Major
Rifampicin × Sirolimus
Antituberculous antibiotic×Selective immunosuppressant, mTOR inhibitor
Mechanism
Strong CYP3A4 + P-gp inducer. Sirolimus falls 70% – rejection risk.
Symptoms
Rejection signs.
Management
Alternative TB regimen. If rifampicin necessary – triple sirolimus dose.
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.