Drug interactions
Ritonavir + Tacrolimus
Severity: Major
Ritonavir 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 is a strong CYP3A4 and P-gp inhibitor and can raise tacrolimus concentrations many-fold. This can cause severe nephrotoxicity, neurotoxicity and other toxicity.
What this interaction means in plain words
Ritonavir 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 belongs to Anti Virals; Tacrolimus belongs to Miscellaneous.
Why it happens
Ritonavir potently inhibits CYP3A4 and P-glycoprotein, strongly reducing tacrolimus clearance.
What to do
Use markedly reduced tacrolimus doses and extended dosing intervals with frequent trough monitoring, guided by a transplant specialist. Recheck levels when ritonavir is started or 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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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
Other interactions of Ritonavir
- Alfuzosin + Ritonavir Contraindicated
- Amiodarone + Ritonavir Contraindicated
- Avanafil + Ritonavir Contraindicated
- Colchicine + Ritonavir Contraindicated
- Dronedarone + Ritonavir Contraindicated
- Eletriptan + Ritonavir Contraindicated
Frequently asked questions
Can I take Ritonavir with Tacrolimus?
MediHelp rates the interaction as major. Ritonavir 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 is a strong CYP3A4 and P-gp inhibitor and can raise tacrolimus concentrations many-fold. This can cause severe nephrotoxicity, neurotoxicity and other toxicity.
How serious is the interaction between Ritonavir 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: Use markedly reduced tacrolimus doses and extended dosing intervals with frequent trough monitoring, guided by a transplant specialist. Recheck levels when ritonavir is started or stopped.
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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