Lewis S M, McCloskey W W
Pharmacy Service, Department of Veterans Affairs Medical Center, Pittsburgh, PA 15240, USA.
Ann Pharmacother. 1997 Mar;31(3):363-5. doi: 10.1177/106002809703100316.
The literature does not support a pharmacodynamic interaction between H2-antagonists and cyclosporine that would result in potentiation of cyclosporine's nephrotoxicity. The increase in serum creatinine associated with cimetidine, in the majority of cases, is due to competition with creatinine for tubular secretion. Ranitidine is unlikely to produce a change in serum creatinine. Additionally, there is no support for a pharmacokinetic interaction. However, cimetidine may influence peak concentrations of cyclosporine. Besides the clinical data reviewed here, two abstracts concur with these findings. Information was unavailable regarding interactions between cyclosporine and either famotidine or nizatidine that potentiate nephrotoxicity in transplant patients. Furthermore, the drug manufacturers state that no evidence is available to support any interaction of their products with cyclosporine. Thus, interpretation of renal function may be confusing with concomitant administration of cimetidine and cyclosporine unless GFR is accurately monitored. On the basis of the information available at this time, ranitidine may be considered the H2-antagonist of choice in a patient treated with cyclosporine.
文献并不支持H2拮抗剂与环孢素之间存在药效学相互作用，这种相互作用会增强环孢素的肾毒性。在大多数情况下，与西咪替丁相关的血清肌酐升高是由于其与肌酐竞争肾小管分泌所致。雷尼替丁不太可能导致血清肌酐发生变化。此外，也没有证据支持存在药代动力学相互作用。然而，西咪替丁可能会影响环孢素的峰值浓度。除了此处回顾的临床数据外，两篇摘要也认同这些发现。关于环孢素与法莫替丁或尼扎替丁之间相互作用增强移植患者肾毒性的信息尚不可得。此外，药品制造商表示，没有证据支持他们的产品与环孢素有任何相互作用。因此，除非准确监测肾小球滤过率（GFR），否则同时给予西咪替丁和环孢素时，肾功能的解读可能会令人困惑。基于目前可得的信息，雷尼替丁可被视为环孢素治疗患者的首选H2拮抗剂。
