lMONITORING REQUIREMENTS
▶Monitor whole blood-sirolimus trough concentration
(Afro-Caribbean patients may require higher doses).
▶Monitor kidney function when given with ciclosporin;
monitor lipids; monitor urine proteins.
lDIRECTIONS FOR ADMINISTRATIONFood may affect
absorption (take at the same time with respect to food).
Sirolimus oral solution should be mixed with at least 60 mL
water or orange juice in a glass or plastic container
immediately before taking; refill container with at least
120 mL of water or orange juice and drink immediately (to
ensure total dose). Do not mix with any other liquids.
lPATIENT AND CARER ADVICEPatient or carers should be
given advice on how to administer sirolimus.
Patients should be advised to avoid excessive exposure
to UV light.
lNATIONAL FUNDING/ACCESS DECISIONS
NICE decisions
▶Immunosuppressive therapy for kidney transplant in children
and young people (October 2017 )NICE TA482
Sirolimus is not recommended as an initial treatment to
prevent organ rejection in patients having a kidney
transplant. Patients whose treatment was started within
the NHS before this guidance was published should have
the option to continue treatment, without change to their
funding arrangements, until they and their NHS clinician
consider it appropriate to stop.
http://www.nice.org.uk/guidance/TA482lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Oral solution
EXCIPIENTS:May contain Ethanol
▶Rapamune(Pfizer Ltd)
Sirolimus 1 mg per 1 mlRapamune 1 mg/ml oral solution sugar-free
| 60 mlP£ 162. 41
Tablet
▶Rapamune(Pfizer Ltd)
Sirolimus 500 microgramRapamune 0. 5 mg tablets|
30 tabletP£ 69. 00 DT = £ 69. 00
Sirolimus 1 mgRapamune 1 mg tablets| 30 tabletP£ 86. 49 DT =
£ 86. 49
Sirolimus 2 mgRapamune 2 mg tablets| 30 tabletP£ 172. 98 DT
=£ 172. 98Tacrolimus 19-Mar-2018
lDRUG ACTIONTacrolimus is a calcineurin inhibitor.lINDICATIONS AND DOSE
ADOPORT®
Prophylaxis of graft rejection following liver
transplantation, starting 12 hours after transplantation
▶BY MOUTH
▶Neonate:Initially 150 micrograms/kg twice daily.▶Child:Initially 150 micrograms/kg twice daily
Prophylaxis of graft rejection following kidney
transplantation, starting within 24 hours of
transplantation
▶BY MOUTH
▶Neonate:Initially 150 micrograms/kg twice daily.▶Child:Initially 150 micrograms/kg twice daily, a lower
initial dose of 100 micrograms/kg twice daily has been
used in adolescents to prevent very high‘trough’
concentrationsProphylaxis of graft rejection following heart
transplantation following antibody induction, starting
within 5 days of transplantation
▶BY MOUTH
▶Neonate:Initially 50 – 150 micrograms/kg twice daily.▶Child:Initially 50 – 150 micrograms/kg twice daily
Prophylaxis of graft rejection following heart
transplantation without antibody induction, starting
within 12 hours of transplantation
▶BY MOUTH
▶Neonate:Initially 150 micrograms/kg twice daily, dose to
be given as soon as clinically possible ( 8 – 12 hours after
discontinuation of intravenous infusion).▶Child:Initially 150 micrograms/kg twice daily, dose to
be given as soon as clinically possible ( 8 – 12 hours after
discontinuation of intravenous infusion)
Allograft rejection resistant to conventional
immunosuppressive therapy
▶BY MOUTH
▶Child:Seek specialist advice
CAPEXION®
Prophylaxis of graft rejection following liver
transplantation, starting 12 hours after transplantation
▶BY MOUTH
▶Neonate:Initially 150 micrograms/kg twice daily.▶Child:Initially 150 micrograms/kg twice daily
Prophylaxis of graft rejection following kidney
transplantation, starting within 24 hours of
transplantation
▶BY MOUTH
▶Neonate:Initially 150 micrograms/kg twice daily.▶Child:Initially 150 micrograms/kg twice daily, a lower
initial dose of 100 micrograms/kg twice daily has been
used in adolescents to prevent very high‘trough’
concentrations
Prophylaxis of graft rejection following heart
transplantation following antibody induction, starting
within 5 days of transplantation
▶BY MOUTH
▶Neonate:Initially 50 – 150 micrograms/kg twice daily.▶Child:Initially 50 – 150 micrograms/kg twice daily
Prophylaxis of graft rejection following heart
transplantation without antibody induction, starting
within 12 hours of transplantation
▶BY MOUTH
▶Neonate:Initially 150 micrograms/kg twice daily, dose to
be given as soon as clinically possible ( 8 – 12 hours after
discontinuation of intravenous infusion).▶Child:Initially 150 micrograms/kg twice daily, dose to
be given as soon as clinically possible ( 8 – 12 hours after
discontinuation of intravenous infusion)
Allograft rejection resistant to conventional
immunosuppressive therapy
▶BY MOUTH
▶Child:Seek specialist advice
MODIGRAF®
Prophylaxis of graft rejection following liver
transplantation, starting 12 hours after transplantation
▶BY MOUTH
▶Neonate:Initially 150 micrograms/kg twice daily.▶Child:Initially 150 micrograms/kg twice daily522 Immune system disorders and transplantation BNFC 2018 – 2019
Immune system and malignant disease8