{"id":1593,"date":"2018-09-12T13:45:17","date_gmt":"2018-09-12T13:45:17","guid":{"rendered":"http:\/\/edren.org\/ren\/?page_id=1593"},"modified":"2018-09-12T13:46:42","modified_gmt":"2018-09-12T13:46:42","slug":"1593-2","status":"publish","type":"page","link":"https:\/\/edren.org\/ren\/handbook\/transplant-handbook\/immunosuppressive-drugs\/1593-2\/","title":{"rendered":"Sirolimus"},"content":{"rendered":"<h5><span style=\"font-family: georgia, palatino, serif;\"><strong><span style=\"color: #993300;\">Sirolimus (Rapamune<sup>\u00ae<\/sup>)<\/span><\/strong><\/span><\/h5>\n<p><span style=\"font-family: georgia, palatino, serif;\">(should not be prescribed as rapamycin)<\/span><\/p>\n<h5><strong><span style=\"font-family: georgia, palatino, serif; color: #993300;\">Indication<\/span><\/strong><\/h5>\n<p><span style=\"font-family: georgia, palatino, serif;\">As an adjunct to or substitute to a calcineurin phosphatase inhibitor for immunosuppression in patients in whom ciclosporin\/tacrolimus have been implicated in allograft pathology. <img decoding=\"async\" class=\"cke_anchor\" title=\"Anchor\" src=\"data:image\/gif;base64,R0lGODlhAQABAPABAP\/\/\/wAAACH5BAEKAAAALAAAAAABAAEAAAICRAEAOw==\" alt=\"Anchor\" align=\"\" data-cke-realelement=\"%3Ca%20data-cke-saved-name%3D%22_Toc100314210%22%20name%3D%22_Toc100314210%22%3E%3C%2Fa%3E\" data-cke-real-node-type=\"1\" data-cke-real-element-type=\"anchor\" \/><\/span><\/p>\n<h5><strong><span style=\"font-family: georgia, palatino, serif; color: #993300;\">Contraindications<\/span><\/strong><\/h5>\n<ul style=\"list-style-type: disc;\">\n<li><span style=\"font-family: georgia, palatino, serif;\">Hypersensitivity to <span style=\"color: #993300;\">sirolimus<\/span> and its derivatives.<\/span><\/li>\n<li><span style=\"font-family: georgia, palatino, serif;\">Pregnancy and breast feeding<\/span><\/li>\n<li><span style=\"font-family: georgia, palatino, serif;\">Presentation &#8211; 1mg and 2mg tablet<\/span><\/li>\n<\/ul>\n<h5><strong><span style=\"font-family: georgia, palatino, serif; color: #993300;\">Dosage and Administration<\/span><\/strong><\/h5>\n<p><span style=\"font-family: georgia, palatino, serif;\"><span style=\"color: #993300;\">Sirolimus<\/span> 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 <span style=\"color: #993300;\">sirolimus<\/span> levels are therapeutic.<\/span><\/p>\n<ul style=\"list-style-type: disc;\">\n<li><span style=\"font-family: georgia, palatino, serif;\">Doses should be given on an empty stomach.<\/span><\/li>\n<li><span style=\"font-family: georgia, palatino, serif;\">Day 1 &#8211; 6mg daily<\/span><\/li>\n<li><span style=\"font-family: georgia, palatino, serif;\">Day 2 onwards &#8211;\u00a0 2mg daily adjusted according to levels<\/span><\/li>\n<li><span style=\"font-family: georgia, palatino, serif;\">Check s<span style=\"color: #993300;\">irolimus<\/span> level at 1 week<\/span><\/li>\n<\/ul>\n<h5><strong><span style=\"font-family: georgia, palatino, serif; color: #993300;\">Monitoring<\/span><\/strong><\/h5>\n<p><span style=\"font-family: georgia, palatino, serif;\">Target range 5-15ng\/ml depending on whether it is an adjunct to or substitute for a CNI.<\/span><\/p>\n<p><span style=\"font-family: georgia, palatino, serif;\">Note that target in SYMPHONY 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.<\/span><\/p>\n<h5><strong><span style=\"font-family: georgia, palatino, serif; color: #993300;\">Side Effects<\/span><\/strong><\/h5>\n<p><span style=\"font-family: georgia, palatino, serif;\">Raised triglycerides and cholesterol\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/p>\n<table class=\" cke_show_border\" style=\"width: 90%;\" border=\"0\" cellspacing=\"1\" cellpadding=\"1\">\n<tbody>\n<tr>\n<td style=\"background-color: #e6f7ed; width: 30%;\"><span style=\"font-family: georgia, palatino, serif;\">Thrombocytopeania\u00a0\u00a0\u00a0\u00a0<\/span><\/td>\n<td style=\"background-color: #e6f7ed; width: 30%;\"><span style=\"font-family: georgia, palatino, serif;\">Mouth Ulceration\u00a0<\/span><\/td>\n<td style=\"background-color: #e6f7ed; width: 30%;\"><span style=\"font-family: georgia, palatino, serif;\">Proteinuria<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"background-color: #e6f7ed; width: 30%;\"><span style=\"font-family: georgia, palatino, serif;\">Anaemia<\/span><\/td>\n<td style=\"background-color: #e6f7ed; width: 30%;\"><span style=\"font-family: georgia, palatino, serif;\">Neutropenia<\/span><\/td>\n<td style=\"background-color: #e6f7ed; width: 30%;\"><span style=\"font-family: georgia, palatino, serif;\">Diarrhoea<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"background-color: #e6f7ed; width: 30%;\"><span