Can you take Everolimus with Viramune?

Everolimus has a moderate potential interaction with Brain Tumor.

Inhibition of mTOR activity results in delays of wound healing and increases the occurrence of wound-related complications, which might require surgical intervention. Patients with central nervous system tumors (primary CNS tumor or metastases) and/or receiving anticoagulation therapy may be at an increased risk of developing intracerebral bleeding (including fatal outcomes). Caution is recommended when using these agents, particularly in the perioperative period.

Everolimus has a moderate potential interaction with Coagulation Defects and Disorders.

Inhibition of mTOR activity results in delays of wound healing and increases the occurrence of wound-related complications, which might require surgical intervention. Patients with central nervous system tumors (primary CNS tumor or metastases) and/or receiving anticoagulation therapy may be at an increased risk of developing intracerebral bleeding (including fatal outcomes). Caution is recommended when using these agents, particularly in the perioperative period.

The nevirapine in Viramune has a major potential interaction with Dermatitis, Drug-Induced.

Nevirapine can cause severe, life-threatening skin reactions such as Stevens-Johnson syndrome, toxic epidermal necrolysis, and hypersensitivity reactions characterized by rash, constitutional findings, and organ dysfunction including hepatic failure. Fatalities in association with these reactions have been reported. The first 6 weeks of therapy is the period of greatest risk, and intense monitoring is recommended during the first 18 weeks. In controlled clinical trials, Grade 3 and 4 rashes were reported during the first 6 weeks in 1.5 % of nevirapine-treated patients compared to 0.1% of placebo subjects. Patients who develop signs or symptoms of severe skin reactions or hypersensitivity reactions possibly related to nevirapine at any time during therapy must discontinue the drug and seek medical attention immediately. Because nevirapine-induced hepatitis and hepatic failure may be associated with hypersensitivity reactions, liver function tests should be performed in these patients as well as all patients who develop a rash within the first 18 weeks of treatment. Nevirapine should be permanently discontinued if clinical hepatitis or transaminase elevations combined with rash or other systemic symptoms occur, and should not be restarted after recovery. Nevirapine therapy should also not be restarted following severe skin or hypersensitivity reactions or a rash that is accompanied by fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, facial edema, eosinophilia, granulocytopenia, lymphadenopathy, or renal dysfunction. During the initial 2-week lead-in period of 200 mg/day (4 mg/kg/day in pediatric patients), the dosage of nevirapine should not be increased if any rash occurs. Dose escalation should only be attempted after the rash resolves.

Everolimus has a moderate potential interaction with Diabetes Mellitus.

Elevations in serum blood glucose levels have been reported in patients taking inhibitors of mTOR (mammalian target of rapamycin). Monitoring of fasting serum glucose levels is recommended prior to the start of therapy and periodically thereafter. Clinicians should achieve control of glucose levels before initiating therapy with these agents.

The nevirapine in Viramune has a moderate potential interaction with Hemodialysis.

Nevirapine is partially removed by hemodialysis. In a pharmacokinetic study of nevirapine in patients with renal impairment, six subjects requiring hemodialysis exhibited a 44% reduction in nevirapine systemic exposure (AUC) over a one-week period. There was also evidence of accumulation of nevirapine hydroxy-metabolites in plasma in these patients; however, the clinical significance is unknown. A supplemental dose following each dialysis session is indicated for patients undergoing chronic hemodialysis.

Everolimus has a moderate potential interaction with High Cholesterol.

Elevations in cholesterol and triglyceride levels have been reported in patients taking inhibitors of mTOR (mammalian target of rapamycin). Monitoring of fasting lipid profile is recommended prior to the start of therapy and periodically thereafter. Clinicians should achieve control of lipid levels before initiating therapy with these agents.

Everolimus has a moderate potential interaction with Immunodeficiency.

Hematologic abnormalities, including decreased levels of hemoglobin, lymphocytes, platelets, and white blood cell have been observed in patients taking everolimus. Caution is recommended when treating patients predisposed to hematologic changes. Periodic monitoring of complete blood count is recommended before starting therapy and periodically thereafter.

Everolimus has a moderate potential interaction with Infection.

The immunosuppressant effect of inhibitors of mTOR (mammalian target of rapamycin) may decrease host resistance to infectious agents and may predispose patients to bacterial, fungal, viral, or protozoal infections, infections with opportunistic pathogens, and reactivation of viral infections. Therapy with these agents should be administered with caution in patients with an infection, particularly active infections or any untreated systemic fungal, bacterial, parasitic, or viral infection. It is recommended to complete the treatment of preexisting invasive fungal infections prior to starting treatment and if a diagnosis of invasive systemic fungal infection is made during treatment, discontinue and treat with appropriate antifungal therapy.

