Drug interactions
Sirolimus + Tocilizumab
Severity: Major
Sirolimus and Tocilizumab: 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
Concurrent use adds immunosuppressive effects and increases the risk of serious infection. Tocilizumab may also alter sirolimus exposure by reversing inflammation-related CYP3A4 suppression.
What this interaction means in plain words
Sirolimus and Tocilizumab 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; Tocilizumab belongs to Musculoskeletal.
Why it happens
Additive immunosuppression, with possible IL-6 blockade restoring CYP3A4 activity and lowering sirolimus levels.
What to do
Avoid if an alternative exists. If both are needed, monitor for infection and measure sirolimus trough levels when tocilizumab 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 Tocilizumab
- Bcg vaccine live + Tocilizumab Contraindicated
- Measles mumps and rubella vaccine live + Tocilizumab Contraindicated
- Measles mumps rubella and varicella vaccine live + Tocilizumab Contraindicated
- Measles vaccine + Tocilizumab Contraindicated
- Rubella vaccine + Tocilizumab Contraindicated
- Smallpox vaccine live + Tocilizumab 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 Tocilizumab?
MediHelp rates the interaction as major. Sirolimus and Tocilizumab 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. Concurrent use adds immunosuppressive effects and increases the risk of serious infection. Tocilizumab may also alter sirolimus exposure by reversing inflammation-related CYP3A4 suppression.
How serious is the interaction between Sirolimus and Tocilizumab?
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 if an alternative exists. If both are needed, monitor for infection and measure sirolimus trough levels when tocilizumab is started or stopped.
What other medicines interact with Tocilizumab?
MediHelp also lists interactions of Tocilizumab with, for example, Bcg vaccine live, Measles mumps and rubella vaccine live, Measles mumps rubella and varicella vaccine live. The full list is on the Tocilizumab page.
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