Drug interactions
Ombitasvir / paritaprevir / ritonavir and dasabuvir + Tacrolimus
Severity: Major
Ombitasvir / paritaprevir / ritonavir and dasabuvir and Tacrolimus: major interaction.
Last updated
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-boosted paritaprevir strongly inhibits CYP3A4, which markedly increases tacrolimus concentrations and the risk of severe nephrotoxicity, neurotoxicity and QT effects. Tacrolimus dosing must be drastically reduced and spaced out during treatment.
What this interaction means in plain words
Ombitasvir / paritaprevir / ritonavir and dasabuvir and Tacrolimus 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
Potent inhibition of CYP3A4 (and P-glycoprotein) by ritonavir and paritaprevir greatly reduces tacrolimus clearance.
What to do
Hold tacrolimus on the day the regimen starts, then restart at a markedly reduced dose or extended interval guided by frequent trough levels. Continue close monitoring of levels and renal function during treatment and after it ends.
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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Other interactions of Tacrolimus
- Adenovirus types 4 and 7 live + Tacrolimus Contraindicated
- Bcg vaccine live + Tacrolimus Contraindicated
- Cidofovir + Tacrolimus Contraindicated
- Cyclosporin + Tacrolimus Contraindicated
- Influenza virus vaccine quadrivalent intranasal + Tacrolimus Contraindicated
- Measles mumps and rubella vaccine live + Tacrolimus Contraindicated
Frequently asked questions
Can I take Ombitasvir / paritaprevir / ritonavir and dasabuvir with Tacrolimus?
MediHelp rates the interaction as major. Ombitasvir / paritaprevir / ritonavir and dasabuvir and Tacrolimus 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-boosted paritaprevir strongly inhibits CYP3A4, which markedly increases tacrolimus concentrations and the risk of severe nephrotoxicity, neurotoxicity and QT effects. Tacrolimus dosing must be drastically reduced and spaced out during treatment.
How serious is the interaction between Ombitasvir / paritaprevir / ritonavir and dasabuvir and Tacrolimus?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Hold tacrolimus on the day the regimen starts, then restart at a markedly reduced dose or extended interval guided by frequent trough levels. Continue close monitoring of levels and renal function during treatment and after it ends.
What other medicines interact with Tacrolimus?
MediHelp also lists interactions of Tacrolimus with, for example, Adenovirus types 4 and 7 live, Bcg vaccine live, Cidofovir. The full list is on the Tacrolimus page.
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