Drug General Information (ID: DDIYA6MKRC)
Drug Name			Cyclosporine		Drug Info		Trandolapril		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiviral Agents				Antihypertensive Agents
Structure

Mechanism of Cyclosporine-Trandolapril Interaction (Severity Level: Moderate)
Increased risk of hyperkalemia Click to Show/Hide Mechanism Graph
Drug Name		Cyclosporine				Trandolapril
Mechanism 1		Hyperkalemia				Hyperkalemia
Key Mechanism Factor 1
		Factor Name		Hyperkalemia
		Factor Description		Hyperkalemia is a condition in which the level of potassium in the blood is higher than normal. While mild cases may not produce symptoms, severe hyperkalemia can lead to fatal arrhythmias if left untreated.
Mechanism Description		Increased risk of hyperkalemia by the combination of Cyclosporine and Trandolapril
Increased risk of nephrotoxicity Click to Show/Hide Mechanism Graph
Drug Name		Cyclosporine				Trandolapril
Mechanism 2		Nephrotoxicity				Nephrotoxicity
Key Mechanism Factor 2
		Factor Name		Nephrotoxicity
		Factor Description		The combination of drugs that can induce nephrotoxicity may increase the risk of kidney injury. When kidney injury occurs, the inability to remove excess urine and waste from the body can lead to high levels of urea nitrogen, creatinine, and electrolytes (such as potassium and magnesium) in the blood.
Mechanism Description		Increased risk of nephrotoxicity by the combination of Cyclosporine and Trandolapril
Mechanism 3		Nephrotoxicity				Nephrotoxicity Decrease renal perfusion
Key Mechanism Factor 3
		Factor Name		Nephrotoxicity
		Factor Description		The combination of drugs that can induce nephrotoxicity may increase the risk of kidney injury. When kidney injury occurs, the inability to remove excess urine and waste from the body can lead to high levels of urea nitrogen, creatinine, and electrolytes (such as potassium and magnesium) in the blood.
Mechanism Description		Increased risk of nephrotoxicity by the combination of Cyclosporine and Trandolapril
Mechanism 4		Nephrotoxicity				Decrease renal perfusion/blood flow rate
Key Mechanism Factor 4
		Factor Name		Nephrotoxicity
		Factor Description		The combination of drugs that can induce nephrotoxicity may increase the risk of kidney injury. When kidney injury occurs, the inability to remove excess urine and waste from the body can lead to high levels of urea nitrogen, creatinine, and electrolytes (such as potassium and magnesium) in the blood.
Mechanism Description		Increased risk of nephrotoxicity by the combination of Cyclosporine and Trandolapril

Recommended Action
Management		Serum potassium levels and renal function should be checked regularly when cyclosporine is used in combination with ACE inhibitors or angiotensin II receptor antagonists. Particular caution is warranted in patients with renal impairment, diabetes, old age, severe or worsening heart failure, or dehydration. Patients should be advised to seek medical attention if they experience signs and symptoms of hyperkalemia such as nausea, vomiting, weakness, listlessness, tingling of the extremities, paralysis, confusion, weak pulse, and a slow or irregular heartbeat.

References
1	Cerner Multum, Inc. "Australian Product Information.".
2	Cerner Multum, Inc. "UK Summary of Product Characteristics.".
3	Murray BM, Venuto RC, Kohli R, Cunningham EE "Enalapril-associated acute renal failure in renal transplants: possible role of cyclosporine." Am J Kidney Dis 16 (1990): 66-9. [PMID: 2368707]
4	Perazella MA "Drug-induced hyperkalemia: old culprits and new offenders." Am J Med 109 (2000): 307-14. [PMID: 10996582]
5	Product Information. Neoral Soft Gelatin Capsules (cyclosporine). Sandoz Pharmaceuticals Corporation, East Hanover, NJ.