Drug Interaction Report

MONITOR: Sirolimus may be systemically absorbed following topical administration and in some patients may have systemic immunosuppressive effects. Theoretically, administration of vaccines during treatment with topical sirolimus may result in a diminished or suboptimal immunologic response to the vaccine. No formal studies have been conducted to evaluate the response to vaccination during treatment with topical sirolimus.

MANAGEMENT: All age-appropriate vaccinations should be completed as recommended by current immunization guidelines prior to initiating treatment with topical sirolimus. In general, the U.S. Department of Public Health Advisory Committee on Immunization Practices (ACIP) recommends that inactivated or killed vaccines be administered to non-HIV immunosuppressed patients according to the same guidelines as for healthy patients. However, higher dosages, more frequent boosters, and/or serological testing may be required in some cases. Local guidelines and prescribing information for individual vaccines should be consulted.

ADJUST DOSING INTERVAL: Coadministration of oral cholera vaccine with food or an oral beverage may impair its efficacy. The formulations of both the inactivated and live, attenuated oral cholera vaccines (Dukoral and Vaxchora, respectively) are acid-labile, and must be administered with a buffer. According to the manufacturer, eating and drinking may interfere with the protective effect of the buffer. However, clinical data are not available.

MANAGEMENT: It is recommended that patients avoid eating or drinking for 60 minutes before and after administration of either Dukoral or Vaxchora oral cholera vaccines.