Indications & Dose: ADVANCED PANCREATIC NEUROENDOCRINE TUMORS PO Adult 10mg OD | RENAL CELL CANCER (RCC), ADVANCED PO Adult 10mg/day | RENAL TRANSPLANTATION, REJECTION PROPHYLAXIS PO Adult Initially 0.75mg BID, adjust MD at a 4-5 day interval, if needed | SUBEPENDYMAL GIANT CELL ASTROCYTOMA (SEGA) PO Adult BSA based dosing: Initially 0.5 m2-1.2 m2: 2.5mg/day, 1.3 m2-2.1 m2: 5mg/day, =2.2 m2: 7.5mg/day, adjust MD if needed at 2 wk interval based on response, serum trough concentrations, tolerability & concomitant medications Child =3 yrs: Same as adult dose

Precautions: Concomitant use of moderate CYP3A4 inhibitors, patients with hyperlipidemia

ADR: Serious: Leucopenia, anemia, thrombocytopenia, hemolysis, hypercholesterolemia, hyperlipidemia, hypertriglyceridemia, hypertension, venous thromboembolism, lymphocele, pneumonia, pneumonitis, pyelonephritis, hepatitis, jaundice, renal tubular necrosis, edema, hematuria, creatinine increased, pulmonary alveolar hemorrhage, sinusitis, pneumonitis, rhinitis, pulmonary toxicity, Others: Acne, rash, pruritus, cellulitis, UTI, dysuria, URTI, weakness, limb pain, back pain, fever, fatigue, insomnia, headache, dizziness, personality change

DDI: Others Verapamil Increases everolimus and its levels, Ciclosporin Increases everolimus level, CYP3A4 Inhibitors increases everolimus level, Ketoconazole/Diltiazem Increases everolimus level, Macrolides increases everolimus level, Rifampicin/CYP3A4 Inducers reduces everolimus bioavailability & increases its clearance

Diet: With/without food

Monitor: CBC, LFT, SeCr, BUN, fasting Se glucose, lipid profile, for infection