Drug Interaction Report

MONITOR: Higher dosages of lipid-lowering agents may be required during concomitant administration of sirolimus or temsirolimus. Dose-related serum lipid abnormalities, including but not limited to increased serum cholesterol and triglycerides, have been frequently reported in patients treated with sirolimus or temsirolimus.

MANAGEMENT: Close clinical monitoring of serum cholesterol and triglycerides is recommended if sirolimus or temsirolimus is prescribed to patients receiving lipid-lowering agents. Modification of the antihyperlipidemic regimen or dosages may be necessary.

ADJUST DOSING INTERVAL: Consumption of food can decrease the rate and extent of gastrointestinal absorption of sirolimus. Also, the consumption of grapefruit juice may result in increased sirolimus trough concentrations.

MANAGEMENT: Experts recommend that this drug be taken either at least one hour prior to eating or consistently with or without food to avoid variations in sirolimus blood levels. The manufacturer recommends against using grapefruit juice for dilution of sirolimus doses. Patients should be monitored for clinical and laboratory evidence of altered immunosuppressant effects.