Moderate
Ciclosporin × Paracetamol
Immunosuppressants. Calcineurin inhibitors×Anilides. Analgesics and antipyretics
Mechanism
Paracetamol does not interact significantly with ciclosporin in short courses. On long-term high-dose use (over 3 g/day for more than 7 days), mild hepatocyte suppression may slightly amplify ciclosporin hepatotoxicity.
Symptoms
Fatigue, nausea, jaundice, elevated liver enzymes. Symptoms with long-term therapy are rare.
Management
Paracetamol remains the analgesic and antipyretic of choice in transplant patients. For chronic need, cap at 2 g/day. Check ALT, AST, GGT monthly. If enzymes rise 2–3-fold above the upper limit, stop paracetamol temporarily.