Vonoprazan and Everolimus: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Vonoprazan
Everolimus
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
Avoid coadministration of everolimus (a CYP3A4 substrate) with vonoprazan (a dual strong CYP3A4 and P-gp inhibitor) due to the potential for elevated everolimus exposure21. If concurrent therapy is necessary in transplant recipients, closely monitor everolimus whole blood trough levels 3. Frequently monitor concentrations and/or adverse reactions related to everolimus. Dosage reduction of everolimus may be needed 567.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of everolimus; inhibition of P-gp mediated efflux transport of everolimus
Literature reports
3 reports — tap to read
a) A 78-year-old female heart transplant recipient receiving everolimus-based immunosuppressive therapy for 11 years (1 mg every 12 hours) with stable trough levels experienced an 11.4-fold increase in everolimus (greater than 20 nanograms (ng)/mL) 4 days following initiation of clarithromycin (500 mg ever 12 hours) for the treatment of pneumonia. Despite a reduction in everolimus to 0.25 mg every 12 hours, her everolimus level remained elevated (18.59 ng/mL). Upon discontinuation of clarithromycin, the everolimus Cmin returned to a stable level of 8.53 ng/mL. The patient did not experience any adverse events 4.
b) Coadministration of everolimus (a CYP3A4 and P-gp substrate) and ketoconazole (a strong CYP3A4 and P-gp inhibitor) in healthy volunteers increased everolimus Cmax by 3.9-fold, AUC by 15-fold, and half-life by 89% 3.
c) When a single oral dose of midazolam 2 mg (a CYP3A4 substrate) was administered following vonoprazan 20 mg twice daily for 7 days (N=20), midazolam AUC increased 93% compared to administration of midazolam alone 567.
Common questions
Can I take Vonoprazan and Everolimus together?
Increased everolimus exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Vonoprazan and Everolimus 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 Vonoprazan or Everolimus 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 (7)
- Product Information: AFINITOR DISPERZ® tablets for oral suspension, everolimus tablets for oral suspension. Novartis Pharmaceuticals Corporation, East Hanover, NJ, 2026. DailyMed
- Product Information: AFINITOR® oral tablets, everolimus oral tablets. Novartis Pharmaceuticals Corporation, East Hanover, NJ, 2026. DailyMed
- Product Information: ZORTRESS(R) oral tablets, everolimus oral tablets. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2023. DailyMed
- Pea F, Cojutti P, Tursi V, et al: Everolimus overexposure in a heart transplant patient receiving clarithromycin for the treatment of pneumonia. Transpl Infect Dis 2015; 17(6):926-928. PubMed
- Product Information: VOQUEZNA(R) oral tablets, vonoprazan oral tablets. Phathom Pharmaceuticals Inc (per FDA), Buffalo Grove, IL, 2023. DailyMed
- Product Information: VOQUEZNA(TM) DUAL PAK(TM) oral kit, vonoprazan oral tablets, amoxicillin oral capsules kit. Phathom Pharmaceuticals (per FDA), Buffalo Grove, IL, 2023. DailyMed
- Product Information: VOQUEZNA(TM) TRIPLE PAK(TM) oral kit, vonoprazan oral tablets, amoxicillin oral capsules, clarithromycin oral tablets kit. Phathom Pharmaceuticals (per FDA), Buffalo Grove, IL, 2023. DailyMed
Keep reading about Vonoprazan
Keep reading about Everolimus
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Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
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