Critical
Ciclosporin × ritonavir
Immunosuppressants. Calcineurin inhibitors×HIV protease inhibitor / pharmacokinetic booster
Mechanism
Ritonavir is the strongest CYP3A4 inhibitor. Cyclosporine rises 5-10 fold – acute nephrotoxicity.
Symptoms
Sharp creatinine rise, hypertension.
Management
Combination contraindicated.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.