Indications & Dose: RENAL ALLOTRANSPLANTATION Severe PO Adult Initial loading dose 15mg on day 1 post-transplantation, MD 5mg/day on day 2, adjust dose based on serum trough concentrations. Prednisone (5mg OD) and ciclosporin (7mg/kg/day in divided doses) may be used with sirolimus for 1 yr after transplantationImmunologic high risk patients | Mild-to-moderate PO Adult Loading dose: 6mg soon after transplantation, then MD 2mg/day, 4h after ciclosporin. Adjust sirolimus dose to maintain trough serum concentration of 16-24ng/ml for 1st yr, thereafter 12-20ng/ml. After 2-3 month, ciclosporin gradually stopped over 4-8 wk Child >13 yr or <40 kg: 1mg/m2 based on BSA with loading dose of 3mg/m2

Precautions: hepatic/renal impairment, drugs alter renal function, cancer, DM, hyperlipidemia, children (<13 yrs)

ADR: Serious: lymphoma, increases risk of infect, peripheral edema, HTN, edema, increased TC level, increased SeCr, hypokalemia, UTI, blood disorders, bone necrosis, anaphylactic reactions, Others: arthralgia, hypophosphatemia, GI disturbances, rash, constipation, abdominal pain, diarrhea, nausea, headache, insomnia, acne

DDI: Serious Phenytoin/Phenobarbital/Rifabutin/Rifampicin decreases drug level, Azoles increases drug levels, Macrolides markedly increases drugs levels and renal impairment, Erythromycin/Diltiazem/Verapamil raises drug levels

Diet: With/without food

Monitor: Signs & symptoms of infection, renal function tests, lipid panel, electrolyte levels, blood chemistry studies, sirolimus blood level & neurologic status