CONCOMITANT USE OF STRONG CYP3A4 INHIBITORS SHOULD BE AVOIDED (E.G. KETOCONAZOLE, ITRACONAZOLE, CLARITHROMYCIN, ATAZANAVIR, INDINAVIR, NEFAZODONE, NELFINAVIR, RITONAVIR, SAQUINAVIR, TELITHROMYCIN, AND VORICONAZOLE). GRAPEFRUIT JUICE MAY ALSO INCREASE PLASMA CONCENTRATIONS OF SIROLIMUS (A MAJOR METABOLITE OF TEMSIROLIMUS).
CONCOMITANT USE OF STRONG CYP3A4 INDUCERS SHOULD BE AVOIDED (E.G. DEXAMETHASONE, PHENYTOIN, CARBAMAZEPINE, RIFAMPIN, RIFABUTIN, RIFAMPACIN, PHENOBARBITAL). IF PATIENTS MUST BE CO-ADMINISTERED, TORISEL DOSE INCREASE FROM 25 MG/WEEK UP TO 50 MG/WEEK SHOULD BE CONSIDERED.