Drug interactions
Sirolimus + Verapamil
Severity: Major
Sirolimus and Verapamil: 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
Verapamil increases sirolimus concentrations considerably, with a reported rise in both peak and total exposure. This can cause excess immunosuppression, hyperlipidemia, cytopenias and impaired wound healing, and sirolimus may also raise verapamil levels.
What this interaction means in plain words
Sirolimus and Verapamil 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; Verapamil belongs to Cardiovascular.
Why it happens
Inhibition of CYP3A4 metabolism and P-gp efflux of sirolimus by verapamil.
What to do
Monitor sirolimus trough concentrations and reduce the dose as needed when starting verapamil, and readjust when it is stopped. Watch blood pressure and heart rate for increased verapamil effect.
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 Verapamil
- Dofetilide + Verapamil Contraindicated
- Flibanserin + Verapamil Contraindicated
- Lomitapide + Verapamil Contraindicated
- Lonafarnib + Verapamil Contraindicated
- Pimozide + Verapamil Contraindicated
- Acebutolol + Verapamil Major
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 Verapamil?
MediHelp rates the interaction as major. Sirolimus and Verapamil 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. Verapamil increases sirolimus concentrations considerably, with a reported rise in both peak and total exposure. This can cause excess immunosuppression, hyperlipidemia, cytopenias and impaired wound healing, and sirolimus may also raise verapamil levels.
How serious is the interaction between Sirolimus and Verapamil?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor sirolimus trough concentrations and reduce the dose as needed when starting verapamil, and readjust when it is stopped. Watch blood pressure and heart rate for increased verapamil effect.
What other medicines interact with Verapamil?
MediHelp also lists interactions of Verapamil with, for example, Dofetilide, Flibanserin, Lomitapide. The full list is on the Verapamil page.
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