Drug interactions
Everolimus + Nirmatrelvir / ritonavir
Severity: Major
Everolimus and Nirmatrelvir / ritonavir: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Ritonavir is a strong CYP3A and P-gp inhibitor and can sharply raise everolimus concentrations, risking serious toxicity. The effect may persist for several days after the short antiviral course.
What this interaction means in plain words
Everolimus and Nirmatrelvir / ritonavir can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Ritonavir strongly inhibits CYP3A4 and P-gp, markedly decreasing everolimus clearance.
What to do
Avoid the combination where possible and consider an alternative COVID-19 antiviral. If it is used, withhold or substantially reduce everolimus and monitor trough levels, resuming therapy after the inhibitory effect has worn off.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Everolimus
- Bcg vaccine live + Everolimus Contraindicated
- Everolimus + Influenza virus vaccine quadrivalent intranasal Contraindicated
- Everolimus + Levoketoconazole Contraindicated
- Everolimus + Measles mumps and rubella vaccine live Contraindicated
- Everolimus + Measles mumps rubella and varicella vaccine live Contraindicated
- Everolimus + Measles vaccine Contraindicated
Frequently asked questions
Can I take Everolimus with Nirmatrelvir / ritonavir?
MediHelp rates the interaction as major. Everolimus and Nirmatrelvir / ritonavir can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Ritonavir is a strong CYP3A and P-gp inhibitor and can sharply raise everolimus concentrations, risking serious toxicity. The effect may persist for several days after the short antiviral course.
How serious is the interaction between Everolimus and Nirmatrelvir / ritonavir?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination where possible and consider an alternative COVID-19 antiviral. If it is used, withhold or substantially reduce everolimus and monitor trough levels, resuming therapy after the inhibitory effect has worn off.
What other medicines interact with Everolimus?
MediHelp also lists interactions of Everolimus with, for example, Bcg vaccine live, Influenza virus vaccine quadrivalent intranasal, Levoketoconazole. The full list is on the Everolimus page.
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