Critical
Ketoconazole × Sirolimus
Systemic antimycotics. Imidazole derivatives×Selective immunosuppressant, mTOR inhibitor
Mechanism
Ketoconazole is a strong CYP3A4 inhibitor. Sirolimus rises 11-fold. FDA Rapamune Section 4 strict contraindication.
Symptoms
Severe immunosuppression.
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.