Drug Interaction Report

GENERALLY AVOID: Sirolimus may be systemically absorbed following topical administration and in some patients may have systemic immunosuppressive effects. Theoretically, administration of vaccines or oncolytic immunotherapy containing live, attenuated virus or bacteria during treatment with topical sirolimus may be associated with a risk of infection due to enhanced replication of virus or bacteria in the presence of diminished immune competence. These patients may also have decreased or suboptimal immunologic response to vaccines or oncolytic immunotherapy. However, no formal studies have been conducted to evaluate the response to vaccination or oncolytic immunotherapy during treatment with topical sirolimus.

MANAGEMENT: Live vaccines and oncolytic immunotherapy such as talimogene laherparepvec and the BCG strain of Mycobacterium bovis should be avoided in patients receiving topical sirolimus. Complete all age-appropriate vaccinations as recommended by current immunization guidelines prior to initiating treatment with topical sirolimus. Current local immunization guidelines should be consulted for recommendations on waiting periods for treatment with topical sirolimus before and after administration of live, attenuated viral or bacterial vaccines.