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Drug Interactions between sirolimus and Sovuna

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

hydroxychloroquine sirolimus

Applies to: Sovuna (hydroxychloroquine) and sirolimus

MONITOR: Coadministration with drugs that are inhibitors of CYP450 3A4 may increase the blood concentrations of the macrolide immunosuppressants sirolimus and tacrolimus, both of which are metabolized by the isoenzyme.

MANAGEMENT: The possibility of prolonged and/or increased pharmacologic effects of macrolide immunosuppressant therapy should be considered, including adverse effects such as fever, infection, diarrhea, hypokalemia, anemia, thrombocytopenia, leukopenia, and hyperlipidemia. Dosage adjustments as well as clinical and laboratory monitoring may be appropriate whenever a CYP450 3A4 inhibitor is added to or withdrawn from therapy.

References (7)
  1. (2001) "Product Information. Prograf (tacrolimus)." Fujisawa
  2. (2001) "Product Information. Parlodel (bromocriptine)." Sandoz Pharmaceuticals Corporation
  3. Christians U, Schmidt G, Bader A, et al. (1996) "Identification of drugs inhibiting the in vitro metabolism of tacrolimus by human liver microsomes." Br J Clin Pharmacol, 41, p. 187-90
  4. (2001) "Product Information. Rapamune (sirolimus)." Wyeth-Ayerst Laboratories
  5. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  6. Cerner Multum, Inc. "Australian Product Information."
  7. (2021) "Product Information. Qelbree (viloxazine)." Supernus Pharmaceuticals Inc

Drug and food interactions

Moderate

hydroxychloroquine food

Applies to: Sovuna (hydroxychloroquine)

GENERALLY AVOID: Theoretically, grapefruit and grapefruit juice may increase the plasma concentrations of hydroxychloroquine or chloroquine and the risk of toxicities such as QT interval prolongation and ventricular arrhythmias. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall induced by certain compounds present in grapefruit. Following coadministration with cimetidine, a weak to moderate CYP450 3A4 inhibitor, a 2-fold increase in chloroquine exposure occurred. Since chloroquine and hydroxychloroquine have similar structures and metabolic elimination pathways, a similar interaction may be observed with hydroxychloroquine. In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition. Pharmacokinetic interactions involving grapefruit juice are also subject to a high degree of interpatient variability, thus the extent to which a given patient may be affected is difficult to predict.

ADJUST DOSING INTERVAL: Administration with food or milk may reduce the incidence of hydroxychloroquine-related gastrointestinal adverse effects.

MANAGEMENT: Although clinical data are lacking, it may be advisable to avoid the consumption of grapefruit, grapefruit juice, and any supplement containing grapefruit extract during hydroxychloroquine or chloroquine therapy. Hydroxychloroquine should be administered with food or milk to reduce the occurrence of gastrointestinal upset.

References (5)
  1. (2024) "Product Information. Hydroxychloroquine Sulfate (hydroxychloroquine)." Dr. Reddy's Laboratories Inc
  2. (2023) "Product Information. Plaquenil (hydroxychloroquine)." Sanofi-Aventis Canada Inc
  3. (2024) "Product Information. Quinoric (hydroxychloroquine)." Bristol Laboratories Ltd
  4. (2024) "Product Information. Hydroxychloroquine (GH) (hydroxychloroquine)." Generic Health Pty Ltd
  5. (2023) "Product Information. HIDROXICLOROQUINA RATIOPHARM (hidroxicloroquina)." RATIOPHARM ESPANA S.A.
Moderate

sirolimus food

Applies to: sirolimus

ADJUST DOSING INTERVAL: Consumption of food can decrease the rate and extent of gastrointestinal absorption of sirolimus. Also, the consumption of grapefruit juice may result in increased sirolimus trough concentrations.

MANAGEMENT: Experts recommend that this drug be taken either at least one hour prior to eating or consistently with or without food to avoid variations in sirolimus blood levels. The manufacturer recommends against using grapefruit juice for dilution of sirolimus doses. Patients should be monitored for clinical and laboratory evidence of altered immunosuppressant effects.

References (1)
  1. (2001) "Product Information. Rapamune (sirolimus)." Wyeth-Ayerst Laboratories

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.