voclosporin (Rx)

Brand and Other Names:Lupkynis
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule

  • 7.9mg

Lupus Nephritis

Indicated in combination with a background immunosuppressive therapy regimen for active lupus nephritis (LN)

23.7 mg PO BID initially; modify dose based on eGFR

Use in combination with mycophenolate mofetil (MMF) and corticosteroids

Consider discontinuation if no therapeutic benefit by 24 weeks

Safety and efficacy not established >1 year; consider risks and benefits of longer durations of treatment in light of treatment response and risk of nephrotoxicity

Dosage Modifications

eGFR dosage adjustments

  • If eGFR <60 mL/min/1.73 m2 and reduced from baseline by >20 to <30%: Reduce by 7.9 mg BID; reassess within 2 weeks; if eGFR is still reduced from baseline by >20%, reduce dose again by 7.9 mg BID
  • If eGFR <60 mL/min/1.73 m2 and reduced from baseline by ≥30%: Discontinue; reassess within 2 weeks; consider restarting at lower dose (eg, 7.9 mg BID) only if eGFR returns to ≥80% of baseline
  • Dose reductions due to eGFR: Consider increasing dose by 7.9 mg BID for each eGFR ≥80% of baseline; do not exceed starting dose

Coadministration of CYP3A4 inhibitors/inducers

  • Strong CYP3A4 inhibitors: Contraindicated
  • Moderate CYP3A4 inhibitors: Reduce voclosporin to 15.8 mg qAM and 7.9 mg qPM
  • Mild CYP3A4 inhibitors: No dosage adjustment necessary
  • Strong CYP3A4 inducers: Avoid coadministration
  • Avoid any food or drink containing grapefruit

Renal impairment

  • Baseline eGFR ≤45 mL/min/1.73 m2: Use not recommended unless benefits outweigh risks; not studied If used in patients with severe renal impairment (eGFR <30 mL/min/1.73 m2) at baseline: Decrease starting dose to 15.8 mg PO BID
  • End-stage renal disease with or without hemodialysis: Pharmacokinetics are unknown

Hepatic impairment

  • Mild or moderate (Child-Pugh A or B): Reduce to 15.8 mg BID
  • Severe (Child-Pugh C): Not recommended

Dosing Considerations

Monitoring parameters

  • Before initiating therapy
    • Baseline parameters: eGFR and blood pressure (BP)
    • Use not recommended in patients with a baseline eGFR ≤45 mL/min/1.73 m2 unless benefits outweigh risks
    • Do not initiate in if BP >165/105 mmHg or with hypertensive emergency
  • During treatment
    • eGFR: Every 2 weeks for first month, and every 4 weeks thereafter
    • BP: Every 2 weeks for first month, and as clinically indicated thereafter

Limitation of use

  • Safety and efficacy not established in combination with cyclophosphamide; use not recommended

Safety and efficacy not established

Next:

Interactions

Interaction Checker

and voclosporin

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      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (27)

            • abametapir

              abametapir will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • atazanavir

              atazanavir will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • ceritinib

              ceritinib and voclosporin both increase QTc interval. Contraindicated.

            • chloramphenicol

              chloramphenicol will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • clarithromycin

              clarithromycin will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • cobicistat

              cobicistat will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • conivaptan

              conivaptan will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • darunavir

              darunavir will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              elvitegravir/cobicistat/emtricitabine/tenofovir DF will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • grapefruit

              grapefruit will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • idelalisib

              idelalisib will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • indinavir

              indinavir will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • isoniazid

              isoniazid will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • itraconazole

              itraconazole will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • ketoconazole

              ketoconazole will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • lonafarnib

              lonafarnib will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • lopinavir

              lopinavir will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • mifepristone

              mifepristone will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • nefazodone

              nefazodone will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • nelfinavir

              nelfinavir will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • posaconazole

              posaconazole will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • ritonavir

              ritonavir will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • rucaparib

              rucaparib will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • saquinavir

              saquinavir will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • stiripentol

              stiripentol will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • tipranavir

              tipranavir will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • voriconazole

              voriconazole will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            Serious - Use Alternative (56)

            • adenovirus types 4 and 7 live, oral

              voclosporin decreases effects of adenovirus types 4 and 7 live, oral by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Immunosuppressants also increase risk of infection with concomitant live vaccines. Avoid live vaccines for at least 3 months after immunosuppressants.

            • amobarbital

              amobarbital will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • apalutamide

              apalutamide will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • armodafinil

              armodafinil will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • artemether

              artemether and voclosporin both increase QTc interval. Avoid or Use Alternate Drug.

            • BCG vaccine live

              voclosporin decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Immunosuppressants also increase risk of infection with concomitant live vaccines. Avoid live vaccines for at least 3 months after immunosuppressants.

            • bexarotene

              bexarotene will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • bosentan

              bosentan will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • brigatinib

              brigatinib will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • butabarbital

              butabarbital will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • butalbital

              butalbital will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • carbamazepine

              carbamazepine will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • chloroquine

              chloroquine and voclosporin both increase QTc interval. Avoid or Use Alternate Drug.

            • cholera vaccine

              voclosporin decreases effects of cholera vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Immunosuppressants also increase risk of infection with concomitant live vaccines. Avoid live vaccines for at least 3 months after immunosuppressants.

            • clobazam

              clobazam will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • dabrafenib

              dabrafenib will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • dengue vaccine

              voclosporin decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Immunosuppressants also increase risk of infection with concomitant live vaccines. Avoid live vaccines for at least 3 months after immunosuppressants.

            • desflurane

              desflurane and voclosporin both increase QTc interval. Avoid or Use Alternate Drug.

            • Ebola Zaire vaccine

              voclosporin decreases effects of Ebola Zaire vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Immunosuppressants also increase risk of infection with concomitant live vaccines. Avoid live vaccines for at least 3 months after immunosuppressants.

            • efavirenz

              efavirenz will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              efavirenz and voclosporin both increase QTc interval. Avoid or Use Alternate Drug.

