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Nonsteroidal anti-inflammatory drugs (standard or coxibs) - prescribing issues - Management
What should I do for a person who requires ciclosporin and an NSAID?
- There is no need to avoid the concurrent use of ciclosporin and a nonsteroidal anti-inflammatory drug (NSAID), but monitoring is necessary:
- Renal function should be closely monitored.
- Liver function requires less close monitoring, but hepatotoxicity is a potential adverse effect of both drugs.
- Ciclosporin can double serum levels of diclofenac, therefore:
- If diclofenac is being started in a person receiving ciclosporin, initially use diclofenac doses at the lower end of the range.
- If ciclosporin is being started in a person receiving diclofenac, halve the diclofenac dose.
Basis for recommendation
- These recommendations are based on information in an authoritative reference manual on drug interactions and the British National Formulary [Baxter, 2006; BNF 55, 2008]:
- Available data are limited, but both ciclosporin and NSAIDs can reduce renal function in some individuals.
- It is difficult to generalize about what will or will not happen if a particular NSAID is used, but expert opinion highlights that diclofenac use is of particular concern.
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