style=\"font-family: georgia, palatino, serif;\">Hypokalaemia<\/span><\/td>\n<td style=\"background-color: #e6f7ed; width: 30%;\"><span style=\"font-family: georgia, palatino, serif;\">Arthalgia<\/span><\/td>\n<td style=\"background-color: #e6f7ed; width: 30%;\"><span style=\"font-family: georgia, palatino, serif;\">Epistaxis<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"background-color: #e6f7ed; width: 30%;\"><span style=\"font-family: georgia, palatino, serif;\">Delayed wound healing<\/span><\/td>\n<td style=\"background-color: #e6f7ed; width: 30%;\"><span style=\"font-family: georgia, palatino, serif;\">Lymphocele<\/span><\/td>\n<td style=\"background-color: #e6f7ed; width: 30%;\"><span style=\"font-family: georgia, palatino, serif;\">Rash<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"background-color: #e6f7ed; width: 30%;\"><span style=\"font-family: georgia, palatino, serif;\">Oedema<\/span><\/td>\n<td style=\"background-color: #e6f7ed; width: 30%;\"><span style=\"font-family: georgia, palatino, serif;\">Infections<\/span><\/td>\n<td style=\"background-color: #e6f7ed; width: 30%;\"><span style=\"font-family: georgia, palatino, serif;\">PTLD<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h5><strong><span style=\"font-family: georgia, palatino, serif; color: #993300;\">Drug Interactions<\/span><\/strong><\/h5>\n<p><span style=\"font-family: georgia, palatino, serif;\"><em>Compounds which modulate CYP3A4 activity may affect <span style=\"color: #993300;\">Sirolimus<\/span> levels.<\/em><\/span><\/p>\n<p><span style=\"font-family: georgia, palatino, serif;\">Drugs which may increase <span style=\"color: #993300;\">sirolimus<\/span> levels:<\/span><\/p>\n<table class=\" cke_show_border\" style=\"width: 90%;\" border=\"0\" cellspacing=\"1\" cellpadding=\"1\">\n<tbody>\n<tr>\n<td style=\"width: 30%; background-color: #e6f7ed;\"><span style=\"font-family: georgia, palatino, serif;\">Diltiazem<\/span><\/td>\n<td style=\"width: 30%; background-color: #e6f7ed;\"><span style=\"font-family: georgia, palatino, serif;\">Bromocriptine<\/span><\/td>\n<td style=\"width: 30%; background-color: #e6f7ed;\"><span style=\"font-family: georgia, palatino, serif;\">Prokinetic agents<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 30%; background-color: #e6f7ed;\"><span style=\"font-family: georgia, palatino, serif;\">Azole antifungals<\/span><\/td>\n<td style=\"width: 30%; background-color: #e6f7ed;\"><span style=\"font-family: georgia, palatino, serif;\">Cimetidine<\/span><\/td>\n<td style=\"width: 30%; background-color: #e6f7ed;\"><span style=\"font-family: georgia, palatino, serif;\">Protease inhibitors<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 30%; background-color: #e6f7ed;\"><span style=\"font-family: georgia, palatino, serif;\">Macrolide antibiotics<\/span><\/td>\n<td style=\"width: 30%; background-color: #e6f7ed;\"><span style=\"font-family: georgia, palatino, serif;\">Danazol<\/span><\/td>\n<td style=\"width: 30%; background-color: #e6f7ed;\"><span style=\"font-family: georgia, palatino, serif;\">Grapefruit juice<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><span style=\"font-family: georgia, palatino, serif;\">Drugs which may decrease <span style=\"color: #993300;\">sirolimus<\/span> levels: \u00a0Rifampicin, anticonvulsants<\/span><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Sirolimus (Rapamune\u00ae) (should not be prescribed as rapamycin) Indication As an adjunct to or substitute to a calcineurin phosphatase inhibitor for immunosuppression in patients in whom ciclosporin\/tacrolimus have been implicated in allograft pathology. Contraindications Hypersensitivity to sirolimus and its derivatives. Pregnancy and breast feeding Presentation &#8211; 1mg and 2mg tablet\u2026<\/p>\n<p> <a class=\"continue-reading-link\" href=\"https:\/\/edren.org\/ren\/handbook\/transplant-handbook\/immunosuppressive-drugs\/1593-2\/\"><span>Continue reading<\/span><i class=\"crycon-right-dir\"><\/i><\/a> <\/p>\n","protected":false},"author":2,"featured_media":0,"parent":1568,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"class_list":["post-1593","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/1593","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/comments?post=1593"}],"version-history":[{"count":4,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/1593\/revisions"}],"predecessor-version":[{"id":1598,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/1593\/revisions\/1598"}],"up":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/1568"}],"wp:attachment":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/media?parent=1593"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}