All the Drug Class Drugs
mTOR Kinase inhibitor. Sirolimus 1 mg. COAT. TABS.: 30. Init. ther. (2 to 3 mnths. post-transplant.).
The usual regimen is a 6 mg single oral load. dose, admin. as soon as possible after transplant., follow. by 2 mg once dly. until results of therap. monitor. of the medic. product are available. The dose should then be individualised to obtain whole blood trough levels of 4-12 ng/mL. The ther. should be optimised with a tapering regimen of steroids & ciclosporin microemulsion. Suggested ciclosporin trough conc. ranges for the first 2-3 mnths. after transplant. are 150-400 ng/mL.
To minimise variability, Sirolimus should be taken at the same time in relation to ciclosporin, 4 hrs. after the ciclosporin dose, and consistent. either with/without food.
Mainten. therapy: Ciclosporin should be progres. discont. over 4-8 wks., and the Sirolimus dose should be adjust. to obtain whole blood trough levels of 12-20 ng/mL. Sirolimus should be given with corticosteroids. In pts. for whom ciclosporin withdrawal is either unsuccessf. cannot be attempted, the comb. of ciclosporin and Sirolimus should not be maintain. for more than 3 mnths. post-transplant. In such pts., when clinically appropr., Sirolimus should be discont. and an alternative immunosuppress. regimen instituted. See lit.
Indicated for the prophylax. of organ reject. in adult pts. at low to moder. immunolog. risk receiving a renal transplant. It is recomm. that Rapamune be used initially in comb. with cyclosporine microemulsion and corticosteroids for 2-3 mnths. Rapamune may be contin. as mainten. ther. with corticosteroids only if cyclosporine can be progressively discont.