Table 2 Common CYP 3A4/5 Inhibitors. Empiric dose adjustments are suggested for tacrolimus. Cyclosporine and mTOR inhibitors have similar interactions given the overlap in metabolism, although the severity of the reaction may be reduced with cyclosporine
From: Management of kidney transplant recipients for primary care practitioners
Very Weak Inhibitors | Weak Inhibitors | Moderate Inhibitors | Strong Inhibitors | Very Strong Inhibitors |
|---|---|---|---|---|
Monitoring levels without empiric adjustment | Monitor levels without empiric adjustment or up to 20% empiric dose decrease | Empiric dose 20–40% dose decrease | Empiric 40–85% dose decrease | Empiric > 85% dose decrease after holding doses |
Ciprofloxacin | Isavuconazonium | Amiodarone | Cannabidiol†| Cobicistat |
Isoniazid |  | Cannabidiol†| Clarithromycin | Nirmatrelvir/Ritonavir |
| Â | Â | Clotrimazole | Erythromycin | Ritonavir |
|  |  | Diltiazem | Fluconazole (≥ 400 mg/day) |  |
|  |  | Fluconazole (≤ 200 mg/day) | Grapefruit†|  |
|  |  | Grapefruit†| Itraconazole |  |
| Â | Â | Letermovir | Ketoconazole | Â |
| Â | Â | Verapamil | Posaconazole | Â |
| Â | Â | Â | Voriconazole | Â |