Version July 2025
| Tacrolimus | Cyclosporine | Sirolimus | Everolimus | Azathioprine | Mycophenolate mofetil | |
| Glecaprevir-pibrentasvir | Monitor levels* | If cyclosporine dose >100 mg/day, not recommended | Monitor levels¶ | Monitor levelsΔ | ✓ | ✓ |
| Sofosbuvir-velpatasvir | Monitor levels* | Monitor levels◊ | Monitor levels¶ | Monitor levelsΔ | ✓ | ✓ |
| Ledipasvir-sofosbuvir | Monitor levels* | ✓ | Monitor levels¶ | Monitor levelsΔ | ✓ | ✓ |
| Sofosbuvir-velpatasvir-voxilaprevir | Monitor levels* | Not recommended | Monitor levels¶ | Monitor levelsΔ | ✓ | ✓ |
| Sofosbuvir | Monitor levels* | ✓ | ✓ | ✓ | ✓ | ✓ |
| Daclatasvir | Monitor levels* | ✓ | Monitor levels¶ | Monitor levelsΔ | ✓ | ✓ |
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.DAA: direct-acting antiviral; HCV: hepatitis C virus.
* Levels of tacrolimus may initially increase with concurrent administration, particularly with glecaprevir-pibrentasvir. Additionally, tacrolimus levels may decrease during DAA treatment related to changes in liver function with clearance of HCV. Tacrolimus levels should be followed, with dose adjustments as necessary.
¶ Levels of sirolimus may be increased with concurrent administration and should be followed, with dose adjustments as necessary.
Δ Levels of everolimus may be increased with concurrent administration and should be followed, with dose adjustments as necessary.
◊ Levels of cyclosporine may be affected with concurrent administration and should be followed, with dose adjustments as necessary.