Common use of xx/xxx Clause in Contracts

xx/xxx. Drug Interactions Ciclosporin is metabolised by cytochrome P450 and therefore interacts with many drugs that are also metabolised by this group of liver enzymes. The following drugs /foods increase or reduce ciclosporin levels – Interacting drugs Effects on ciclosporin blood levels Antibiotics - Erythromycin, Increased clarithromycin, azithromycin Calcium channel blockers - Increased Diltiazem, nicardipine verapamil. Lercanidipine(BNF advises to avoid) Antifungals - Fluconazole, Increased itraconazole, ketoconazole Grapefruit juice or fruit Increased Others - metoclopramide, oral Increased contraceptives, danazol, allopurinol, amiodarone, colchicine Rifampicin Decreased Antiepileptics – Carbamazepine, Decreased phenobarbital, phenytoin Anti-obesity - Orlistat Decreased St John’s Wort Decreased Other interacting agents:  Tacrolimus – contraindicated  Statins –  Simvastatin and rosuvastatin are contra-indicated with ciclosporin  Atorvastatin should be used at a maximum dose of 10mg daily in combination with ciclosporin  Pravastatin can be used to a maximum dose of 40mg daily in combination with ciclosporin  NSAIDs and other nephrotoxic drugs (e.g. aminoglycosides,amphotericin B, ciprofloxacin, trimethoprim, methotrexate (unless initiated by consultant team)  Diclofenac – see above under NSAIDS. In addition always half the dose of diclofenac when ciclosporin is co-prescribed.  Potassium-sparing medicines may exacerbate ciclosporin- induced hyperkalaemia and should only be initiated with regular monitoring of U&E’s.  Live vaccines – avoid  Digoxin, colchicine – ciclosporin may increases levels of these drugs For full list see BNF or SPC at xxx.xxxxxxxxx.xxx.

xx/xxx. Drug Interactions Ciclosporin is metabolised by cytochrome P450 and therefore interacts with many drugs that are also metabolised by this group of liver enzymes. The following drugs /foods increase or reduce ciclosporin levels – Interacting drugs Effects on ciclosporin blood levels Antibiotics - Erythromycin, Increased clarithromycin, azithromycin Calcium channel blockers - Increased Diltiazem, nicardipine verapamil. Lercanidipine(BNF advises to avoid) Antifungals - Fluconazole, Increased itraconazole, ketoconazole Grapefruit juice or fruit Increased Others - metoclopramide, oral Increased contraceptives, danazol, allopurinol, amiodarone, colchicine Rifampicin Decreased Antiepileptics – Carbamazepine, Decreased phenobarbital, phenytoin Anti-obesity - Orlistat Decreased St John’s Wort Decreased Other interacting agents:  • Tacrolimus – contraindicated  • Statins –  ⮚ Simvastatin and rosuvastatin are contra-indicated with ciclosporin  ⮚ Atorvastatin should be used at a maximum dose of 10mg daily in combination with ciclosporin  ⮚ Pravastatin can be used to a maximum dose of 40mg daily in combination with ciclosporin  • NSAIDs and other nephrotoxic drugs (e.g. aminoglycosides,amphotericin B, ciprofloxacin, trimethoprim, methotrexate (unless initiated by consultant team)  • Diclofenac – see above under NSAIDS. In addition always half the dose of diclofenac when ciclosporin is co-prescribed.  • Potassium-sparing medicines may exacerbate ciclosporin- induced hyperkalaemia and should only be initiated with regular monitoring of U&E’s.  • Live vaccines – avoid  • Digoxin, colchicine – ciclosporin may increases levels of these drugs For full list see BNF or SPC at xxx.xxxxxxxxx.xxx.

xx/xxx. Drug Interactions Ciclosporin is metabolised by cytochrome P450 and therefore interacts with many drugs that are also metabolised by this group of liver enzymes. The following drugs /foods increase or reduce ciclosporin levels – Interacting drugs Effects on ciclosporin blood levels Antibiotics - Erythromycin, Increased clarithromycin, azithromycin Calcium channel blockers - Increased Diltiazem, nicardipine verapamil. Lercanidipine(BNF advises to avoid) Antifungals - Fluconazole, Increased itraconazole, ketoconazole Grapefruit juice or fruit Increased Others - metoclopramide, oral Increased contraceptives, danazol, allopurinol, amiodarone, colchicine Rifampicin Decreased Antiepileptics – Carbamazepine, Decreased phenobarbital, phenytoin Anti-obesity - Orlistat Decreased St John’s Wort Decreased Other interacting agents:  • Tacrolimus – contraindicated  • Statins –  ⮚ Simvastatin and rosuvastatin are contra-indicated with ciclosporin  ⮚ Atorvastatin should be used at a maximum dose of 10mg daily in combination with ciclosporin  ⮚ Pravastatin can be used to a maximum dose of 40mg daily in combination with ciclosporin  • NSAIDs and other nephrotoxic drugs (e.g. aminoglycosides,amphotericin B, ciprofloxacin, trimethoprim, methotrexate (unless initiated by consultant team)  • Diclofenac – see above under NSAIDS. In addition always half the dose of diclofenac when ciclosporin is co-prescribed.  • Potassium-sparing medicines may exacerbate ciclosporin- induced hyperkalaemia and should only be initiated with regular monitoring of U&E’s.  • Live vaccines – avoid  • Digoxin, colchicine – ciclosporin may increases levels of these drugs • Grapefruit and grapefruit juice: avoid an hour before and after taking ciclosporin. For full list see BNF or SPC at xxx.xxxxxxxxx.xxx.

xx/xxx. Drug Interactions Ciclosporin is metabolised by cytochrome P450 and therefore interacts with many drugs that are also metabolised by this group of liver enzymes. The following drugs /foods increase or reduce ciclosporin levels – Interacting drugs Effects on ciclosporin blood levels Antibiotics - Erythromycin, Increased clarithromycin, azithromycin Calcium channel blockers - Increased Diltiazem, nicardipine verapamil. Lercanidipine(BNF advises to avoid) Antifungals - Fluconazole, Increased itraconazole, ketoconazole Grapefruit juice or fruit Increased Others - metoclopramide, oral Increased contraceptives, danazol, allopurinol, amiodarone, colchicine Rifampicin Decreased Antiepileptics – Carbamazepine, Decreased phenobarbital, phenytoin Anti-obesity - Orlistat Decreased St John’s Wort Decreased Other interacting agents:  Tacrolimus – contraindicated  Statins –  Simvastatin and rosuvastatin are contra-indicated with ciclosporin  Atorvastatin should be used at a maximum dose of 10mg daily in combination with ciclosporin  Pravastatin can be used to a maximum dose of 40mg daily in combination with ciclosporin  NSAIDs and other nephrotoxic drugs (e.g. aminoglycosides,amphotericin B, ciprofloxacin, trimethoprim, methotrexate (unless initiated by consultant team)  Diclofenac – see above under NSAIDS. In addition always half the dose of diclofenac when ciclosporin is co-prescribed.  Potassium-sparing medicines may exacerbate ciclosporin- induced hyperkalaemia and should only be initiated with regular monitoring of U&E’s.  Live vaccines – avoid  Digoxin, colchicine – ciclosporin may increases levels of these drugs  Grapefruit and grapefruit juice: avoid an hour before and after taking ciclosporin. For full list see BNF or SPC at xxx.xxxxxxxxx.xxx.