Rapamune

Prophylaxis of organ rejection in patients receiving renal transplant.

De novo transplant combination therapy: Low to moderate immunologic risk Loading dose: 6 mg as soon as possible after transplant. Maintenance: 2 mg daily. High immunologic risk Loading dose: 15 mg on day 1 post-transplant. Maintenance: Initially 5 mg daily on day 2, adjust dose based on whole blood conc 10-15 ng/mL by obtaining trough levels on days 5-7. Cyclosporine w/drawal Discontinue use over 4-8 wk at 2-4 mth after transplantation. Adjust dose based on whole blood trough conc 16-24 ng/mL (chromatographic method) for 1st yr, thereafter 12-20 ng/mL. Hepatic impairment Reduce maintenance dose by approx ¹/₃ to ½.

May be taken with or without food: Take consistently either always w/ or always w/o meals. Avoid grapefruit juice.

Hypersensitivity.

Hypersensitivity eg, anaphylactic/anaphylactoid reactions, angioedema, exfoliative dermatitis & hypersensitivity vasculitis. Not recommended in liver or lung transplant patients. Increased risk of lymphoma & other skin malignancies; opportunistic, sepsis & fatal infections; latent viral infections activation; ILD. Impaired or delayed wound healing, fluid accumulation. Administer Pneumocystis carinii pneumonia prophylaxis for 1 yr post-transplant & cytomegalovirus (CMV) prophylaxis for 3 mth after transplant. Limit exposure to sun & UV light. Monitor serum cholesterol & triglycerides levels; possible rhabdomyolysis development. Perform periodic quantitative monitoring of urinary protein excretion. Monitor renal function during therapy. Not recommended in co-administration w/ CYP3A4 &/or P-gp strong inhibitors & inducers. Co-administration w/ cannabidiol, calcineurin & ACE inhibitors. Not recommended in high-risk renal transfer patients eg, Banff 93 grade III acute or vascular rejection, dialysis-dependent or w/ serum creatinine >4.5 mg/dL, Black patients, renal re-transplants, multi-organ transplants & patients w/ high reactive Ab panel. Hepatic impairment. Initiate effective contraception prior to, during & for 12 wk after last dose. Pregnancy & lactation. Childn <13 yr.

Pneumonia, fungal, viral & bacterial infection, herpes simplex, UTI; thrombocytopenia, anaemia, leukopenia; hypokalaemia, hypophosphataemia, hyperlipidaemia, hyperglycaemia, hypertriglyceridaemia, fluid retention, DM; headache; tachycardia; HTN, lymphocele; abdominal pain, constipation, diarrhoea, nausea; rash, acne; arthralgia; proteinuria; menstrual disorders; impaired healing, oedema, peripheral oedema, pyrexia, pain; abnormal LFTs, increased blood creatinine & LDH. Sepsis, pyelonephritis, CMV infection, herpes zoster; squamous cell skin & basal cell carcinoma; haemolytic uraemic syndrome, neutropenia; hypersensitivity; pericardial effusion; venous thrombosis; pulmonary embolism, pneumonitis, pleural effusion, epistaxis; pancreatitis, stomatitis, ascites; osteonecrosis; ovarian cyst.

Increased levels w/ CYP3A4 & P-gp inhibitors eg, diltiazem, nicardipine, verapamil, clotrimazole, fluconazole, itraconazole, ketoconazole, voriconazole, clarithromycin, erythromycin, telithromycin, troleandomycin, cisapride, metoclopramide, bromocriptine, cimetidine, cyclosporine, danazol, letermovir, ritonavir, indinavir, boceprevir, telaprevir, grapefruit juice. Decreased levels w/ CYP3A4 & P-gp inducers eg, carbamazepine, phenobarb, phenytoin, rifabutin, rifampicin, rifapentine, St. John's wort. Monitor for rhabdomyolysis development w/ cyclosporine, HMG-CoA reductase inhibitors &/or fibrates. Monitor blood levels & toxicity w/ cannabidiol. Calcineurin inhibitor-induced hemolytic uremic syndrome/TTP/thrombotic microangiopathy w/ calcineurin inhibitor. Avoid use of live vaccines. Affected bioavailability by concomitant food intake.

Immunosuppressants

L04AH01 - sirolimus ; Belongs to the class of mammalian target of rapamycin (mTOR) kinase inhibitors. Used as immunosuppressants.

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