MajorCalcineurin inhibitor (immunosuppressant)×Triazole derivatives, systemic antifungals
Updated · Methodology
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.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Vfend (voriconazole) prescribing information – CYP3A4 inhibitor, statin/immunosuppressant interactions (2020)– FDA Vfend label, Drug Interactions §7 – tacrolimus, cyclosporine, sirolimus, statins; DailyMed setid ce3ef5cf-3087-4d92-9d94-9eb8287228db
- EMA: Vfend (voriconazole) Summary of Product Characteristics, Section 4.3 (2024)
- AEMPS: Ficha técnica: Voriconazol (nº registro 80105), sección 4.5 (2026)– AEMPS, CIMA, nº registro 80105, sección 4.5