MajorImmunosuppressants. Calcineurin inhibitors×Calcium channel blocker, non-DHP (benzothiazepine derivative)
Updated · Methodology
Mechanism
Diltiazem blocks CYP3A4 and P-glycoprotein – cyclosporine clearance routes. Cyclosporine plasma levels rise by 50–100%. The combination is sometimes used intentionally in transplant patients to reduce cyclosporine dose (sparing effect), but requires monitoring.
Symptoms
Acute nephrotoxicity: rising creatinine, hypertension, tremor, headache. In transplant patients: accelerated graft function decline.
Management
For intentional sparing, reduce cyclosporine by 25–50% when starting diltiazem; check trough (C0) at days 3 and 7. For incidental combination: monitor cyclosporine and creatinine.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Sandimmune section 7 (2015)– ; DailyMed setid 5e5926a7-1de0-4b54-a5c0-286b6200ff82
- AEMPS: Ficha técnica: Diltiazem (nº registro 62328), sección 4.5 (2023)– AEMPS, CIMA, nº registro 62328, revisión 06/2023, sección 4.5