of the next dose. Usually the doctors like to see that level at 175, higher than 200 you start having renal complications, in our case was increase creatinine and BUN.

You seem to have a science background, are you a researcher?

What worries me about your wife is that if she got candidosis, it is very likely she's neutropenic (ANC - absolute neutrophil count- below 500). The counts that you posted initially looked to me as she was more likely to fall into the severe AA diagnosis, not moderate, as your doctor said. This would warrant an ATG course, not just CsA.

Here is a link to the latest article available online of Dr. Neil Young, who's considered one of the best specialist in US when it comes to AA:

http://bloodjournal.hematologylibrar...ull/108/8/2509

There is a newer version of this article (2008), but is not available online. If you are interested, you can post your e-mail and I can sent you some pdf articles.

Sandra