Important interactions for immunosuppressive drugs used in cardiac transplantation

Drugs that increase levels of cyclosporine, tacrolimus, and sirolimus
Calcium channel blockers	Diltiazem Nifedipine Nicardipine Verapamil
Antifungal drugs	Itraconazole Fluconazole Ketoconazole Voriconazole Posaconazole
Macrolide antibiotics	All
Fluoroquinolone antibiotics	Ciprofloxacin
HIV-protease inhibitors	All
Antiarrhythmic agents	Amiodarone
Gastrointestinal agents	Metoclopramide
Miscellaneous	Grapefruit juice
Drugs that decrease levels of cyclosporine, tacrolimus, and sirolimus
Anti-tubercular drugs	Rifampin
Anti-seizure drugs	Phenytoin Phenobarbital
Gastrointestinal drugs	Octreotide
Miscellaneous	St. John's wort
Drugs with synergistic nephrotoxicity when used with cyclosporine or tacrolimus
Aminoglycoside antibiotics
Amphotericin B
Non-steroidal anti-inflammatory agents (NSAIDs)
Drugs whose concentrations are increased when used with cyclosporine or tacrolimus
Lovastatin
Simvastatin
Atorvastatin
Ezetimibe
Colchicine*

* Based upon newer understanding of drug interactions, colchicine has been moved from "Drugs with synergistric nephrotoxicity" to "Drugs whose concentration are increased when used with cyclosporine or tacrolimus."

Reproduced with permission from: Pham MX, Chen JM, Berry GJ, Rose EA, Schroeder JS. Surgical Treatment of Heart Failure, Cardiac Transplantation, and Mechanical Ventricular Support. In: Hurst's The Heart, 12th ed, V, Fuster R, O'Rourke R, Walsh P, Poole-Wilson (eds). McGraw-Hill, New York 2007. Copyright © 2007 McGraw-Hill Companies Inc.

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Important interactions for immunosuppressive drugs used in cardiac transplantation