            • elagolix

              elagolix will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • encorafenib

              encorafenib will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • enzalutamide

              enzalutamide will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • eslicarbazepine acetate

              eslicarbazepine acetate will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • etravirine

              etravirine will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • influenza virus vaccine quadrivalent, intranasal

              voclosporin decreases effects of influenza virus vaccine quadrivalent, intranasal by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Immunosuppressants also increase risk of infection with concomitant live vaccines. Avoid live vaccines for at least 3 months after immunosuppressants.

            • ivosidenib

              ivosidenib will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • lorlatinib

              lorlatinib will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • lumacaftor/ivacaftor

              lumacaftor/ivacaftor will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • measles (rubeola) vaccine

              voclosporin decreases effects of measles (rubeola) vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Immunosuppressants also increase risk of infection with concomitant live vaccines. Avoid live vaccines for at least 3 months after immunosuppressants.

            • measles mumps and rubella vaccine, live

              voclosporin decreases effects of measles mumps and rubella vaccine, live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Immunosuppressants also increase risk of infection with concomitant live vaccines. Avoid live vaccines for at least 3 months after immunosuppressants.

            • measles, mumps, rubella and varicella vaccine, live

              voclosporin decreases effects of measles, mumps, rubella and varicella vaccine, live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Immunosuppressants also increase risk of infection with concomitant live vaccines. Avoid live vaccines for at least 3 months after immunosuppressants.

            • mitotane

              mitotane will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • modafinil

              modafinil will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • nafcillin

              nafcillin will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • pentobarbital

              pentobarbital will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • pexidartinib

              pexidartinib will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • phenobarbital

              phenobarbital will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • phenytoin

              phenytoin will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • poliovirus vaccine live oral trivalent

              voclosporin decreases effects of poliovirus vaccine live oral trivalent by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Immunosuppressants also increase risk of infection with concomitant live vaccines. Avoid live vaccines for at least 3 months after immunosuppressants.

            • primidone

              primidone will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • rifabutin

              rifabutin will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • rifapentine

              rifapentine will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • rotavirus oral vaccine, live

              voclosporin decreases effects of rotavirus oral vaccine, live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Immunosuppressants also increase risk of infection with concomitant live vaccines. Avoid live vaccines for at least 3 months after immunosuppressants.

            • rubella vaccine

              voclosporin decreases effects of rubella vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Immunosuppressants also increase risk of infection with concomitant live vaccines. Avoid live vaccines for at least 3 months after immunosuppressants.

            • secobarbital

              secobarbital will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • smallpox (vaccinia) and monkeypox vaccine, live, nonreplicating

              voclosporin decreases effects of smallpox (vaccinia) vaccine, attenuated by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Immunosuppressants also increase risk of infection with concomitant live vaccines. Avoid live vaccines for at least 3 months after immunosuppressants.

            • smallpox (vaccinia) vaccine, attenuated

              voclosporin decreases effects of smallpox (vaccinia) vaccine, attenuated by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Immunosuppressants also increase risk of infection with concomitant live vaccines. Avoid live vaccines for at least 3 months after immunosuppressants.

            • smallpox (vaccinia) vaccine, live

              voclosporin decreases effects of smallpox (vaccinia) vaccine, live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Immunosuppressants also increase risk of infection with concomitant live vaccines. Avoid live vaccines for at least 3 months after immunosuppressants.

            • St John's Wort

              St John's Wort will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • telotristat ethyl

              telotristat ethyl will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • typhoid polysaccharide vaccine

              voclosporin decreases effects of typhoid polysaccharide vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Immunosuppressants also increase risk of infection with concomitant live vaccines. Avoid live vaccines for at least 3 months after immunosuppressants.

            • typhoid vaccine live

              voclosporin decreases effects of typhoid vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Immunosuppressants also increase risk of infection with concomitant live vaccines. Avoid live vaccines for at least 3 months after immunosuppressants.

            • varicella virus vaccine live

              voclosporin decreases effects of varicella virus vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Immunosuppressants also increase risk of infection with concomitant live vaccines. Avoid live vaccines for at least 3 months after immunosuppressants.

            • yellow fever vaccine

              voclosporin decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Immunosuppressants also increase risk of infection with concomitant live vaccines. Avoid live vaccines for at least 3 months after immunosuppressants.

            • zoster vaccine live

              voclosporin decreases effects of zoster vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Immunosuppressants also increase risk of infection with concomitant live vaccines. Avoid live vaccines for at least 3 months after immunosuppressants.

            Monitor Closely (343)

            • adefovir

              voclosporin, adefovir. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • albuterol

              albuterol and voclosporin both increase QTc interval. Use Caution/Monitor.

            • aldesleukin

              voclosporin, aldesleukin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • alendronate

              voclosporin, alendronate. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • alfuzosin

              voclosporin, alfuzosin. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • aliskiren

              voclosporin and aliskiren both increase serum potassium. Use Caution/Monitor.

              voclosporin, aliskiren. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • amikacin

              voclosporin, amikacin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • amikacin liposome inhalation

              voclosporin, amikacin liposome inhalation. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • amiloride

              voclosporin and amiloride both increase serum potassium. Use Caution/Monitor.

            • aminosalicylic acid

              voclosporin, aminosalicylic acid. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • amiodarone

              amiodarone will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

              voclosporin, amiodarone. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • amitriptyline

              voclosporin, amitriptyline. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • amoxapine

              voclosporin, amoxapine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • amphotericin B cholesteryl sulfate

              voclosporin, amphotericin B cholesteryl sulfate. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • amphotericin B deoxycholate

              voclosporin, amphotericin B deoxycholate. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • amphotericin B liposomal

              voclosporin, amphotericin B liposomal. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • amphotericin B phospholipid complex

              voclosporin, amphotericin B phospholipid complex. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • anidulafungin

              voclosporin, anidulafungin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • anthrax vaccine adsorbed

              voclosporin decreases effects of anthrax vaccine adsorbed by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • apomorphine

              voclosporin, apomorphine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • aprepitant

              aprepitant will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • arformoterol

              voclosporin, arformoterol. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • aripiprazole

              aripiprazole and voclosporin both increase QTc interval. Use Caution/Monitor.

