MajormTOR kinase inhibitor – immunosuppressant and antineoplastic×HIV protease inhibitor / pharmacokinetic booster
Updated · Methodology
Mechanism
Ritonavir is one of the strongest CYP3A4 inhibitors, and CYP3A4 clears everolimus. With ketoconazole, an inhibitor of the same strength, everolimus AUC rises 15-fold.
Symptoms
Acute nephrotoxicity, pneumonitis.
Management
The combination is not recommended. The European everolimus SmPCs for cancer and tuberous sclerosis (EMA) name ritonavir among strong CYP3A4 inhibitors and advise against the pair, as there are no data to guide dosing. The US cancer label (FDA) says to avoid it. After organ transplantation, the Spanish everolimus SmPC allows the pair only if the benefit outweighs the risk, and the US transplant label only with close monitoring of everolimus trough levels. In that case, adjust the dose to trough levels measured at least 4–5 days after the previous dose change (everolimus SmPC). The ritonavir label calls for careful monitoring of everolimus effect and adverse reactions.
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.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- EMA: Votubia (everolimus) EPAR – EMA (2024)– EMA EPAR Certican
- AEMPS: Ficha técnica: Ritonavir (nº registro 81039), sección 4.5 (2025)– AEMPS, CIMA, nº registro 81039, sección 4.5
- AEMPS: Ficha técnica: Everolimus (nº registro 84203), sección 4.5 (2024)– AEMPS, CIMA, nº registro 84203, sección 4.5
- FDA: Everolimus Tablets – Prescribing Information (2026)– FDA, DailyMed SPL, Hikma Pharmaceuticals, разделы 2.11 и 7.1, пересмотр этикетки 08/2026
- FDA: Zortress (everolimus) tablets – Prescribing Information (2026)– FDA, DailyMed SPL, Novartis Pharmaceuticals, разделы 5.14 и 7.1, пересмотр этикетки 02/2026
- EMA: Ficha técnica: Everolimus (EU/1/09/538), secciones 4.4 y 4.5 (2025)– EMA, Afinitor 10 mg comprimidos, ficha técnica en CIMA (nº registro 09538004), revisión 11/2025, secciones 4.4 y 4.5
- AEMPS: Ficha técnica: Everolimus (Certican 0,25 mg) (nº registro 66001), secciones 4.2, 4.4 y 4.5 (2024)– AEMPS, CIMA, nº registro 66001, revisión 07/2024, secciones 4.2, 4.4 y 4.5
- FDA: Afinitor (everolimus) prescribing information (2026)– FDA, DailyMed setid 2150f73a-179b-4afc-b8ce-67c85cc72f04 (Novartis Pharmaceuticals Corporation), revised 06/2026, sections 2.11, 4 and 7.1