Table 2.

Drug–drug Interactions of experimental COVID-19 agents and immunosuppressive therapy.

Combination		Potential risk of interactions	Recommendations
Immunosuppressants	COVID-19 therapy
Calcineurin inhibitor (tacrolimus or ciclosporin)	Atazanavir or lopinavir/ritonavir or chloroquine or hydrocholoquine	Potentially increased exposure of immunosuppressant	Dose adjustment or close monitoring
Sirolimus	Atazanavir or lopinavir/ritonavir	Potentially increased exposure of immunosuppressant	Avoid coadministration
Sirolimus	Chloroquine or hydrocholoquine	Potentially increased exposure of immunosuppressant	Dose adjustment or close. monitoring
Tacrolimus or ciclosporin or sirolimus	Tocilizumab	Potentially decreased exposure of immunosuppressant	Interaction of weak intensity; additional action/monitoring or dose adjustment unlikely required
Mycophenolate	Lopinavir/ritonavir	Potentially increased or decreased exposure of mycophenolate	Dose adjustment or close monitoring
Basiliximab	Tocilizumab	Enhanced immunosuppressive effect	Avoid coadministration
Azathioprine	Ribavarin	Myelotoxicity due to accumulation of 6-methylthioinosine monophosphate	Dose adjustment or close monitoring
Azathioprine	Tocilizumab or interferon-β	Additive hematological toxicity	Caution required; close monitoring of hematological parameters

Modified from Liverpool Drug interactions Group (5 April 2020; https://www.hep-druginteractions.org/).