            • arsenic trioxide

              voclosporin, arsenic trioxide. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • artemether/lumefantrine

              voclosporin, artemether/lumefantrine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • asenapine

              voclosporin, asenapine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • asenapine transdermal

              voclosporin, asenapine transdermal. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • aspirin

              voclosporin, aspirin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • aspirin rectal

              voclosporin, aspirin rectal. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • atomoxetine

              atomoxetine and voclosporin both increase QTc interval. Use Caution/Monitor.

            • azilsartan

              voclosporin and azilsartan both increase serum potassium. Use Caution/Monitor.

              voclosporin, azilsartan. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • azithromycin

              voclosporin, azithromycin. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • balsalazide

              voclosporin, balsalazide. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • bedaquiline

              voclosporin, bedaquiline. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • benazepril

              voclosporin and benazepril both increase serum potassium. Use Caution/Monitor.

              voclosporin, benazepril. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • berotralstat

              berotralstat will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • bicalutamide

              bicalutamide will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • bosutinib

              bosutinib and voclosporin both increase QTc interval. Use Caution/Monitor.

            • canagliflozin

              voclosporin and canagliflozin both increase serum potassium. Use Caution/Monitor.

            • candesartan

              voclosporin and candesartan both increase serum potassium. Use Caution/Monitor.

              voclosporin, candesartan. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • capecitabine

              capecitabine and voclosporin both increase QTc interval. Use Caution/Monitor.

            • capreomycin

              voclosporin, capreomycin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • captopril

              voclosporin and captopril both increase serum potassium. Use Caution/Monitor.

              voclosporin, captopril. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • carboplatin

              voclosporin, carboplatin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • caspofungin

              voclosporin, caspofungin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • cefaclor

              voclosporin, cefaclor. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • cefadroxil

              voclosporin, cefadroxil. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • cefazolin

              voclosporin, cefazolin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • cefdinir

              voclosporin, cefdinir. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • cefditoren

              voclosporin, cefditoren. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • cefixime

              voclosporin, cefixime. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • cefotaxime

              voclosporin, cefotaxime. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • cefotetan

              voclosporin, cefotetan. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • cefoxitin

              voclosporin, cefoxitin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • cefpodoxime

              voclosporin, cefpodoxime. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • cefprozil

              voclosporin, cefprozil. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ceftazidime

              voclosporin, ceftazidime. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ceftazidime/avibactam

              voclosporin, ceftazidime/avibactam. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ceftibuten

              voclosporin, ceftibuten. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ceftizoxime

              voclosporin, ceftizoxime. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ceftriaxone

              voclosporin, ceftriaxone. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • cefuroxime

              voclosporin, cefuroxime. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • celecoxib

              voclosporin, celecoxib. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • cephalexin

              voclosporin, cephalexin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ceritinib

              ceritinib will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • chlorpromazine

              voclosporin, chlorpromazine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • choline magnesium trisalicylate

              voclosporin, choline magnesium trisalicylate. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • cidofovir

              voclosporin, cidofovir. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ciprofloxacin

              voclosporin, ciprofloxacin. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • cisplatin

              voclosporin, cisplatin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • citalopram

              voclosporin, citalopram. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • clarithromycin

              voclosporin, clarithromycin. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • clofazimine

              voclosporin, clofazimine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • clomipramine

              voclosporin, clomipramine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • clonidine

              voclosporin will increase the level or effect of clonidine by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Coadministration of voclosporin (a P-gp inhibitor) increases exposure and risk of adverse reactions of P-gp substrates. For certain P-gp substrates with a narrow therapeutic window, refer to prescribing information of these substrates for dosage modifications, if needed.

            • clotrimazole

              clotrimazole will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • clozapine

              clozapine will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

              voclosporin, clozapine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • colchicine

              voclosporin will increase the level or effect of colchicine by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Coadministration of voclosporin (a P-gp inhibitor) increases exposure and risk of adverse reactions of P-gp substrates. For certain P-gp substrates with a narrow therapeutic window, refer to prescribing information of these substrates for dosage modifications, if needed.

            • colistin

              voclosporin, colistin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • COVID-19 vaccine, mRNA-Pfizer

              voclosporin decreases effects of COVID-19 vaccine, mRNA-Pfizer by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • COVID-19 vaccine, subunit-Novavax

              voclosporin decreases effects of COVID-19 vaccine, subunit-Novavax by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • COVID-19 vaccine, viral vector-Janssen

              voclosporin decreases effects of COVID-19 vaccine, viral vector-Janssen by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • crizotinib

              crizotinib will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

              voclosporin, crizotinib. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • cyclophosphamide

              voclosporin, cyclophosphamide. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • cyclosporine

              cyclosporine will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

              voclosporin and cyclosporine both increase serum potassium. Use Caution/Monitor.

            • dasatinib

              voclosporin, dasatinib. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • degarelix

              voclosporin, degarelix. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • desipramine

              desipramine will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

              voclosporin, desipramine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • deutetrabenazine

              voclosporin, deutetrabenazine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • diatrizoate

              voclosporin, diatrizoate. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • diatrizoate meglumine/diatrizoate sodium

              voclosporin, diatrizoate meglumine/diatrizoate sodium. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • diclofenac

              voclosporin, diclofenac. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • diflunisal

              voclosporin, diflunisal. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • diltiazem

              diltiazem will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • disopyramide

              voclosporin, disopyramide. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • dofetilide

              voclosporin, dofetilide. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • dolasetron

              voclosporin, dolasetron. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • donepezil

              donepezil and voclosporin both increase QTc interval. Use Caution/Monitor.

            • doxepin

              doxepin and voclosporin both increase QTc interval. Use Caution/Monitor.

            • doxycycline

              doxycycline will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • dronedarone

              dronedarone will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

              voclosporin, dronedarone. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • droperidol

              voclosporin, droperidol. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • drospirenone

              voclosporin and drospirenone both increase serum potassium. Use Caution/Monitor.

