From the Guidelines
Nifedipine can be used with cyclosporine, but the combination requires careful monitoring due to the potential increased risk of gingival hyperplasia and other interactions. According to the British Association of Dermatologists guidelines for the safe and effective prescribing of oral ciclosporin in dermatology 2018 1, concurrent administration of nifedipine with ciclosporin may result in an increased risk of gingival hyperplasia. However, another study from the same guidelines 1 suggests that calcium antagonists such as nifedipine can be used to treat hypertension in patients on ciclosporin, as they do not interact with ciclosporin metabolism and are also nephroprotective.
Key Considerations
- The combination of nifedipine and cyclosporine may increase the risk of gingival hyperplasia, as noted in the guidelines 1.
- Nifedipine is recommended as a treatment option for hypertension in patients on ciclosporin, due to its lack of interaction with ciclosporin metabolism and its nephroprotective effects 1.
- Healthcare providers should monitor patients closely for signs of cyclosporine toxicity and excessive nifedipine effects when using this combination.
Monitoring and Dose Adjustments
- Patients on nifedipine and cyclosporine should be monitored for signs of cyclosporine toxicity, such as tremors, kidney dysfunction, and gum hyperplasia.
- Dose adjustments of either medication may be required based on clinical response and drug levels.
- Healthcare providers should consult up-to-date references, such as the British National Formulary or the Summary of Product Characteristics, regarding possible drug interactions whenever a concomitant medication is used 1.
From the FDA Drug Label
Frequent gingival hyperplasia when nifedipine is given concurrently with cyclosporine have been reported. The concomitant use of nifedipine should be avoided in patients in whom gingival hyperplasia develops as a side effect of cyclosporine
- Nifedipine and cyclosporine are not compatible due to the risk of frequent gingival hyperplasia.
- The concomitant use of nifedipine should be avoided in patients who develop gingival hyperplasia as a side effect of cyclosporine 2
From the Research
Compatibility of Nifedipine with Cyclosporine
- The compatibility of nifedipine with cyclosporine has been studied in various research papers 3, 4, 5, 6.
- A study published in the European journal of dermatology found that sustained-release nifedipine is useful for hypertensive psoriatic patients under long-term treatment with cyclosporin A, but patients should be monitored for gingival hyperplasia 3.
- However, another study published in Pediatric nephrology found that nifedipine aggravates cyclosporine A-induced gingival hyperplasia, and recommends avoiding calcium channel blockers in the long-term management of hypertension in patients receiving cyclosporine 4.
- A study published in the Journal of clinical hypertension discusses the general use of calcium channel blockers, including nifedipine, but does not specifically address the compatibility with cyclosporine 5.
- It is worth noting that other calcium channel blockers, such as amlodipine, can increase cyclosporine levels in hypertensive renal transplant patients 6.
- In terms of specific interactions between nifedipine and cyclosporine, a study published in Cardiovascular drugs and therapy mentions that drug interactions of calcium antagonists, including nifedipine, can occur with other cardiovascular agents, but does not specifically mention cyclosporine 7.