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Sirolimus 1mg is an immunosuppressant, which is referred to natural antibiotics. It is used to prevent transplant rejection. It is prescribed to adult patients who have low or moderate immunological risk after kidney transplantation. It is used in combination with GCS and cyclosporine.
Clinical studies have found that the drug is able to reduce the risk of squamous cell skin cancer after kidney transplantation. During the study, it was found that the therapy with Sirolimus 1mg is more effective than with the use of calcineurin inhibitors. The total survival rate in the group taking Sirolimus 1mg was higher (the development of new foci was recorded in 22% of patients versus 39% of those who was taking calcineurin inhibitors). Thus, it was possible to prove that sirolimus can be used as a secondary prevention of squamous cell skin cancer (if patients have a low degree of lesions).
During the first 2-3 months Sirolimus 1mg is used in combination with glucocorticosteroids and cyclosporine. Cyclosporine should be gradually abolished in the subsequent.
The initial dose of the drug is 6 mg 1 time per day for 48 hours after the operation, then – 2 mg 1 time per day.
If the cancellation of cyclosporine is not possible, you should pick up another immunosuppressant, since the treatment with cyclosporine in combination with sirolimus is unacceptable for longer than 3 months.
Sirolimus 1mg treatment should be carried out only under the supervision of a doctor who has experience in transplantology.
It is undesirable to use sirolimus together with strong inducers (rifampicin, rifabutin) or inhibitors (ketoconazole) of CYP3A4 cytochrome system
In case of liver failure, the concentration of sirolimus in the blood should be carefully monitored.
The drug should be taken at the same time (4 hours after taking cyclosporine) to prevent fluctuations in concentration.
During the treatment, it is necessary to limit exposure to sunlight.
If the patient has not received antimicrobial prophylaxis, they may suffer from pneumonia. The appropriate prevention is needed during the first year after the operation.
It is recommended to prevent CMV infection in the first 3 months after surgery.
Sirolimus 1mg is used with extreme caution in patients with hyperlipidemia.
Sirolimus 1mg should be used with extreme caution in combination with drugs that have nephrotoxicity.
During the treatment, it is necessary to monitor kidney function in patients with hypercreatininemia.
The drug is not indicated for use during pregnancy (due to embryonic and fetotoxicity).