            • elvitegravir

              voclosporin, elvitegravir. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • enalapril

              voclosporin and enalapril both increase serum potassium. Use Caution/Monitor.

              voclosporin, enalapril. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • encorafenib

              voclosporin, encorafenib. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • entacapone

              entacapone will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • entrectinib

              voclosporin, entrectinib. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • eplerenone

              voclosporin and eplerenone both increase serum potassium. Use Caution/Monitor.

            • eprosartan

              voclosporin and eprosartan both increase serum potassium. Use Caution/Monitor.

              voclosporin, eprosartan. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • eribulin

              voclosporin, eribulin. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • erythromycin base

              erythromycin base will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

              voclosporin, erythromycin base. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • erythromycin ethylsuccinate

              erythromycin ethylsuccinate will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

              voclosporin, erythromycin ethylsuccinate. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • erythromycin lactobionate

              erythromycin lactobionate will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

              voclosporin, erythromycin lactobionate. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • erythromycin stearate

              erythromycin stearate will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

              voclosporin, erythromycin stearate. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • escitalopram

              voclosporin, escitalopram. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • ethiodized oil

              voclosporin, ethiodized oil. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • etidronate

              voclosporin, etidronate. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • etodolac

              voclosporin, etodolac. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • everolimus

              voclosporin, everolimus. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ezogabine

              voclosporin, ezogabine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • fedratinib

              fedratinib will increase the level or effect of voclosporin by affecting hepatic enzyme CYP2E1 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • fenoprofen

              voclosporin, fenoprofen. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • finerenone

              voclosporin and finerenone both increase serum potassium. Use Caution/Monitor.

            • flecainide

              voclosporin, flecainide. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • fluconazole

              fluconazole will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

              voclosporin, fluconazole. Either increases effects of the other by QTc interval. Use Caution/Monitor.

              voclosporin, fluconazole. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • flucytosine

              voclosporin, flucytosine. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • fluoxetine

              voclosporin, fluoxetine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • flurbiprofen

              voclosporin, flurbiprofen. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • fluvoxamine

              fluvoxamine will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • fosamprenavir

              fosamprenavir will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • foscarnet

              voclosporin, foscarnet. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • fosinopril

              voclosporin and fosinopril both increase serum potassium. Use Caution/Monitor.

              voclosporin, fosinopril. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • gadobenate

              voclosporin, gadobenate. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • gadobutrol

              voclosporin, gadobutrol. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • gadodiamide

              voclosporin, gadodiamide. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • gadofosveset

              voclosporin, gadofosveset. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • gadopentetate

              voclosporin, gadopentetate. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • gadoterate meglumine

              voclosporin, gadoterate meglumine. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • gadoteridol

              voclosporin, gadoteridol. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • gadoversetamide

              voclosporin, gadoversetamide. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • gadoxetate

              voclosporin, gadoxetate. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ganciclovir

              voclosporin, ganciclovir. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • gemtuzumab

              voclosporin, gemtuzumab. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • gentamicin

              voclosporin, gentamicin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • glasdegib

              voclosporin, glasdegib. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • griseofulvin

              voclosporin, griseofulvin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • haemophilus influenzae type b vaccine

              voclosporin decreases effects of haemophilus influenzae type b vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • haloperidol

              haloperidol will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

              voclosporin, haloperidol. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • heparin

              voclosporin and heparin both increase serum potassium. Use Caution/Monitor.

            • hepatitis A vaccine inactivated

              voclosporin decreases effects of hepatitis A vaccine inactivated by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • hepatitis a/b vaccine

              voclosporin decreases effects of hepatitis a/b vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • hepatitis b vaccine

              voclosporin decreases effects of hepatitis b vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • HIV vaccine

              voclosporin decreases effects of HIV vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • human papillomavirus vaccine, bivalent

              voclosporin decreases effects of human papillomavirus vaccine, bivalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • human papillomavirus vaccine, nonavalent

              voclosporin decreases effects of human papillomavirus vaccine, nonavalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • human papillomavirus vaccine, quadrivalent

              voclosporin decreases effects of human papillomavirus vaccine, quadrivalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • hydroxychloroquine sulfate

              voclosporin, hydroxychloroquine sulfate. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • ibandronate

              voclosporin, ibandronate. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ibrexafungerp

              voclosporin, ibrexafungerp. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ibuprofen

              voclosporin, ibuprofen. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ibuprofen IV

              voclosporin, ibuprofen IV. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ibuprofen/famotidine

              voclosporin, ibuprofen/famotidine. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ibutilide

              voclosporin, ibutilide. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • ifosfamide

              voclosporin, ifosfamide. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • iloperidone

              iloperidone will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

              voclosporin, iloperidone. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • imatinib

              imatinib will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • indacaterol, inhaled

              voclosporin, indacaterol, inhaled. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • indapamide

              voclosporin, indapamide. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • indomethacin

              voclosporin, indomethacin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • influenza A (H5N1) vaccine

              voclosporin decreases effects of influenza A (H5N1) vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • influenza virus vaccine (H5N1), adjuvanted

              voclosporin decreases effects of influenza virus vaccine (H5N1), adjuvanted by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • influenza virus vaccine quadrivalent

              voclosporin decreases effects of influenza virus vaccine quadrivalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • influenza virus vaccine quadrivalent, adjuvanted

              voclosporin decreases effects of influenza virus vaccine quadrivalent, adjuvanted by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • influenza virus vaccine quadrivalent, cell-cultured

              voclosporin decreases effects of influenza virus vaccine quadrivalent, cell-cultured by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • influenza virus vaccine quadrivalent, recombinant

              voclosporin decreases effects of influenza virus vaccine quadrivalent, recombinant by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • influenza virus vaccine trivalent

              voclosporin decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • influenza virus vaccine trivalent, adjuvanted

              voclosporin decreases effects of influenza virus vaccine trivalent, adjuvanted by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • influenza virus vaccine trivalent, recombinant

              voclosporin decreases effects of influenza virus vaccine trivalent, recombinant by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • inotersen

              voclosporin, inotersen. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • inotuzumab

              voclosporin, inotuzumab. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • iodixanol

              voclosporin, iodixanol. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ioflupane I 123

              voclosporin, ioflupane I 123. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • iohexol

              voclosporin, iohexol. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • iopamidol

              voclosporin, iopamidol. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • iopromide

              voclosporin, iopromide. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ioversol

              voclosporin, ioversol. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ioxilan

              voclosporin, ioxilan. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • irbesartan

              voclosporin and irbesartan both increase serum potassium. Use Caution/Monitor.

