mTOR inhibitor (immunosuppressant)
Sirolimus
Brand names: Rapamune
Adult dose
Dose: Initial 6mg PO loading then 2mg OD; titrate to trough level
Route: PO
Frequency: OD
Clinical pearls
- Renal transplant prophylaxis (calcineurin-sparing), lymphangioleiomyomatosis (LAM), tuberous sclerosis
- Trough levels guide dosing
Contraindications
- Hypersensitivity
- Severe hepatic impairment (caution)
- Pregnancy
Side effects
- Hyperlipidaemia
- Cytopenias
- Impaired wound healing
- Pneumonitis
- Lymphoedema
- Mouth ulcers
- Proteinuria
- Infections
Interactions
- Strong CYP3A4 modulators
- Ciclosporin (raises sirolimus)
- Grapefruit juice
- Live vaccines
Monitoring
- Drug levels
- Lipids
- FBC
- Renal function
- Wound healing
Reference: BNF; NICE; SmPC; https://bnf.nice.org.uk/drugs/sirolimus/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- SMART Risk Score for Recurrent CVD · Cardiovascular Risk
- PCSK9 Inhibitor Eligibility Assessment · Lipid Management
- Immune-Related Adverse Events (irAE) -- GI Toxicity Colitis Grading · Oncology-Related GI
- irAE Hepatitis Grading (CTCAE) · Immunotherapy
- DIPSS — Dynamic International Prognostic Scoring System for Myelofibrosis · Cancer Prognosis
- BALL Score for Relapsed/Refractory CLL · Leukaemia
Pathways
- Cutaneous Lupus Erythematosus · BAD; EULAR
- Osteoporosis / Fragility Fracture · NOGG 2021; NICE NG147; NG224
- Arteritic AION (Giant Cell Arteritis) · RCOphth; BSR
- Osteoarthritis Hip / Knee Management · NICE NG226 (2022)
- Lupus Nephritis · EULAR/ERA-EDTA 2019; KDIGO 2024
- Rheumatoid Arthritis Management · NICE CG79 2018 / EULAR 2022