Sirolimus Calcium-channel blockers

SIROLIMUS CALCIUM CHANNEL BLOCKERS Plasma concentrations of sirolimus are t when given with diltiazem Plasma concentrations of both drugs are t when verapamil and sirolimus are co-administered Diltiazem and verapamil inhibit intestinal CYP3A, which is the main site of sirolimus metabolism Watch for side-effects of sirolimus when it is co-administered with diltiazem or verapamil monitor renal and hepatic function. Monitor PR and BP closely when sirolimus is given with verapamil... 

Drugs affected by voriconazole include the following benzodiazepines, calcium channel blockers, cisapride, coumarin anticoagulants, cyclosporine, ergot alkaloids, HMG-CoA reductase inhibitors, NNRTIs, phenytoin, protease inhibitors, pimozide, proton pump inhibitors, quinidine, prednisolone, rifabutin, sirolimus, sulfonylureas, tacrolimus, vinca alkaloids. 

In 26 healthy subjects the concurrent use of sirolimus oral solution 2 g daily and verapamil 180 mg every 12 hours resulted in an increase in the sirolimus maximum levels and AUC, of 2.3-fold and 2.2-fold, respectively, and an increase in the maximum levels and AUC of S-verapamil of 1.5-fold.The manufacturer notes that other calcium-channel blockers that inhibit CYP3A4 might interact similarly, and they specifically name nicardipine. ... 

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