              voclosporin, irbesartan. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • isradipine

              voclosporin, isradipine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • itraconazole

              voclosporin, itraconazole. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ivacaftor

              ivacaftor will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • Japanese encephalitis virus vaccine

              voclosporin decreases effects of Japanese encephalitis virus vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • kanamycin

              voclosporin, kanamycin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ketoconazole

              voclosporin, ketoconazole. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ketoprofen

              voclosporin, ketoprofen. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ketorolac

              voclosporin, ketorolac. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ketorolac intranasal

              voclosporin, ketorolac intranasal. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • lapatinib

              lapatinib will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

              voclosporin, lapatinib. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • larotrectinib

              larotrectinib will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • lefamulin

              lefamulin will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

              voclosporin, lefamulin. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • letermovir

              letermovir will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

              voclosporin, letermovir. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • levofloxacin

              voclosporin, levofloxacin. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • lisinopril

              voclosporin and lisinopril both increase serum potassium. Use Caution/Monitor.

              voclosporin, lisinopril. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • lofexidine

              voclosporin, lofexidine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • lopinavir

              voclosporin, lopinavir. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • losartan

              voclosporin and losartan both increase serum potassium. Use Caution/Monitor.

              voclosporin, losartan. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • mannitol

              voclosporin, mannitol. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • maprotiline

              voclosporin, maprotiline. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • maribavir

              voclosporin, maribavir. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • meclofenamate

              voclosporin, meclofenamate. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • mefenamic acid

              voclosporin, mefenamic acid. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • mefloquine

              voclosporin, mefloquine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • meloxicam

              voclosporin, meloxicam. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • melphalan

              voclosporin, melphalan. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • meningococcal A C Y and W polysaccharide tetanus toxoid conjugate vaccine

              voclosporin decreases effects of meningococcal A C Y and W polysaccharide tetanus toxoid conjugate vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • meningococcal A C Y and W-135 diphtheria conjugate vaccine

              voclosporin decreases effects of meningococcal A C Y and W-135 diphtheria conjugate vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • meningococcal A C Y and W-135 polysaccharide vaccine combined

              voclosporin decreases effects of meningococcal A C Y and W-135 polysaccharide vaccine combined by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • meningococcal C and Y/haemophilus influenza type B vaccine

              voclosporin decreases effects of meningococcal C and Y/haemophilus influenza type B vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • meningococcal group B vaccine

              voclosporin decreases effects of meningococcal group B vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • mesalamine

              voclosporin, mesalamine. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • mesalamine rectal

              voclosporin, mesalamine rectal. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • methadone

              voclosporin, methadone. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • methotrexate

              voclosporin, methotrexate. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • metronidazole

              metronidazole will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • micafungin

              voclosporin, micafungin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • mifepristone

              voclosporin, mifepristone. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • moexipril

              voclosporin and moexipril both increase serum potassium. Use Caution/Monitor.

              voclosporin, moexipril. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • moxifloxacin

              voclosporin, moxifloxacin. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • nabumetone

              voclosporin, nabumetone. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • naproxen

              voclosporin, naproxen. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • neomycin PO

              voclosporin, neomycin PO. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • netupitant/palonosetron

              netupitant/palonosetron will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • nilotinib

              voclosporin, nilotinib. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • nortriptyline

              voclosporin, nortriptyline. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • nystatin

              voclosporin, nystatin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • octreotide

              voclosporin, octreotide. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • ofloxacin

              voclosporin, ofloxacin. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • olanzapine

              voclosporin, olanzapine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • olmesartan

              voclosporin and olmesartan both increase serum potassium. Use Caution/Monitor.

              voclosporin, olmesartan. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • olsalazine

              voclosporin, olsalazine. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ondansetron

              voclosporin, ondansetron. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • osilodrostat

              voclosporin, osilodrostat. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • osimertinib

              voclosporin, osimertinib. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • oteseconazole

              voclosporin, oteseconazole. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • oxaprozin

              voclosporin, oxaprozin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ozanimod

              voclosporin, ozanimod. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • paliperidone

              voclosporin, paliperidone. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • panobinostat

              voclosporin, panobinostat. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • pasireotide

              voclosporin, pasireotide. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • pazopanib

              voclosporin, pazopanib. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • pentamidine

              voclosporin and pentamidine both increase serum potassium. Use Caution/Monitor.

              voclosporin, pentamidine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

              voclosporin, pentamidine. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • perindopril

              voclosporin and perindopril both increase serum potassium. Use Caution/Monitor.

              voclosporin, perindopril. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • pimavanserin

              voclosporin, pimavanserin. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • pimozide

              voclosporin, pimozide. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • piroxicam

              voclosporin, piroxicam. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • pitolisant

              voclosporin, pitolisant. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • plazomicin

              voclosporin, plazomicin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • pneumococcal vaccine 13-valent

              voclosporin decreases effects of pneumococcal vaccine 13-valent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • pneumococcal vaccine 15-valent

              voclosporin decreases effects of pneumococcal vaccine 15-valent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • pneumococcal vaccine 20-valent

              voclosporin decreases effects of pneumococcal vaccine 20-valent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • pneumococcal vaccine heptavalent

              voclosporin decreases effects of pneumococcal vaccine heptavalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • pneumococcal vaccine polyvalent

              voclosporin decreases effects of pneumococcal vaccine polyvalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • poliovirus vaccine inactivated

              voclosporin decreases effects of poliovirus vaccine inactivated by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • polymyxin B

              voclosporin, polymyxin B. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • posaconazole

              voclosporin, posaconazole. Either increases effects of the other by QTc interval. Use Caution/Monitor.

              voclosporin, posaconazole. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • potassium acid phosphate

              voclosporin and potassium acid phosphate both increase serum potassium. Use Caution/Monitor.

