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Discussion:

Tacrolimus toxicity can cause various symptoms, and CNI nephrotoxicity is reversible. Nirmatrelvir/ritonavir-induced tacrolimus toxicity in three case reports. Due to severe drug interactions, the COVID-19 Drug Interactions database warns against nirmatrelvir/ritonavir use with tacrolimus. The American Society of Transplantation recommends alternative therapy, and the National Institutes of Health suggests holding tacrolimus during nirmatrelvir/ritonavir treatment. Avoiding nirmatrelvir/ritonavir in people taking tacrolimus is crucial, if possible, due to the severe drug-to-drug interaction, as highlighted in our case.