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What is Sirolimus
Sirolimus (rapamycin) is an immunosuppressant. Sirolimus is a macrolide produced by Streptomyces hydroscopicus, a streptomycete that was isolated from a soil sample from Easter Island.
Sirolimus has antifungal, antitumor, and immunosuppressive activities.
Brand Name
Rapamune
Indications & Dosage
- heart transplant rejection prophylaxis
- kidney transplant rejection prophylaxis
- lymphangioleiomyomatosis
For kidney transplant rejection prophylaxis
Side Effects
- abdominal pain
- acne vulgaris
- acneiform rash
- alopecia
- amenorrhea
- anaphylactic shock
- anaphylactoid reactions
- anemia
- angioedema
- arthralgia
- ascites
- azoospermia
- BK virus-associated nephropathy
- bronchiolitis obliterans
- cardiac tamponade
- chest pain (unspecified)
- constipation
- cough
- cystitis
- diabetes mellitus
- diarrhea
- dizziness
- dyspnea
- dysuria
- edema
- elevated hepatic enzymes
- encephalopathy
- epistaxis
- exfoliative dermatitis
- fatigue
- fever
- folliculitis
- gingivitis
- headache
- hematuria
- hemolytic-uremic syndrome
- hepatic necrosis
- hypercholesterolemia
- hyperglycemia
- hyperlipidemia
- hypertension
- hypertrichosis
- hypertriglyceridemia
- hypokalemia
- hypophosphatemia
- hypoxia
- immunosuppression
- impaired wound healing
- infection
- leukoencephalopathy
- leukopenia
- lymphocele
- lymphoma
- menorrhagia
- myalgia
- nausea
- nephrotic syndrome
- neutropenia
- new primary malignancy
- oligospermia
- onycholysis
- oral ulceration
- pancreatitis
- pancytopenia
- pericardial effusion
- peripheral edema
- pharyngitis
- pleural effusion
- pneumonitis
- post-transplant lymphoproliferative disorder (PTLD)
- proteinuria
- pruritus
- pulmonary embolism
- pulmonary fibrosis
- pulmonary hypertension
- rash
- sinus tachycardia
- stomatitis
- thrombocytopenia
- thromboembolism
- thrombosis
- thrombotic thrombocytopenic purpura (TTP)
- vasculitis
- wound dehiscence
- xerosis
Monitoring Parameters
- CBC
- serum cholesterol profile
- serum creatinine/BUN
- serum lipid profile
- serum potassium
- sirolimus concentrations
Contraindications
- accidental exposure
- Black patients
- breast-feeding
- cardiac arrhythmias
- cardiac disease
- children
- contraception requirements
- coronary artery disease
- diabetes mellitus
- dialysis
- heart failure
- hepatic disease
- hypercholesterolemia
- hyperlipidemia
- hypertriglyceridemia
- immunosuppression
- infants
- infection
- infertility
- liver transplant
- lung transplant
- lymphoma
- neonates
- new primary malignancy
- ocular exposure
- pregnancy
- proteinuria
- renal failure
- renal impairment
- reproductive risk
- requires a specialized care setting
- requires an experienced clinician
- soya lecithin hypersensitivity
- sunlight (UV) exposure
- surgery
- vaccination
- wound dehiscence
Interactions
- Acetaminophen; Butalbital
- Acetaminophen; Butalbital; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Aliskiren; Amlodipine
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Alpelisib
- Amiodarone
- Amlodipine
- Amlodipine; Atorvastatin
- Amlodipine; Benazepril
- Amlodipine; Celecoxib
- Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
- Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
- Amlodipine; Olmesartan
- Amlodipine; Telmisartan
- Amlodipine; Valsartan
- Amobarbital
- Amoxicillin; Clarithromycin; Lansoprazole
- Amoxicillin; Clarithromycin; Omeprazole
- Amprenavir
- Angiotensin-converting enzyme inhibitors
- Apalutamide