            • potassium chloride

              voclosporin and potassium chloride both increase serum potassium. Use Caution/Monitor.

            • potassium citrate

              voclosporin and potassium citrate both increase serum potassium. Use Caution/Monitor.

            • potassium citrate/citric acid

              voclosporin and potassium citrate/citric acid both increase serum potassium. Use Caution/Monitor.

            • potassium phosphates, IV

              voclosporin and potassium phosphates, IV both increase serum potassium. Use Caution/Monitor.

            • procainamide

              voclosporin, procainamide. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • protriptyline

              voclosporin, protriptyline. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • quetiapine

              voclosporin, quetiapine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • quinapril

              voclosporin and quinapril both increase serum potassium. Use Caution/Monitor.

              voclosporin, quinapril. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • quinidine

              voclosporin, quinidine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • quinine

              voclosporin, quinine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • rabies vaccine

              voclosporin decreases effects of rabies vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • rabies vaccine chick embryo cell derived

              voclosporin decreases effects of rabies vaccine chick embryo cell derived by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • ramipril

              voclosporin and ramipril both increase serum potassium. Use Caution/Monitor.

              voclosporin, ramipril. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • ranolazine

              voclosporin, ranolazine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • ribociclib

              ribociclib will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

              voclosporin, ribociclib. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • rilpivirine

              voclosporin, rilpivirine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • risedronate

              voclosporin, risedronate. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • risperidone

              voclosporin, risperidone. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • ritonavir

              voclosporin, ritonavir. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • romidepsin

              voclosporin, romidepsin. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • sacubitril/valsartan

              voclosporin and sacubitril/valsartan both increase serum potassium. Use Caution/Monitor.

              voclosporin, sacubitril/valsartan. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • salsalate

              voclosporin, salsalate. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • saquinavir

              voclosporin, saquinavir. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • SARS-CoV-2 vaccine, inactivated

              voclosporin decreases effects of SARS-CoV-2 vaccine, inactivated by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • schisandra

              schisandra will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • selpercatinib

              voclosporin, selpercatinib. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • sertraline

              sertraline will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

              voclosporin, sertraline. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • sirolimus

              voclosporin will increase the level or effect of sirolimus by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Coadministration of voclosporin (a P-gp inhibitor) increases exposure and risk of adverse reactions of P-gp substrates. For certain P-gp substrates with a narrow therapeutic window, refer to prescribing information of these substrates for dosage modifications, if needed.

            • sodium phosphates, IV

              voclosporin, sodium phosphates, IV. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • solifenacin

              voclosporin, solifenacin. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • sorafenib

              voclosporin, sorafenib. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • sotalol

              voclosporin, sotalol. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • spironolactone

              voclosporin and spironolactone both increase serum potassium. Use Caution/Monitor.

            • streptomycin

              voclosporin, streptomycin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • streptozocin

              voclosporin, streptozocin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • succinylcholine

              voclosporin and succinylcholine both increase serum potassium. Use Caution/Monitor.

            • sulfadiazine

              voclosporin, sulfadiazine. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • sulfasalazine

              voclosporin, sulfasalazine. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • sulfisoxazole

              voclosporin, sulfisoxazole. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • sulindac

              voclosporin, sulindac. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • sunitinib

              voclosporin, sunitinib. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • tacrolimus

              voclosporin and tacrolimus both increase serum potassium. Use Caution/Monitor.

              voclosporin, tacrolimus. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • telavancin

              voclosporin, telavancin. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • telmisartan

              voclosporin and telmisartan both increase serum potassium. Use Caution/Monitor.

              voclosporin, telmisartan. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • temsirolimus

              voclosporin will increase the level or effect of temsirolimus by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Coadministration of voclosporin (a P-gp inhibitor) increases exposure and risk of adverse reactions of P-gp substrates. For certain P-gp substrates with a narrow therapeutic window, refer to prescribing information of these substrates for dosage modifications, if needed.

            • tenofovir AF

              voclosporin, tenofovir AF. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • tenofovir DF

              voclosporin, tenofovir DF. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • terbinafine

              voclosporin, terbinafine. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • tetanus toxoid adsorbed or fluid

              voclosporin decreases effects of tetanus toxoid adsorbed or fluid by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • tetrabenazine

              voclosporin, tetrabenazine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • tetracycline

              tetracycline will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • thioridazine

              voclosporin, thioridazine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • thiothixene

              voclosporin, thiothixene. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • tick-borne encephalitis vaccine

              voclosporin decreases effects of tick-borne encephalitis vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            • tiludronate

              voclosporin, tiludronate. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • tobramycin

              voclosporin, tobramycin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • tobramycin inhaled

              voclosporin, tobramycin inhaled. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • tolmetin

              voclosporin, tolmetin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • trandolapril

              voclosporin and trandolapril both increase serum potassium. Use Caution/Monitor.

              voclosporin, trandolapril. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • triamterene

              voclosporin and triamterene both increase serum potassium. Use Caution/Monitor.

            • trimethoprim

              voclosporin and trimethoprim both decrease serum potassium. Use Caution/Monitor.

