Major

tacrolimus × Voriconazole

Calcineurin inhibitor (immunosuppressant)×Triazole derivatives, systemic antifungals

Mechanism

Voriconazole inhibits CYP3A4. Tacrolimus concentration rises 3-fold with risk of nephrotoxicity and neurotoxicity (tremor, headache, paresthesia). FDA requires reducing tacrolimus to one third of baseline and frequent blood-level monitoring.

Symptoms

Rising creatinine, tremor, headache, paresthesia, hypertension within 7 days. Tacrolimus trough above target range.

Management

Reduce tacrolimus to one third of baseline. Check trough after 2 days, then weekly. Up-titrate after voriconazole withdrawal.

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.

Open checker

Sources

FDA: Vfend (voriconazole) prescribing information – CYP3A4 inhibitor, statin/immunosuppressant interactions (2020)– FDA Vfend label, Drug Interactions §7 – tacrolimus, cyclosporine, sirolimus, statins
EMA: Vfend (voriconazole) Summary of Product Characteristics, Section 4.3 (2024)

← All interactions

Major

tacrolimus × Voriconazole

Calcineurin inhibitor (immunosuppressant)×Triazole derivatives, systemic antifungals

Mechanism

Symptoms

Rising creatinine, tremor, headache, paresthesia, hypertension within 7 days. Tacrolimus trough above target range.

Management

Reduce tacrolimus to one third of baseline. Check trough after 2 days, then weekly. Up-titrate after voriconazole withdrawal.

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.

Open checker

Sources

FDA: Vfend (voriconazole) prescribing information – CYP3A4 inhibitor, statin/immunosuppressant interactions (2020)– FDA Vfend label, Drug Interactions §7 – tacrolimus, cyclosporine, sirolimus, statins
EMA: Vfend (voriconazole) Summary of Product Characteristics, Section 4.3 (2024)

← All interactions