Everolimus has a major potential interaction with Liver Disease.

Everolimus exposure was increased in patients with mild (Child-Pugh class A), moderate (Child-Pugh class B), and severe (Child-Pugh class C) hepatic impairment. In patients with mild or moderate hepatic impairment, a dose reduction is recommended. Patients with severe hepatic impairment, everolimus may be used at a reduced dose if the desired benefit outweighs the risk.

The nevirapine in Viramune has a major potential interaction with Liver Disease.

The use of nevirapine has been associated with severe, life-threatening, and fatal hepatotoxicity, particularly in the first 18 weeks of therapy. Fulminant and cholestatic hepatitis, hepatic necrosis, and hepatic failure have been reported. Nevirapine-induced hepatitis and hepatic failure may be associated with signs of hypersensitivity, which can include severe rash or rash accompanied by fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, facial edema, eosinophilia, granulocytopenia, lymphadenopathy, or renal dysfunction. In controlled clinical trials, symptomatic hepatic events regardless of severity occurred on average in 4% (range 0% to 11%) of patients who received nevirapine and 1.2% of patients in control groups. The risk was greatest in the first 6 weeks of therapy and continued to be greater in the nevirapine groups compared to controls through 18 weeks of treatment. In general, the patients at greatest risk of hepatic events are women with high CD4 counts. During the first 6 weeks of treatment, women have a 3-fold higher risk than men for symptomatic, often rash-associated, hepatic events (5.8% vs. 2.2%). In a retrospective review, women with CD4 counts greater than 250 cells/mm3 had a 12-fold higher risk of symptomatic hepatic events compared to women with lower CD4 counts (11% vs. 0.9%). A 5-fold increased risk was observed in men with CD4 counts greater than 400 cells/mm3 compared to men with lower CD4 counts (6.3% vs. 1.2%). Additionally, coinfection with hepatitis B or C and/or increased liver function tests at the start of therapy are associated with a greater risk of later symptomatic events (6 weeks or more after starting nevirapine) and asymptomatic increases in AST or ALT. Therapy with nevirapine should be administered cautiously in patients with preexisting liver disease or liver function test abnormalities. Due to the risk of drug accumulation, nevirapine should not be administered to patients with severe hepatic impairment. All patients treated with nevirapine should undergo intensive clinical and laboratory monitoring (i.e., once a month or more) during the first 18 weeks of therapy, and regular monitoring thereafter. Liver function tests should be performed at baseline, prior to dose escalation, and at two weeks post-dose escalation. Patients should be instructed to discontinue nevirapine and seek medical attention promptly if signs and symptoms of hepatic injury or hypersensitivity develop such as fever, pruritus, rash, facial edema, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice. Nevirapine should be permanently discontinued if clinical hepatitis or transaminase elevations combined with rash or other systemic symptoms occur, and should not be restarted after recovery. In some cases, hepatic injury progresses despite discontinuation of treatment.

Everolimus has a major potential interaction with Renal Dysfunction.

Cases of renal failure, including acute renal failure and elevations of serum creatinine and proteinuria, some with a fatal outcome, have been observed in patients treated with inhibitors of mTOR (mammalian target of rapamycin). Therapy with these agents should be administered cautiously in patients with renal dysfunction, in particularly where patients have additional risk factors that may further impair renal function. Renal impairment is not expected to influence drug exposure, and no dosage adjustment is recommended in patients with renal impairment. Monitoring of renal function, including measurement of blood urea nitrogen (BUN), urinary protein, or serum creatinine, is recommended prior to the start of therapy and periodically thereafter.

The nevirapine in Viramune has a moderate potential interaction with Renal Dysfunction.

Nevirapine metabolites are primarily eliminated by the kidney. The clinical significance of possible reduced metabolite clearance in renal impairment is uncertain. Therapy with nevirapine should be administered cautiously in patients with renal impairment.

Everolimus has a major potential interaction with Vaccination.

The administration of live vaccines should be avoided during therapy with inhibitor of mTOR (mammalian target of rapamycin). It is recommended that close contact with individuals who have received live vaccines should be avoided because of the potential risk for shedding from the household contact and transmission to patient. It is recommended to be up-to-date with all required immunizations, as recommended by current immunization guidelines, before initiating therapy with these agents.