Prescription validity date — GPhC CRA MCQ
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Correct answer: D — Clarithromycin may double ciclosporin exposure; seek an alternative or institute close therapeutic monitoring
Explanation lettering: E = shown as A · A = shown as B · B = shown as D · D = shown as E
A reverses the interaction: clarithromycin inhibits rather than induces ciclosporin metabolism and transport. B is correct because the Neoral SmPC reports approximately doubled ciclosporin exposure; an alternative antimicrobial is preferable, or ciclosporin concentrations, renal function and blood pressure require close management with the transplant team. C is wrong because dose separation does not prevent metabolic inhibition. D is wrong because even a short course can produce clinically important nephrotoxicity. E invents an absorption interaction and an unsafe antibiotic escalation.
Reference: Neoral soft gelatin capsules SmPC. https://www.medicines.org.uk/emc/product/1034/smpc