            • trimipramine

              voclosporin, trimipramine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • umeclidinium bromide/vilanterol inhaled

              voclosporin, umeclidinium bromide/vilanterol inhaled. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • valganciclovir

              voclosporin, valganciclovir. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • valsartan

              voclosporin and valsartan both increase serum potassium. Use Caution/Monitor.

              voclosporin, valsartan. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • vancomycin

              voclosporin, vancomycin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • vandetanib

              voclosporin, vandetanib. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • vardenafil

              voclosporin, vardenafil. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • vemurafenib

              voclosporin, vemurafenib. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • verapamil

              verapamil will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • voriconazole

              voclosporin, voriconazole. Either increases effects of the other by QTc interval. Use Caution/Monitor.

              voclosporin, voriconazole. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • vorinostat

              voclosporin, vorinostat. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • voxelotor

              voxelotor will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • ziprasidone

              voclosporin, ziprasidone. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • zoledronic acid

              voclosporin, zoledronic acid. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • zoster vaccine recombinant

              voclosporin decreases effects of zoster vaccine recombinant by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

            Minor (30)

            • ambrisentan

              voclosporin will increase the level or effect of ambrisentan by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • atorvastatin

              voclosporin will increase the level or effect of atorvastatin by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • bosentan

              voclosporin will increase the level or effect of bosentan by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • caspofungin

              voclosporin will increase the level or effect of caspofungin by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • elagolix

              voclosporin will increase the level or effect of elagolix by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • elbasvir/grazoprevir

              voclosporin will increase the level or effect of elbasvir/grazoprevir by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • eluxadoline

              voclosporin will increase the level or effect of eluxadoline by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • enalapril

              voclosporin will increase the level or effect of enalapril by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • ezetimibe

              voclosporin will increase the level or effect of ezetimibe by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • fexofenadine

              voclosporin will increase the level or effect of fexofenadine by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • fluvastatin

              voclosporin will increase the level or effect of fluvastatin by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • fostamatinib

              fostamatinib will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • glecaprevir/pibrentasvir

              voclosporin will increase the level or effect of glecaprevir/pibrentasvir by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • glyburide

              voclosporin will increase the level or effect of glyburide by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • letermovir

              voclosporin will increase the level or effect of letermovir by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • lovastatin

              voclosporin will increase the level or effect of lovastatin by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • methotrexate

              voclosporin will increase the level or effect of methotrexate by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • olmesartan

              voclosporin will increase the level or effect of olmesartan by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • ombitasvir/paritaprevir/ritonavir

              voclosporin will increase the level or effect of ombitasvir/paritaprevir/ritonavir by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • ombitasvir/paritaprevir/ritonavir & dasabuvir

              voclosporin will increase the level or effect of ombitasvir/paritaprevir/ritonavir & dasabuvir by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • pitavastatin

              voclosporin will increase the level or effect of pitavastatin by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • pravastatin

              voclosporin will increase the level or effect of pravastatin by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • quinupristin/dalfopristin

              quinupristin/dalfopristin will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • repaglinide

              voclosporin will increase the level or effect of repaglinide by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • rifamycin

              voclosporin will increase the level or effect of rifamycin by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • rosuvastatin

              voclosporin will increase the level or effect of rosuvastatin by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • simvastatin

              voclosporin will increase the level or effect of simvastatin by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • troglitazone

              voclosporin will increase the level or effect of troglitazone by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • valsartan

              voclosporin will increase the level or effect of valsartan by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

            • voxilaprevir

              voclosporin will increase the level or effect of voxilaprevir by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

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            Adverse Effects

            >10%

            Glomerular filtration rate decreased (26%)

            Hypertension (19%)

            Diarrhea (19%)

            Headache (15%)

            Anemia (12%)

            Cough (11%)

            1-10%

            Urinary tract infection (10%)

            Upper abdominal pain (7%)

            Dyspepsia (6%)

            Alopecia (6%)

            Renal Impairment (6%)

            Abdominal pain (5%)

            Mouth ulceration (4%)

            Fatigue (4%)

            Tremor (3%)

            Acute kidney injury (3%)

            Decreased appetite (3%)

            Gingivitis (<3%)

            Hypertrichosis (<3%)

            Frequency Not Defined

            Upper respiratory tract infections (bacterial and viral)

            Herpes zoster

            Pneumonia

            Gastroenteritis

            Urinary tract infections

            Cytomegalovirus chorioretinitis

            Cytomegalovirus infection

            Herpes zoster cutaneous disseminated

            Blood creatinine increased

            Azotemia

            Renal failure

            Oliguria

            Proteinuria

            Hyperkalemia

            QT prolongation

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            Warnings

            Black Box Warnings

            Malignancies and serious infections

            • Increased risk for developing malignancies and serious infections with voclosporin or other immunosuppressants that may lead to hospitalization or death

            Contraindications

            Coadministration of strong CYP3A4 inhibitors (eg, ketoconazole, itraconazole, clarithromycin)

            Serious or severe hypersensitivity reactions to voclosporin or any of its excipients

            Cautions

            Hypertension is a common adverse reaction and may require antihypertensive therapy; monitor relevant drug interactions

            May cause a spectrum of neurotoxicities, which may include posterior reversible encephalopathy syndrome, delirium, seizure, coma, tremors, paresthesia, headache, mental status changes, and changes in motor and sensory functions; monitor for neurologic abnormalities; reduce dosage or discontinue therapy

            Hyperkalemia reported with calcineurin inhibitors; risk may be increased if coadministered with other agents associated with hyperkalemia (eg, potassium-sparing diuretics, ACE inhibitors, angiotensin receptor blockers); monitor serum potassium levels

            Cases of pure red cell aplasia (PRCA) reported in patients treated with another calcineurin-inhibitor immunosuppressant; reported risk factors were parvovirus B19 infection, underlying disease, or concomitant medications associated with PRCA; if diagnosed, consider discontinuation

            Lymphoma and other malignancies

            • Immunosuppressants, including voclosporin, increase risk of developing lymphomas and other malignancies, particularly of the skin
            • Risk may be related to intensity and duration of immunosuppression
            • Examine for skin changes
            • Avoid or limit sun exposure and avoid artificial UV light (tanning beds, sun lamps) by wearing protective clothing and using a broad-spectrum sunscreen with a high protection factor (SPF ≥30)

            Serious infections

            • Immunosuppressants, including voclosporin, increase the risk of developing bacterial, viral, fungal, and protozoal infections, including opportunistic infections
            • Infections may lead to serious, including fatal, outcomes
            • Viral infections reported include cytomegalovirus and herpes zoster infections
            • Monitor for any developing infection
            • Consider benefits and risks; use the lowest effective dose needed to maintain response

