Drug General Information (ID: DDIZ75JH86)
Drug Name			Cyclosporine		Drug Info		Omeprazole		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiviral Agents				Antiulcer Agents
Structure

Mechanism of Cyclosporine-Omeprazole Interaction (Severity Level: Moderate)
Increased risk of hypomagnesemia Click to Show/Hide Mechanism Graph
Drug Name		Cyclosporine				Omeprazole
Mechanism		Hypomagnesemia				Hypomagnesemia
Key Mechanism Factor 1
		Factor Name		Hypomagnesemia
		Factor Description		Hypomagnesemia is a condition that occurs when you have too much magnesium in your body. Symptoms of hypomagnesemia include: nausea, vomiting, neurological damage, abnormally low blood pressure (hypotension), flushing, and headaches.
Mechanism Description		Increased risk of hypomagnesemia by the combination of Cyclosporine and Omeprazole

Recommended Action
Management		Monitoring of serum magnesium levels is recommended prior to initiation of therapy and periodically thereafter if prolonged treatment with a proton pump inhibitor is anticipated or when combined with other agents that can cause hypomagnesemia such as cyclosporine. Patients should be advised to seek immediate medical attention if they develop potential signs and symptoms of hypomagnesemia such as palpitations, arrhythmia, muscle spasm, tremor, or convulsions. In children, abnormal heart rates may cause fatigue, upset stomach, dizziness, and lightheadedness. Magnesium replacement as well as discontinuation of the PPI may be required in some patients. A potential interaction with omeprazole should also be considered when cyclosporine levels are altered and no other causes can be identified. Occasionally, a dosage adjustment of cyclosporine may be necessary.

References
1	Arranz R, Yanez E, Franceschi JL, Fernandez-Ranada JM "More about omeparazole-cyclosporine interaction." Am J Gastroenterol 88 (1993): 154. [PMID: 8420264]
2	Blohme I, Idstrom JP, Andersson T "A study of the interaction between omeprazole and cyclosporine in renal transplant patients." Br J Clin Pharmacol 35 (1993): 156-60. [PMID: 8443034]
3	Castellote E, Bonet J, Lauzurica R, Pastor C, Cofan F, Caralps A "Does interaction between omeprazole and cyclosporin exist?" Nephron 65 (1993): 478. [PMID: 8290007]
4	Schouler L, Dumas F, Couzigou P, et al "Omeprazole-cyclosporin interaction." Am J Gastroenterol 86 (1991): 1097. [PMID: 1858755]
5	FDA. U.S. Food and Drug Administration "FDA Drug Safety Communication: Low magnesium levels can be associated with long-term use of proton pump inhibitor drugs (PPIs).".