Posaconazole is a strong CYP3A4 inhibitor. Sirolimus rises 9-fold with severe immunosuppression. EMA Noxafil Section 4.3 strict contraindication.
Symptoms
Rising creatinine, thrombocytopenia, hepatotoxicity within 5 days.
Management
Combination contraindicated. For invasive mycosis in transplant patient, switch sirolimus to tacrolimus with 75% dose reduction and frequent monitoring.
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.