- Aprepitant, Fosaprepitant
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Pravastatin
- Atazanavir
- Atazanavir; Cobicistat
- Atorvastatin
- Atorvastatin; Ezetimibe
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Azathioprine
- Barbiturates
- Basiliximab
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
- Bismuth Subsalicylate; Metronidazole; Tetracycline
- Blinatumomab
- Boceprevir
- Bosentan
- Brigatinib
- Butabarbital
- Cabozantinib
- Canakinumab
- Capmatinib
- Carbamazepine
- Carboplatin
- Carvedilol
- Caspofungin
- Cenobamate
- Ceritinib
- Chlorambucil
- Chloramphenicol
- Cimetidine
- Cisapride
- Clarithromycin
- Clofazimine
- Cobicistat
- Conivaptan
- Crizotinib
- Cyclosporine
- Dabrafenib
- Daclatasvir
- Daclizumab
- Dalfopristin; Quinupristin
- Danazol
- Darunavir
- Darunavir; Cobicistat
- Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Daunorubicin
- Delavirdine
- Dexamethasone
- Diltiazem
- Doxorubicin
- Dronedarone
- Duvelisib
- Echinacea
- Efavirenz
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Elagolix
- Elagolix; Estradiol; Norethindrone acetate
- Elbasvir; Grazoprevir
- Elexacaftor; tezacaftor; ivacaftor
- Eliglustat
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Emapalumab
- Encorafenib
- Enzalutamide
- Erdafitinib
- Erythromycin
- Erythromycin; Sulfisoxazole
- Eslicarbazepine
- Etravirine
- Ezetimibe; Simvastatin
- Fedratinib
- Flibanserin
- Fluconazole
- Fluoxetine
- Fluoxetine; Olanzapine
- Fluvastatin
- Fluvoxamine
- food
- Fosamprenavir
- Fosphenytoin
- Fostamatinib
- Glecaprevir; Pibrentasvir
- Glycerol Phenylbutyrate
- grapefruit juice
- Ibrutinib
- Idelalisib
- Imatinib
- Indinavir
- Infliximab
- Isavuconazonium
- Isoniazid, INH; Pyrazinamide, PZA; Rifampin
- Isoniazid, INH; Rifampin
- Istradefylline
- Itraconazole
- Ivacaftor
- Ivosidenib
- Ixabepilone
- Ketoconazole
- Lapatinib
- Larotrectinib
- Ledipasvir; Sofosbuvir
- Lefamulin
- Letermovir
- Live Vaccines
- Lomitapide
- Lopinavir; Ritonavir
- Lorlatinib
- Lovastatin
- Lovastatin; Niacin
- Lumacaftor; Ivacaftor
- Lumacaftor; Ivacaftor
- Melphalan
- Mephobarbital
- Methohexital
- Metoclopramide
- Metreleptin
- Metronidazole
- Micafungin
- Mifepristone
- Mitotane
- Mycophenolate
- Natalizumab
- Nefazodone
- Nelfinavir
- Neratinib
- Nevirapine
- Niacin; Simvastatin
- Nicardipine
- Nilotinib
- Ombitasvir; Paritaprevir; Ritonavir
- Ombitasvir; Paritaprevir; Ritonavir
- Omeprazole; Amoxicillin; Rifabutin
- Oritavancin
- Osilodrostat
- Osimertinib
- Ozanimod
- Pazopanib
- Pentobarbital
- Perindopril; Amlodipine
- Phenobarbital
- Phenytoin
- Pitavastatin
- Ponatinib
- Posaconazole
- Pravastatin
- Primidone
- Protease inhibitors
- Ranolazine
- Ribociclib
- Ribociclib; Letrozole
- Rifabutin
- Rifampin
- Rifapentine
- Rimegepant
- Ritonavir
- Rolapitant
- Rucaparib
- Rufinamide
- Sapropterin
- Saquinavir
- Sarilumab
- Secobarbital
- Selpercatinib
- Siltuximab
- Simeprevir
- Simvastatin
- Simvastatin; Sitagliptin
- Sofosbuvir; Velpatasvir
- Sofosbuvir; Velpatasvir; Voxilaprevir
- Sorafenib
- St. John’s Wort, Hypericum perforatum
- Streptogramins
- Tacrolimus
- Talazoparib
- Tazemetostat
- Teduglutide
- Telaprevir
- Telithromycin
- Telotristat Ethyl
- Temozolomide
- Temsirolimus
- Tezacaftor; Ivacaftor
- Thiopental
- Tinidazole
- Tipranavir
- Tocilizumab
- Tofacitinib
- Topotecan
- Trandolapril; Verapamil
- Tucatinib
- Ubrogepant
- Upadacitinib
- Vemurafenib
- Venetoclax
- Verapamil
- Voriconazole
- Voxelotor
- Zanubrutinib
- Zileuton
- Zonisamide
