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Rapamune

Generic Name: sirolimus (sih RO lim us)
Brand Names: Rapamune

What is sirolimus?

Sirolimus lowers your body"s immune system. The immune system helps your body fight infections. The immune system can also fight or "reject" a transplanted organ such as a liver or kidney. This is because the immune system treats the new organ as an invader.

Sirolimus is used to prevent your body from rejecting a transplanted kidney. Sirolimus is sometimes used in a combination treatment with cyclosporine (Neoral, Sandimmune) and a steroid medicine such as prednisone.

Sirolimus may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about sirolimus?

The oral liquid form of sirolimus must be mixed with water or orange juice only. Do not use any other liquids to mix this medicine.

Do not mix this medicine with grapefruit juice or potentially dangerous effects may result. Avoid eating grapefruit or drinking grapefruit juice while you are taking sirolimus.

If you also take cyclosporine, take the sirolimus at least 4 hours after taking cyclosporine.

You may take sirolimus with or without food, but take it the same way every time.

Sirolimus can lower the blood cells that help your body fight infections. Avoid contact with people who have colds, the flu, or other contagious illnesses. Do not receive any vaccines. Contact your doctor immediately if you develop signs of infection.

Sirolimus may increase your risk of developing lymphoma, a form of cancer. Talk with your doctor about your specific risk.

What should I discuss with my doctor before taking sirolimus?

Sirolimus may increase your risk of developing lymphoma, a form of cancer. Talk with your doctor about your specific risk.

Before using this medication, tell your doctor if you are allergic to any drugs, or if you have:

• high cholesterol or triglycerides;

• cytomegalovirus (CMV);

• liver disease; or

• kidney disease.

If you have any of these conditions, you may not be able to use sirolimus, or you may need a dosage adjustment or special tests during treatment.

How should I take sirolimus?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor.

The oral liquid (solution) comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

The oral liquid must be mixed with at least 2 ounces (1/4 cup) of water or orange juice. Do not use any other liquids to mix this medicine.

Stir the mixture and drink all of it right away. Then add at least 4 ounces (1/2 cup) more water or orange juice to the same glass, stir again and drink right away.

Sirolimus is usually taken once a day. If you also take cyclosporine, wait at least 4 hours after your cyclosporine dose before you take sirolimus.

You may take sirolimus with or without food, but take it the same way every time.

Sirolimus can lower the blood cells that help your body fight infections. This can make it easier for you to bleed from an injury or get sick from being around others who are ill. To be sure your blood cells do not get too low, your blood will need to be tested on a regular basis. Your kidney function may also need to be tested. Do not miss any scheduled visits to your doctor.

If you are taking Rapamune oral liquid with a disposable syringe, you may store a loaded syringe it in the carrying case provided. Keep the case at room temperature and use the medicine within 24 hours. Use a disposable syringe only once and then throw it away.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

What should I avoid while taking sirolimus?

Grapefruit and grapefruit juice may interact with sirolimus and could lead to potentially dangerous effects. Do not mix this medicine with grapefruit juice. Avoid eating grapefruit or drinking grapefruit juice while you are taking sirolimus.

Avoid contact with people who have colds, the flu, or other contagious illnesses. Contact your doctor immediately if you develop signs of infection.

Do not receive a "live" vaccine while you are being treated with sirolimus, and avoid coming into contact with anyone who has recently received a live vaccine. There is a chance that the virus could be passed on to you.

Sirolimus side effects

• fast heart rate;

• fever, chills, body aches, flu symptoms;

• breathing problems, cough, chest tightness;

• pale skin, easy bruising or bleeding, weakness; or

• pain or burning when you urinate.

Other, less serious side effects may be more likely to occur, such as:

• joint pain;

• nausea, vomiting, diarrhea, constipation, stomach pain;

• headache;

• swelling in your hands or feet, weight gain;

• tremors; or

• acne or skin rash.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect sirolimus?

Before taking sirolimus, tell your doctor if you are using any of the following drugs:

• amphotericin B (Fungizone, AmBisome, Amphotec, Abelcet);

• bromocriptine (Parlodel);

• cimetidine (Tagamet);

• cisapride (Propulsid);

• danazol (Danocrine);

• metoclopramide (Reglan );

• rifampin (Rifater, Rifadin, Rimactane), rifabutin (Mycobutin), rifapentin (Priftin);

• St. John"s wort;

• tacrolimus (Prograf);

• an ACE inhibitor such as benazepril (Lotensin), captopril (Capoten), fosinopril (Monopril), enalapril (Vasotec), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), or trandolapril (Mavik);

• an antibiotic such as clotrimazole (Mycelex Troche), fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral), voriconazole (Vfend), clarithromycin (Biaxin), erythromycin (E-Mycin, Ery-Tab, Erythrocin, E.E.S), telithromycin (Ketek), capreomycin (Capastat), or vancomycin (Vancocin, Vancoled);

• antiviral medicines such as acyclovir (Zovirax), adefovir (Hepsera), cidofovir (Vistide), or foscarnet (Foscavir);

• a calcium channel blocker such as diltiazem (Tiazac, Cardizem), nicardipine (Cardene), or verapamil (Calan, Covera, Verelan);

• cancer medicine such as aldesleukin (Proleukin), carmustine (BiCNU, Gliadel), cisplatin (Platinol), ifosfamide (Ifex), oxaliplatin (Eloxatin), plicamycin (Mithracin), streptozocin (Zanosar), or tretinoin (Vesanoid);

• HIV medicines such as amprenavir (Agenerase), indinavir (Crixivan), saquinavir (Invirase), lopinavir/ritonavir (Kaletra), ritonavir (Norvir), atazanavir (Reyataz), or nelfinavir (Viracept); or

• seizure medicine such as carbamazepine (Tegretol), phenytoin (Dilantin), phenobarbital (Luminal).

If you are using any of these drugs, you may not be able to use sirolimus, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect sirolimus. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist has additional information about sirolimus written for health professionals that you may read.

What does my medication look like?

Sirolimus is available with a prescription under the brand name Rapamune. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

• Rapamune 1 mg-white, triangular-shaped tablet

• Rapamune 2 mg-yellow, triangular-shaped tablet

• Rapamune 1 mg/mL--2 oz (60 mL) amber bottle

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ("Multum") is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum"s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum"s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.