inhibitor for 3 elimination half-lives, resume selumetinib dose that was taken before initiating the inhibitor.sildenafilMonitor Closely (1)cyclosporine will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.silodosinSerious - Use Alternative (2)cyclosporine will increase the level or effect of silodosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. cyclosporine will increase the level or effect of silodosin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.siltuximabMonitor Closely (1)siltuximab, cyclosporine. Other (see comment). Use Caution/Monitor. Comment: CYP450 activity in the liver is down regulated by infection and inflammation stimuli including cytokines (eg, IL-6); inhibition of IL-6 by siltuximab may restore CYP450 enzymatic activity; caution if coadministered with CYP substrates that have a narrow therapeutic index.simvastatinContraindicated (2)cyclosporine will increase the level or effect of simvastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Contraindicated. Increased risk for rhabdomyolysis with drugs that increase simvastatin systemic exposure. cyclosporine will increase the level or effect of simvastatin by Other (see comment). Contraindicated. OATP1B1 inhibitors may increase risk of myopathysiponimodMonitor Closely (1)siponimod, cyclosporine. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.Serious - Use Alternative (1)cyclosporine will increase the level or effect of siponimod by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of siponimod with a moderate or strong CYP3A4 inhibitor PLUS a moderate or strong CYP2C9 inhibitor is not recommended.sipuleucel-TMonitor Closely (1)cyclosporine decreases effects of sipuleucel-T by pharmacodynamic antagonism. Modify Therapy/Monitor Closely.sirolimusMonitor Closely (4)cyclosporine will increase the level or effect of sirolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Simultaneous coadministration significantly increases sirolimus levels; this is minimized by administering sirolimus 4 hr after cyclosporine cyclosporine will increase the level or effect of sirolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Simultaneous coadministration significantly increases sirolimus levels; this is minimized by administering sirolimus 4 hr after cyclosporine cyclosporine, sirolimus. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. sirolimus increases toxicity of cyclosporine by nephrotoxicity and/or ototoxicity. Use Caution/Monitor. Elevations in serum creatinine, hemolytic uremic syndrome, TTP, and microangiopathy were observed when sirolimus used in combination with cyclosporine. Administer oral doses of sirolimus 4 hr after doses of cyclosporine.smallpox (vaccinia) and monkeypox vaccine, live, nonreplicatingSerious - Use Alternative (2)cyclosporine decreases effects of smallpox (vaccinia) vaccine, attenuated by pharmacodynamic antagonism. Contraindicated. Avoid live vaccines in immunocompromised patients due to the risk of developing a clinical infection from the live vaccine. Inadequate immune response to the vaccine may also occur in the presence of immunosuppressants. Avoid live vaccines for at least 3 months after cessation of immunosuppressant therapy unless the benefit of vaccine administration outweighs the potential risk. cyclosporine decreases effects of smallpox (vaccinia) vaccine, attenuated by pharmacodynamic antagonism. Contraindicated. Avoid live vaccines in immunocompromised patients due to the risk of developing a clinical infection from the live vaccine. Inadequate immune response to the vaccine may also occur in the presence of immunosuppressants. Avoid live vaccines for at least 3 months after cessation of immunosuppressant therapy unless the benefit of vaccine administration outweighs the potential risk.smallpox (vaccinia) vaccine, liveSerious - Use Alternative (1)cyclosporine decreases effects of smallpox (vaccinia) vaccine, live by pharmacodynamic antagonism. Contraindicated. Avoid live vaccines in immunocompromised patients due to the risk of developing a clinical infection from the live vaccine. Inadequate immune response to the vaccine may also occur in the presence of immunosuppressants. Avoid live vaccines for at least 3 months after cessation of immunosuppressant therapy unless the benefit of vaccine administration outweighs the potential risk.solifenacinMonitor Closely (1)cyclosporine will increase the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.somapacitanMonitor Closely (1)somapacitan decreases effects of cyclosporine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates.somatrogonMonitor Closely (1)somatrogon decreases effects