Drug-Drug Interactions, Adverse Reactions & Contraindications
In terms of drug-drug interactions, concentration of Sirolimus can increase with concomitant use of CYP3A4/P-gp inducers or inhibitors. Verapamil can also increase the concentration of Sirolimus while drugs like Phenobarbital, Rifapentine, St. John Wort (Hypericum perforatum ), Carbamazepine can decrease the concentration of Sirolimus. Certain other drugs like diltiazem, fluconazole, cimetidine, bromocriptine, protease inhibitors like ritonavir, indinavir and telaprevir\sout, etc. can increase blood concentration of Sirolimus [20]. The use of Sirolimus is not recommended for liver transplant patients as it can cause high mortality due to hepatic artery thrombosis and graft loss,while it can cause bronchial anastomotic dehiscence in lung transplant patients. Most commonly, it can cause peripheral edema, hypertension, hypercholesterolemia in patients with renal transplant. It is contraindicated for patients suffering with hypersensitivity which includes symptoms like anaphylactic reactions, angioedema, hypersensitivity vasculitis, exfoliative dermatitis. [23].