Drug interactions
Miconazole + Sirolimus
Severity: Major
Miconazole and Sirolimus: major interaction.
Last updated Sources: UK SmPC
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
Systemic miconazole may substantially raise sirolimus concentrations, causing immunosuppressant toxicity. Vaginal exposure is low, but sirolimus has a narrow therapeutic range.
What this interaction means in plain words
Miconazole and Sirolimus 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.
Miconazole belongs to Anti Fungals; Sirolimus belongs to Miscellaneous.
Why it happens
Miconazole inhibits CYP3A4 and P-glycoprotein, reducing sirolimus clearance.
What to do
Avoid systemic miconazole; use a non-azole antifungal. With vaginal use, monitor sirolimus trough levels and adjust the dose if needed.
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 Miconazole
Other interactions of Sirolimus
- Adenovirus types 4 and 7 live + Sirolimus Contraindicated
- Bcg vaccine live + Sirolimus Contraindicated
- Influenza virus vaccine quadrivalent intranasal + Sirolimus Contraindicated
- Ketoconazole + Sirolimus Contraindicated
- Levoketoconazole + Sirolimus Contraindicated
- Measles mumps and rubella vaccine live + Sirolimus Contraindicated
Frequently asked questions
Can I take Miconazole with Sirolimus?
MediHelp rates the interaction as major. Miconazole and Sirolimus 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. Systemic miconazole may substantially raise sirolimus concentrations, causing immunosuppressant toxicity. Vaginal exposure is low, but sirolimus has a narrow therapeutic range.
How serious is the interaction between Miconazole and Sirolimus?
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 systemic miconazole; use a non-azole antifungal. With vaginal use, monitor sirolimus trough levels and adjust the dose if needed.
What other medicines interact with Miconazole?
MediHelp also lists interactions of Miconazole with, for example, Cabazitaxel, Dihydroergotamine intranasal, Dihydroergotamine. The full list is on the Miconazole page.
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