In one case
fluconazole caused a significant increase in
sirolimus levels despite dose reductions from 4 mg to 2 mg.
Close monitoring of
sirolimus levels is recommended.
Ketoconazole or Itraconazole
Ketoconazole increases the maximum
serum levels of
sirolimus by 4.3-fold. Itraconazole increases the levels of
sirolimus and dosage reductions of up to 90% have been required.
Concurrent use is not recommended.