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-Background and Objectives: Our case demonstrates the first report of an interaction with sirolimus and nefazodone in a stable renal transplant patient. Nefazodone can inhibit cytochrome P450 3A4 and may result in elevated concentrations of sirolimus since sirolimus is metabolized by cytochrome P450 3A4.Methods: A 44-year-old patient was taking nefazodone pre-transplant and post-transplant. When nefazodone was discontinued the sirolimus level was undetectable.Results: This drug interaction was not suspected because the patient was on nefazodone pre-transplant.Conclusions: It is very important to monitor the sirolimus trough level when nefazodone is initiated, discontinued, or the dose is adjusted to prevent sirolimus subtherapeutic or supratherapeutic trough levels.

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