Drug interactions
Everolimus + Verapamil
Severity: Major
Everolimus and Verapamil: 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
Verapamil inhibits CYP3A4 and P-gp and can substantially increase everolimus blood concentrations. This raises the risk of mTOR-related adverse effects such as stomatitis, infections, hyperlipidemia, myelosuppression and pneumonitis.
What this interaction means in plain words
Everolimus and Verapamil 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.
Everolimus belongs to Oncology; Verapamil belongs to Cardiovascular.
Why it happens
Inhibition of CYP3A4 metabolism and P-gp efflux of everolimus by verapamil.
What to do
Avoid the combination where possible; otherwise reduce the everolimus dose per labeling for moderate CYP3A4/P-gp inhibitors. Monitor everolimus trough levels and toxicity, and readjust the dose after verapamil is stopped.
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 Verapamil
- Dofetilide + Verapamil Contraindicated
- Flibanserin + Verapamil Contraindicated
- Lomitapide + Verapamil Contraindicated
- Lonafarnib + Verapamil Contraindicated
- Pimozide + Verapamil Contraindicated
- Acebutolol + Verapamil Major
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 Verapamil?
MediHelp rates the interaction as major. Everolimus and Verapamil 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. Verapamil inhibits CYP3A4 and P-gp and can substantially increase everolimus blood concentrations. This raises the risk of mTOR-related adverse effects such as stomatitis, infections, hyperlipidemia, myelosuppression and pneumonitis.
How serious is the interaction between Everolimus and Verapamil?
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; otherwise reduce the everolimus dose per labeling for moderate CYP3A4/P-gp inhibitors. Monitor everolimus trough levels and toxicity, and readjust the dose after verapamil is stopped.
What other medicines interact with Verapamil?
MediHelp also lists interactions of Verapamil with, for example, Dofetilide, Flibanserin, Lomitapide. The full list is on the Verapamil page.
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