Sirolimus

What is sirolimus?

Sirolimus (also called Rapamune^®) is a medicine that suppresses the immune system. It is used to decrease the body’s natural immune response and prevent or treat graft-versus-host disease (GVHD) in bone marrow transplant patients. Sirolimus is available as 1 mg and 2 mg tablets and as a liquid. All are taken by mouth.

Possible side effects of sirolimus

Early

• Nausea and vomiting

Later (usually more than a day after treatment starts)

• Increased risk of infection
• High blood pressure
• Swelling, fluid in arms and legs (called edema)
• Headache
• Stomach pain
• High cholesterol levels
• High triglyceride levels
• Decreased kidney function
• Trouble sleeping
• Shaking and tremors
• Muscle or joint pain

These are the most common side effects, but there may be others. Please report all side effects to the doctor or nurse.

In case of a severe side effect or reaction, call the doctor, nurse, or pharmacist at 595-3300. If you are outside the Memphis area, dial toll-free 1-866-2STJUDE (1-866-278-5833), and press 0 when the call connects.

Special instructions for sirolimus

• Sirolimus must be taken the same way each day. Taking the medicine at the same time each day and at the same time in relation to meals will help keep a constant amount of sirolimus in your body.
• Taking the medicine with meals may reduce stomach problems.
• Swallow tablets whole. Do not cut, crush, or chew tablets.
• Store the tablets at room temperature.
• Store the oral liquid in the refrigerator. The oral liquid bottle may be stored at room temperature for a short period of time not to exceed 15 days.
• If you miss a dose and the next dose is not due for at least 4 hours, take the missed dose right away. If the next dose is due in less than 4 hours, do not take the missed dose. Take the next dose at the scheduled time. Never take a double dose unless your doctor or pharmacist tells you to do so.
• For liquid sirolimus, use an amber oral syringe to remove the solution from the glass bottle. Empty the dose into a cup and add at least 2 ounces water or orange juice. No other liquids should be used to dilute this medicine. You should drink the medicine right away. Then add a little water or orange juice to the glass, swish it around, and drink that. Never take sirolimus with grapefruit juice.
• If you vomit within 20 minutes after a dose, repeat the full dose again.
• Be sure to drink a lot of liquids while you are taking sirolimus. This lessens the chance of kidney damage.
• Sirolimus can make your skin more sensitive to sunlight. This can cause you to have severe sunburns, skin rashes, redness, and itching. Avoid exposing your skin to sunlight and tanning bulbs. Wear protective clothing, wide-brimmed hats, and sunglasses. Use lip sunblock and sunscreen (SPF15 or higher) on exposed skin.
• Plan ahead so you do not run out of your medicine. You may contact the St. JudePharmacy if your prescription has refills.
• Some medicines may either change the blood level of sirolimus or increase the side effects of the drug. These medicines include: cyclosporine, enalapril, erythromycin, fluconazole, itraconazole, metoclopramide, omeprazole, phenytoin, phenobarbital, posaconazole, rifampin, tacrolimus, and voriconazole. Always give a complete list of medicines you are taking to your doctor or pharmacist. Check with your doctor or pharmacist before starting any new vitamins, herbals, or other medicines.

Sirolimus blood levels

The staff will tell you when they will be taking blood samples to measure sirolimus levels in your body. On that day, do not take the medicine until after the blood sample is drawn. If you have already taken sirolimus before the sample is taken, please tell your doctor or pharmacist. The staff will need to reschedule your sirolimus blood level test.