NZ Formulary

Sirolimus (for transplant patients)


What does it do?

Sirolimus is an immunosuppressant used with other medicines to prevent transplant rejection.

How should you take it?

Take sirolimus regularly as directed with a glass of water.
If you are also taking ciclosporin (Neoral®), take sirolimus 4 hours after a ciclosporin dose.
Measure the liquid carefully with the syringe supplied, and add to a glass of water or orange juice (do not use grapefruit juice or paper/polystyrene cups). Stir well and drink straight away. To make sure you get the full dose, add some more juice to the glass and drink that too.

What if you forget a dose?

Take the missed dose as soon as possible. If it is close to the time for your next dose, skip the missed dose and carry on as normal. Do not take two doses at the same time.

Can you take other medicines?

Some medicines available without a prescription may react with sirolimus including:

  • anti-inflammatories, such as diclofenac (e.g. Voltaren®), ibuprofen (e.g. Nurofen®), or aspirin (e.g. Disprin®, in doses used for pain relief). These can also be found in some cold and flu medicines (e.g. Nurofen Cold and Flu®).

Tell your pharmacist or doctor about all medicines or treatments that you may be taking, including vitamins, herbal products (e.g. echinacea, St John's wort) or recreational drugs.

What side effects might you notice?

Side EffectsRecommended action

Symptoms of allergy including: skin rash, itching, swelling, trouble breathing

Swollen lips, tongue, throat or face

Reduced number of blood cells that fight infections or help your blood to clot - symptoms include: fever, chills, sore throat or generally feeling unwell, or easy or unusual bruising or bleeding

Persistent dry cough

Symptoms of a blood clot including: sudden shortness of breath, swelling or pain in one leg

Tell your doctor immediately

Joint, muscle or bone aches and pains

Peeing more often, feeling thirsty

Swollen feet or legs

Increased blood pressure

Tell your doctor

Headache, trouble sleeping

Acne, nose bleeds

Changes in periods

Abdominal pain, constipation or diarrhoea, nausea

Tell your doctor if troublesome

If you notice any other effects, discuss them with your doctor or pharmacist.

Other information:

  • Do not stop taking sirolimus unless your doctor at the transplant clinic tells you to. You may have to take sirolimus for the rest of your life.
  • You will need regular blood tests to measure the amount of sirolimus in your blood. On the morning of the blood test, do not take your regular dose of sirolimus until after the blood has been taken. Other blood tests will monitor how your kidneys are working and your cholesterol levels (sirolimus can increase cholesterol).
  • Protect yourself from too much sunlight while taking immunosuppressant medicines (they may increase your risk of skin cancer). Always cover up and apply a thick layer of broad spectrum sunscreen (at least SPF30) when outside. Do not use sunbeds.
  • Use reliable contraception while taking sirolimus, and for 12 weeks after stopping. If you plan to become pregnant, or find you are pregnant, discuss this with your doctor. Tell your doctor if you are breastfeeding.
  • Grapefruit, grapefruit juice or sour/Seville oranges may react with sirolimus. Discuss with your pharmacist.
  • You have an increased risk of getting an infection while taking sirolimus. Discuss with your doctor.
  • Sirolimus affects your immune system. Before you start and while you are using it, check with your doctor what vaccines you might need. You should not have a live vaccine while using it.
  • It is important to tell anyone who gives you medical or dental treatment that you are taking sirolimus.
  • Store sirolimus liquid in the fridge. It expires 30 days after you first open the bottle. If you have any liquid leftover after 30 days, take it back to your pharmacy.