Cyclosporine is an immunosuppressant that is frequently used post-kidney transplant (and is associated with hyperkalemia). I received this question on how eating impacts cyclosporine.
To answer this question, my favourite resource is to look at the CPS – The Compendium of Pharmaceutical Sciences. I am old enough to remember when this was a giant blue book sitting on a bookshelf in the renal unit.
But, lucky for us, these days the CPS is now online resource: CPS (myrxtx.ca) (You may need to access it through your health authorities website).
What is the recommendation for patients?
According to the CPS, cyclosporine can be taken with or with out food. But, it is recommended to take it the same way each time. So, if your patient normally takes it with food, they should try to take it with food each time.
What evidence supports this statement?
When I tried to dig a bit more into this, I found this article from 1991. In this article, it states that the impact of food on cyclosporine levels is debated.
Studies reporting no effect
The authors reports that several studies that examined a standard breakfast on drug levels reported there was no effect. These studies were done in renal transplant recipients, heart transplant recipients and healthy volunteers.
Studies reporting increased bioavailability
In a study of 18 post-kidney transplant patients cyclosporine absorption increased by 60% when taken with a hospital breakfast. A second study in healthy volunteers reported that absorption increased from 21 to 53% when accompanied by a high fat meal.
The author of this article concluded, that light meals likely have little impact on cyclosporine levels, however heavier meals or high fat meals may increase absorption. They also concluded that this effect may be more pronounced in the early post-operative period.
Why might eating impact absorption?
The author reports that bile flow impacts cyclosporine absorption as cyclosporine is absorbed via micelles formed by bile. As bile production increases after larger and fattier meals, it is likely that taking this medication with meals increases absorption.
Take Aways
Does eating time and amount of item eaten impact drug levels? Probably. Larger meals, that are higher in fat likely increase cyclosporine absorption.
