Drug Interactions
Below is a list of drugs that may affect the levels of Tacrolimus, Cyclosporine, Sirolimus, or Everolimus. The list is not exhaustive and whenever a new medication is proposed it is advisable to check if it interacts with immunosuppressants. Medscape is an example of an drug checker.
Drugs That Affect the Levels of Tacrolimus, Cyclosporine, Sirolimus, or Everolimus Adapted from: The International Society for Heart and Lung Transplantation (ISHLT) Guidelines for the Care of Heart Transplant Recipients (Guideline) Table 5. J Heart Lung Transplant. 2022 December | ||
Drug Class | Decrease immunosuppression levels Riduzione dei livelli di immunosoppressione | Increase immunosuppression levels Aumento dei livelli di immunosoppressione |
| Anti-epileptics | Carbamazepine Fosphenytoin Phenobarbital Phenytoin | Clotrimazole Fluconazole Isavuconazole Itraconazole Ketoconazole Posaconazole Voriconazole |
| Anti-microbials | Caspofungin Nafcillin Rifabutin Rifampin Rifapentine | Clarithromycin Erythromycin Metronidazole and tinidazole |
| Anticoagulants | Direct oral anticoagulants (DOACs) e.g.Dabigatran (note CNIs decrease levels of DOACS) | |
| Cardiovascular | Bosentan | Amiodarone Diltiazem Verapamil |
| Drinks, Herbal remedies, Supplements | St. John's Wort | Bitter orange Grapefruit Turmeric |
| Others | Aprepitant Deferasirox Modafinil Thalidomide Ticlopidine | Cimetidine Fluvoxamine Glipizide Glyburide Imatinib Nefazodone Protease inhibitors (general) RilonaceptTheophylline |
Last Updated: April 2023