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everolimus
generic
Black Box Warnings .
Appropriate Use
admin. only by physicians experienced in immunosuppress. tx and mgmt of transplant pts in adequate medical facility; physician responsible for maintenance tx should have all info needed for pt follow-up
Malignancies and Serious Infections
incr. susceptibility to infection and possible development of malignancies may result from immunosuppression
Kidney Graft Thrombosis
incr. thrombosis risk resulting in graft loss has been reported, mostly w/in 30 days post-transplant
Nephrotoxicity
can occur w/ standard doses of cyclosporine in combo w/ everolimus; use reduced doses of cyclosporine w/ everolimus; monitor cyclosporine and everolimus whole blood trough levels
Mortality in Heart Transplantation
incr. mortality, often assoc. w/ serious infection, w/in first 3mo post-transplant observed in clinical trial of de novo heart transplant pts receiving immunosuppressive tx w/ or w/o induction tx; use in heart transplantation is not recommended
Adult Dosing .
Dosage forms: TAB: 0.25 mg, 0.5 mg, 0.75 mg, 1 mg
kidney transplant rejection prophylaxis
- [0.75 mg PO q12h]
- Start: ASAP post-transplant; Info: for pts w/ low-mod immunologic risk; part of multi-drug regimen; may adjust dose q4-5 days based on trough levels; if trough level <3 ng/mL double total daily dose; if 2 consecutive trough level >8 ng/mL decr. dose by 0.5 mg/day; give consistently w/ food or on empty stomach; do not cut/crush/chew tab
liver transplant rejection prophylaxis
- [1 mg PO q12h]
- Start: >30 days post-transplant; Info: part of multi-drug regimen; may adjust dose q4-5 days based on trough levels; if trough level <3 ng/mL double total daily dose; if 2 consecutive trough level >8 ng/mL decr. dose by 0.5 mg/day; give consistently w/ food or on empty stomach; do not cut/crush/chew tab
renal dosing
- [see below]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [adjust dose amount]
- Child-Pugh Class A: decr. usual start dose by 33%; Child-Pugh Class B or C: decr. usual start dose by 50%
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.