Sirolimus

(Rapamune - should not be prescribed as rapamycin)

 


Abbreviated medical protocols from EdREN, the website of the Renal Unit of the Royal Infirmary of Edinburgh

Important: Protocol superseded July 2009 - see new version here at www.edren.co.uk.
That website is in development - you can ignore the 'This website is not ready' signs ONLY for the Transplant protocols. Others are not updated or fully transferred.

This page describes the Edinburgh regimen for the use of the immunosuppressant sirolimus.

 

Indication

As an adjunct or substitute to a calcineurin phosphatase inhibitor for immunosuppression in patients in whom ciclosporin/tacrolimus have been implicated in allograft pathology.


Contra- indications

Hypersensitivity to Sirolimus and its derivatives

Pregnancy and breast feeding


Presentation, Dosage and Administration

1mg and 2mg tablets. Doses should be given on an empty stomach.
Day 1 8mg daily
Day 2 6mg daly
Day 3+ 2mg daily adjusted according to levels


Monitoring

Target range 5-15ng/ml depending on whether it is an adjunct to or substitute for a CNI.


Side Effects

  • Raised triglycerides and cholesterol
  • Thrombocytopeania
  • Mouth Ulceration
  • Anaemia
  • Neutropenia
  • Proteinuria
  • Hypokalaemia
  • Arthralgia
  • Epistaxis
  • Delayed wound healing
  • Lymphocele
  • Rash
  • Oedema
  • Infections
  • PTLD
  • Diarrhoea
  • Pulmonary syndrome

Drug Interactions

Compounds which modulate CYP3A4 activity may effect Sirolimus levels. Drugs and substances which may increase sirolimus levels include:

Drugs which may decrease Sirolimus levels:

Caution should be exercised with concomitant administration of nephrotoxic drugs.



Transplant protocols developed on the Edinburgh Transplant Unit. This page first published March 2002 by Amit Adlakha, updated November 2006 and last modified Tuesday, August 11, 2009.

NOTE that the accuracy of any statements in this information CANNOT be guaranteed. It is published in the belief that it is correct, and we endeavour to keep it so - but we do make mistakes. Furthermore, over some subjects there are differing opinions, or differing degrees of certainty. We have usually not attempted to discuss these here because the aim has been to provide an immediate and brief guide. In all areas, prior medical knowledge is assumed. The EdRenHANDBOOK is not suitable for use by those without such a background. Contact us by email or at the address given at the foot of the contents page with any comments or corrections.

 


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