(should not be prescribed as rapamycin)
Hypersensivity to sirolimus and its derivatives.
Pregnancy and breast feeding
Presentation - 1mg and 2mg tablet
Dosage and Administration
Sirolimus is not used de-novo and is generally switched for tacrolimus. The following doses can be started and tacrolimus continued at half the current dose until sirolimus levels are therapeutic.
Doses should be given on an empty stomach.
Day 1 6mg daily
Day 2 onwards 2mg daily adjusted according to levels
Check sirolimus level at 1 week
Target range 5-15ng/ml depending on whether it is an adjunct to or substitute for a CNI.
Note that target in SMYPHONY study when used in place of a CNI was 4/8 ng/ml and many dropped out due to adverse events despite this lower goal level.
Raised triglycerides and cholesterol
|Delayed wound healing||Lymphocele||Rash|
Compounds which modulate CYP3A4 activity may affect Sirolimus levels.
Drugs which may increase sirolimus levels:
|Azole antifungals||Cimetidine||Protease inhibitors|
|Macrolide antibiotics||Danazol||Grapefruit juice|
Drugs which may decrease sirolimus levels: Rifampicin, anticonvulsants