CriticalHIV protease inhibitor / pharmacokinetic booster×Selective immunosuppressant, mTOR inhibitor
Updated · Methodology
Mechanism
Ritonavir is the strongest CYP3A4 inhibitor. Sirolimus rises 15-fold.
Symptoms
Acute nephrotoxicity, thrombotic microangiopathy.
Management
Combination contraindicated. For HIV in transplant patient – ARV regimen without ritonavir or cobicistat.
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
- FDA: Rapamune (sirolimus) prescribing information (2017)
- EMA: Ficha técnica: Sirolimús (EU/1/01/171), sección 4.5 (2026)– EMA SmPC vía AEMPS CIMA, nº 01171013 (EU/1/01/171), sección 4.5, consultado 10/2026