of cyclosporine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates.somatropinMonitor Closely (1)somatropin decreases effects of cyclosporine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates.sonidegibSerious - Use Alternative (1)cyclosporine will increase the level or effect of sonidegib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sonidegib with moderate CYP3A4 inhibitors. If a moderate CYP3A inhibitor must be used, administer the moderate CYP3A inhibitor for <14 days and monitor closely for adverse reactions, particularly musculoskeletal adverse reactions.sotorasibSerious - Use Alternative (2)sotorasib will decrease the level or effect of cyclosporine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the CYP3A4 substrate for dosage modifications sotorasib will decrease the level or effect of cyclosporine by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications.sparsentanMonitor Closely (1)cyclosporine will increase the level or effect of sparsentan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. No dosage adjustment needed. Monitor blood pressure, serum potassium, edema, and kidney function regularly if sparsentan is coadministered with moderate CYP3A4 inhibitors. spironolactoneSerious - Use Alternative (1)spironolactone and cyclosporine both increase serum potassium. Avoid or Use Alternate Drug. Coadministration not recommendedSt John's WortSerious - Use Alternative (2)St John's Wort will decrease the level or effect of cyclosporine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. St John's Wort will decrease the level or effect of cyclosporine by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.stiripentolMonitor Closely (2)stiripentol, cyclosporine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment. stiripentol will increase the level or effect of cyclosporine by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.streptomycinMonitor Closely (1)cyclosporine and streptomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.streptozocinMonitor Closely (1)cyclosporine and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.sufentanilMonitor Closely (1)cyclosporine will increase the level or effect of sufentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of sufentanil with any CYP3A4 inhibitor may increase sufentanil plasma concentration, and, thereby increase or prolonged adverse effects, including potentially fatal respiratory depression.sufentanil SLMonitor Closely (1)cyclosporine will increase the level or effect of sufentanil SL by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of sufentanil SL with any CYP3A4 inhibitor may increase sufentanil plasma concentration, and, thereby increase or prolonged adverse effects, including potentially fatal respiratory depression.sulbactam/durlobactamSerious - Use Alternative (1)cyclosporine will increase the level or effect of sulbactam/durlobactam by Other (see comment). Avoid or Use Alternate Drug. Sulbactam is predicted to have active secretion by OATP1 as a significant portion of total clearance; therefore, inhibition of OAT1 may increase sulbactam plasma concentrationssulfadiazineMonitor Closely (2)sulfadiazine decreases effects of cyclosporine by unknown mechanism. Use Caution/Monitor. Increased nephrotoxicity with this combination. sulfadiazine, cyclosporine. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Use Caution/Monitor.sulfamethoxazoleMonitor Closely (1)sulfamethoxazole, cyclosporine. Either increases effects of the other by nephrotoxicity and/or ototoxicity. Use Caution/Monitor.sulfasalazineMonitor Closely (1)cyclosporine will increase the level or effect of sulfasalazine by Other (see comment). Use Caution/Monitor. Cyclosporine, a BCRP inhibitor, may increase levels of sulfasalazine (a BCRP substrate) when combined.sulfisoxazoleMonitor Closely (1)sulfisoxazole will decrease the level or effect of cyclosporine by unknown mechanism. Use Caution/Monitor.sulindacMonitor Closely (1)sulindac, cyclosporine. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.sunitinibMonitor Closely (1)cyclosporine will increase the level or effect of sunitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.suvorexantMonitor Closely (1)cyclosporine will increase the level or effect of suvorexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease suvorexant starting dose to 5 mg HS if coadministered with moderate CYP3A4 inhibitorstacrolimusSerious - Use Alternative (1)cyclosporine, tacrolimus. Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of tacrolimus with cyclosporine may increase the risk of nephrotoxicity and immunosuppressive effects. Additionally, both agents are CYP3A4 and P-gp substrates and may elevate serum levels of either agent when coadministered. Discontinue tacrolimus or cyclosporine therapy at least 24 hours before initiating therapy with the other agent.tadalafilMonitor Closely (1)cyclosporine will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.talazoparibSerious - Use Alternative (1)cyclosporine will increase the level or effect of talazoparib by Other (see comment). Avoid or Use Alternate Drug. BCRP inhibitors may increase systemic exposure of talazoparib (a BCRP substrate). If coadministration cannot be avoided, monitor for potential adverse reactions.tamsulosinMonitor Closely (1)cyclosporine increases levels of tamsulosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.tazemetostatSerious - Use Alternative (1)cyclosporine will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of tazemetostat with moderate CYP3A4 inhibitors. If coadministration is unavoidable, reduce tazemetostat current dose (see drug monograph Dosage Modifications). teclistamabMonitor Closely (1)teclistamab will increase the level or effect of cyclosporine by altering metabolism. Use Caution/Monitor. Teclistamab causes release of cytokines that may suppress activity of CYP450 enzymes, resulting in increased exposure of CYP substrates. Monitor for increased concentrations or toxicities of sensitive CYP substrates. Adjust dose of CYP substrate drug as needed. tecovirimatMonitor Closely (1)tecovirimat will decrease the level or effect of cyclosporine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.teduglutideMonitor Closely (1)teduglutide increases levels of cyclosporine by Other (see comment). Use Caution/Monitor. Comment: Teduglutide may increase absorption of concomitant PO medications; caution with with drugs requiring titration or those with a narrow therapeutic index; dose adjustment may be necessary.teicoplaninSerious - Use Alternative (1)cyclosporine and teicoplanin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.telotristat ethylMonitor Closely (1)telotristat ethyl will decrease the level or effect of cyclosporine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Telotristat ethyl induces CYP3A4 and may reduce systemic exposure of sensitive CYP3A4 substrates. Monitor for suboptimal efficacy and consider increasing the dose of the CYP3A4 substrate.temsirolimusMonitor Closely (1)cyclosporine will increase the level or effect of temsirolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)cyclosporine and temsirolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.teniposideMonitor Closely (1)cyclosporine will increase the level or effect of teniposide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.tenofovir DFSerious - Use Alternative (1)cyclosporine and tenofovir DF both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.tepotinibSerious - Use Alternative (1)tepotinib will increase the level or effect of cyclosporine by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If concomitant use unavoidable, reduce the P-gp substrate dosage if recommended in its approved product labeling.testosteroneSerious - Use Alternative (1)testosterone increases effects of cyclosporine by decreasing metabolism. Avoid or Use Alternate Drug.testosterone buccal systemSerious - Use Alternative (1)testosterone buccal system increases effects of cyclosporine by decreasing metabolism. Avoid or Use Alternate Drug.testosterone topicalSerious - Use Alternative (1)testosterone topical increases effects of cyclosporine by decreasing metabolism. Avoid or Use Alternate Drug.tetanus toxoid adsorbed or fluidMonitor Closely (1)cyclosporine decreases effects of tetanus toxoid adsorbed or fluid by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. If possible, complete all age-appropriate vaccinations at least 2 weeks before initiating immunosuppressant therapy. Patients vaccinated <14 days before starting immunosuppressive therapy or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued if immune competence has been restored. Longer waiting periods may be required for drugs that maintain their immunosuppressive effects for more than 3 months after discontinuation (eg, ocrelizumab). .tezacaftorMonitor Closely (1)cyclosporine will increase the level or effect of tezacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust tezacaftor dosage regimen if coadministered with a moderate CYP3A inhibitor.tick-borne encephalitis vaccineMonitor Closely (1)cyclosporine decreases effects of tick-borne encephalitis vaccine by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Immunosuppressants also increase risk of infection with