            Nephrotoxicity

            • Nephrotoxicity reported; may cause acute and/or chronic nephrotoxicity
            • Monitor renal function; consider dosage reduction or discontinuation at baseline
            • Safety and efficacy not established >1 year; consider risks and benefits of longer durations of treatment in light of treatment response and risk of nephrotoxicity
            • Concomitant nephrotoxic drugs may increase risk of nephrotoxicity

            Drug interaction overview

            • Sensitive CYP3A4 substrate; P-gp inhibitor; OATP1B1 inhibitor
            • CYP3A4 inhibitors
              • Coadministration with strong or moderate CYP3A4 inhibitors increases voclosporin effects and risk of adverse reactions
              • Use contraindicated for strong CYP3A4 inhibitors; reduce voclosporin dose for moderate CYP3A4 inhibitors; avoid food or drink containing grapefruit during treatment
            • CYP3A4 inducers
              • Coadministration with strong or moderate CYP3A4 inducers decreases voclosporin effects and efficacy
              • Avoid coadministration of strong and moderate CYP3A4 inducers
            • P-gp substrates
              • Coadministration of voclosporin increases effects and risk of adverse reactions of P-gp substrates; reduce dose of P-gp substrates with a narrow therapeutic window, if needed
            • OATP1B substrates
              • Effects on OATP1B1 substrates (eg, statins) has not been studied clinically; information suggests voclosporin may increase concentration of OATP1B1 substrates; monitor for adverse reactions of OATP1B1 substrates when concomitantly used
            • Vaccines
              • Live attenuated vaccines during treatment: Avoid use
              • Inactivated vaccines: Noted safe for administration; however, may not be sufficiently immunogenic during treatment
            • QT prolongation
              • Prolongs QTc interval in a dose-dependent manner after single-dose administration at a dose higher than the recommended therapeutic dose
              • Use in combination with other drugs that are known to prolong QTc may result in clinically significant QT prolongation
              • Consider obtaining electrocardiograms and monitoring electrolytes in patients at high risk
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            Pregnancy & Lactation

            Pregnancy

            Avoid use in pregnant females; formulation contains alcohol (21.6 mg of dehydrated ethanol per capsule for a dose of 129.4 mg/day); studies have demonstrated that alcohol is associated with fetal harm (eg, central nervous system abnormalities, behavioral disorders, impaired intellectual development)

            Insufficient data available on use in pregnant females to determine drug-associated risks for major birth defects, miscarriage, or adverse maternal or fetal outcomes

            May be used in combination with a immunosuppressive therapy regimen that includes MMF; information for MMF regarding pregnancy, pregnancy testing, contraception, and infertility also applies to this combination regimen; refer to MMF prescribing information for more information

            There are risks (eg, worsening of the underlying disease, premature birth, miscarriage, intrauterine growth restriction) to mother and fetus associated with systemic lupus erythematosus

            Animal data

            • Oral administration of either voclosporin or a 50:50 mixture of voclosporin and its cis-isomer was embryocidal and feticidal in rats and rabbits at doses 15x and 1x, respectively, the maximum recommended human dose (MRHD) of 23.7 mg BID, based on drug exposure AUC
            • Reduced placental and fetal body weights occurred in rabbits at 0.1x-0.3x the MRHD and in rats at higher drug exposures
            • Crosses the placenta in pregnant rats
            • Dystocia was evident in a prenatal and postnatal study in rats

            Lactation

            No available data on presence in human milk, effects on breastfed infants, or effects on milk production

            Present in milk of lactating rats; therefore, drug is likely to be present in human milk

            Breastfeeding is not recommended during treatment and for at least 7 days after last dose (~6 elimination half-lives)

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Calcineurin-inhibitor immunosuppressant

            Mechanism of voclosporin suppression of calcineurin has not been fully established

            Activation of lymphocytes involves an increase in intracellular calcium concentrations that bind to calcineurin regulatory site and activate calmodulin binding catalytic subunit and through dephosphorylation activates the transcription factor, Nuclear Factor of Activated T-Cell Cytoplasmic

            Immunosuppressant activity results in inhibition of lymphocyte proliferation, T-cell cytokine production, and expression of T-cell activation surface antigens

            Absorption

            Peak plasma time: 1.5 hr (empty stomach)

            Steady-state reached at 6 days

            Effects of food

            • Coadministration with either low- or high-fat meals decreased both rate and extent of absorption
            • Plasma concentration and AUC of voclosporin were reduced by 29% to 53% and 15% to 25%

            Distribution

            Vd (steady-state): 2,154 L

            Protein bound: 97%

            Metabolism

            Predominately metabolized by CYP3A4

            Metabolite in human whole blood represented 16.7% of total exposure and is about 8-fold less potent than parent molecule

            Elimination

            Clearance (steady-state): 63.6 L/hr

            Half-life: ~30 hr

            Excretion (single 70-mg dose): Feces (92.7% [5% unchanged]); urine (2.1% [0.25% unchanged])

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            Administration

            Oral Administration

            Swallow capsule whole on an empty stomach

            Do not open, crush, or divide capsule

            Administer at a consistent 12-hr schedule as close as possible and with at least 8 hr between doses

            Avoid eating grapefruit or drinking grapefruit juice

            Missed dose

            • ≤4 hr after missed dose: Take as soon as possible
            • >4 hr after missed dose: Wait until next scheduled dose; do NOT double dose

            Storage

            Store at room temperature (20-25ºC [68-77ºF]); excursions permitted to 15-30ºC (59- 86ºF)

            Do not put in another container

            Keep in original packaging until ready to be taken

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            Images

            No images available for this drug.
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            Patient Handout

            A Patient Handout is not currently available for this monograph.
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            Formulary

            FormularyPatient Discounts

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            • View the formulary and any restrictions for each plan.
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            • Compare formulary status to other drugs in the same class.
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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.