Everolimus and Remdesivir: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Everolimus
Remdesivir
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased everolimus exposure
Interaction Deep Dive
Concomitant administration of everolimus, a CYP3A4 substrate, with remdesivir, a CYP3A4 inhibitor, may increase the exposure of everolimus. Dose reduction or discontinuation of everolimus may be required after initiation of remdesivir. In a case report, tacrolimus and everolimus concentrations were increased when remdesivir was introduced for treatment of COVID-19 pneumonia, which resulted in dose reduction of tacrolimus and discontinuation of everolimus1.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of everolimus
Literature reports
1 report — tap to read
a) A 60-year-old man was stable on an anti-rejection regimen of controlled-release tacrolimus (2 mg once daily), everolimus (0.5 mg twice daily), methylprednisolone (4 mg once daily), and mizoribine (100 mg twice daily) for 1 year following a living-donor kidney transplant. The patient was admitted for the treatment of COVID-19 pneumonia. The tacrolimus concentration 3 days into hospitalization was 4.2 nanograms (ng)/mL. The target concentration was changed to 3 ng/mL with a concern of introducing remdesivir, and the tacrolimus dose was reduced to 1.5 mg once daily. On day 3, the patient received a single dose of casirivimab/imdevimab 1200 mg. On day 4 of hospitalization, remdesivir was initiated at an initial dose of 200 mg followed by 100 mg once daily for 4 days. On day 5, tacrolimus trough concentration had increased to 5.6 ng/mL; the tacrolimus dose was further reduced to 1 mg once daily. On day 6, the tacrolimus concentration rose to 6.9 ng/mL, and tacrolimus was reduced further to 0.5 mg once daily. On day 7, the everolimus concentration was 9.2 ng/mL, and everolimus was discontinued on day 8. On day 9, remdesivir was discontinued. The patient received other treatments for pneumonia including baricitinib 4 mg and levofloxacin 500 mg once daily on day 7 and piperacillin/tazobactam 4.5 mg twice daily (replacing levofloxacin on day 10). Tacrolimus concentration ranged from 4 to 5 ng/mL while the patient was receiving 0.5 mg once daily. On day 15, the tacrolimus dose was gradually increased to 2 mg once daily and everolimus (0.5 mg twice daily) was reintroduced. Trough concentrations of tacrolimus and everolimus on day 21 were in the target range and remained stable through day 90. No toxicity due to immunosuppressive agents were noted during hospitalization 1.
Common questions
Can I take Everolimus and Remdesivir together?
Increased everolimus exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Everolimus and Remdesivir interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Everolimus or Remdesivir need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Hirai T, Mizuta A, Sasaki T, et al: Drug-drug interaction between remdesivir and immunosuppressant agents in a kidney transplant recipient. Int J Clin Pharmacol Ther 2022; 60(10):439-444. DOI
Keep reading about Everolimus
Keep reading about Remdesivir
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