Drug interactions
Sirolimus + Tacrolimus
Severity: Major
Sirolimus 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
The combination is used in some transplant regimens but adds immunosuppression and infection risk. Combined use is also linked to impaired wound healing and, in liver transplant, hepatic artery thrombosis.
What this interaction means in plain words
Sirolimus 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.
Sirolimus belongs to Miscellaneous; Tacrolimus belongs to Miscellaneous.
Why it happens
Additive immunosuppression via different pathways (calcineurin and mTOR inhibition), with possible pharmacokinetic effects.
What to do
Use only under transplant specialist supervision with reduced doses, and monitor trough levels of both drugs, renal function and signs of infection. Avoid in liver transplant patients.
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 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 Sirolimus with Tacrolimus?
MediHelp rates the interaction as major. Sirolimus 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. The combination is used in some transplant regimens but adds immunosuppression and infection risk. Combined use is also linked to impaired wound healing and, in liver transplant, hepatic artery thrombosis.
How serious is the interaction between Sirolimus 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 only under transplant specialist supervision with reduced doses, and monitor trough levels of both drugs, renal function and signs of infection. Avoid in liver transplant patients.
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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