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Drug interactions between immunosuppressive agents and direct-acting antiviral agents for HCV infection

	Tacrolimus	Cyclosporine	Sirolimus	Everolimus	Azathioprine	Mycophenolate mofetil
Sofosbuvir	✓	✓	✓	✓	✓	✓
Ledipasvir-sofosbuvir	✓	✓	✓	Monitor levels*	✓	✓
Sofosbuvir-velpatasvir	✓	✓	✓	Monitor levels*	✓	✓
Daclatasvir	✓	✓	✓	Monitor levels*	✓	✓
Glecaprevir-pibrentasvir	Monitor levels^¶	If cyclosporine dose >100 mg/day, not recommended	Monitor levels^Δ	Monitor levels*	✓	✓
Elbasvir-grazoprevir	Monitor levels^¶	Not recommended	Monitor levels^Δ	Monitor levels*	✓	✓
Sofosbuvir-velpatasvir-voxilaprevir	✓	Not recommended	Monitor levels^Δ	Monitor levels*	✓	✓
Simeprevir	Monitor levels^¶	Not recommended	Monitor levels^Δ	Monitor levels*	✓	✓
Ombitasvir-paritaprevir-ritonavir with or without dasabuvir	Avoid; if used, lower tacrolimus dose to 0.5 mg every 7 days and monitor levels	Avoid; if used, lower cyclosporine to one-fifth dose and monitor levels	Not recommended	Not recommended	✓	Monitor

Overall, data informing the likelihood of drug interactions between direct-acting antivirals and immunosuppressive agents are limited. Most recommendations are based on expected pharmacokinetics.
The checkmark indicates no expected interactions that warrant change in management.

* Levels of everolimus may be increased with concurrent administration and should be followed, with dose adjustments as necessary. Conversely, everolimus may increase concentrations of simeprevir and daclatasvir.
¶ Levels of tacrolimus may be increased with concurrent administration and should be followed, with dose adjustments as necessary.
Δ Levels of sirolimus may be increased with concurrent administration and should be followed, with dose adjustments as necessary.

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