Sirolimus – Uses, Dosage, Side Effects, Interaction Sirolimus is macrocyclic antibiotic with potent immunosuppressive activity that is used alone or in combination with calcineurin inhibitors and corticosteroids to prevent cellular rejection after renal transplantation. Sirolimus therapy can be associated with mild serum enzyme elevations and it has been linked to rare instances of clinically apparent cholestatic liver injury. Sirolimus is a natural macrocyclic lactone produced by the bacterium Streptomyces hygroscopicus, with immunosuppressant properties. In cells, sirolimus binds to the immunophilin FK Binding Protein-12 (FKBP-12) to generate an immunosuppressive complex that binds to and inhibits the activation of the mammalian Target Of Rapamycin (mTOR), a key regulatory kinase. This results in the inhibition of T lymphocyte activation and proliferation that occurs in response to antigenic and cytokine (IL-2, IL-4, and IL-15) stimulation and inhibition of antibody production. (NCI04) Sirolimus is a macrolide lactam isolated from Streptomyces hygroscopicus consisting of a 29-membered ring containing 4 trans double bonds, three of which are conjugated. It is an antibiotic, immunosuppressive, and antineoplastic agent. It has a role as an immunosuppressive agent, an antineoplastic agent, an antibacterial drug, an mTOR inhibitor, a bacterial metabolite, an anticoronaviral agent, and a geroprotector. It is a cyclic acetal, a cyclic ketone, an ether, a secondary alcohol, an organic heterotricyclic compound, an antibiotic antifungal drug, and a macrolide lactam. Mechanism of Action Sirolimus works by inhibiting T-lymphocyte activation and proliferation stimulated by antigens and cytokines such as interleukin (IL)-2, IL-4, and IL-15. In target cells, sirolimus binds to the cytoplasmic receptor FK506-binding protein-12 (FKBP12), an immunophilin, to form an immunosuppressive complex. FKBP12-sirolimus complex binds to and inhibits the activation of the mammalian target of rapamycin (mTOR), which is a serine/threonine-specific protein kinase that regulates cell growth, proliferation, survival, mobility, and angiogenesis. mTOR regulates the downstream signalling pathways involved in cell survival, such as the phosphatidylinositol-3 kinase (PI3K)/Akt signalling pathway. Inhibition of mTOR leads to the suppression of cytokine-driven T-cell proliferation, thus the progression from the G1 to the S phase of the cell cycle is inhibited. Sirolimus also inhibits antibody production. _In vitro_, sirolimus and other mTOR inhibitors inhibit the production of certain growth factors that may affect angiogenesis, fibroblast proliferation, and vascular permeability. Lymphangioleiomyomatosis is a disorder that primarily affects the lungs. It is characterized by lung tissue infiltration, unregulated alveolar smooth muscle proliferation, and cystic destruction of parenchyma. Although infrequent, it occurs as a symptomatic pulmonary complication in tuberous sclerosis complex (TSC), which is an inherited disorder caused by mutations in TSC genes. Loss of functional TSC gene leads to the aberrant activation of the mTOR signalling pathway, resulting in cellular proliferation and release of lymphangiogenic growth factors. Sirolimus inhibits the activated mTOR pathway and proliferation of alveolar smooth muscle cell proliferation. or Sirolimus inhibits cytokine (Interleukin (IL)-2, IL-4, and IL-15) — stimulated T lymphocyte activation and proliferation; it also inhibits antibody production. This may occur through the formation of an immunosuppressive complex with FK Binding Protein-12 (FKBP-12). Although the sirolimus-(FKBP-12) complex is inactive against calcineurin activity, the complex binds to and inhibits activation of a key regulatory kinase, the mammalian Target of Rapamycin (mTOR). This is believed to suppress cytokine-driven T-cell proliferation, inhibiting cell cycle progression from the G, to S phase. Sirolimus is an immunosuppressant drug with antifungal and antitumor effects. In animal models, sirolimus prolonged allograft survival following various organ transplants and reversed an acute rejection of heart and kidney allografts in rats. Upon oral administration of 2 mg/day and 5 mg/day, sirolimus significantly reduced the incidence of organ rejection in low- to moderate-immunologic risk renal transplant patients at six months following transplantation compared with either azathioprine or placebo. In some studies, the immunosuppressive effect of sirolimus lasted up to six months after discontinuation of therapy: this tolerization effect is alloantigen-specific. Sirolimus potently inhibits antigen-induced proliferation of T cells, B cells, and antibody production. In rodent models of autoimmune disease, sirolimus suppressed immune-mediated events associated with systemic lupus erythematosus, collagen-induced arthritis, autoimmune type I diabetes, autoimmune myocarditis, experimental allergic encephalomyelitis, graft-versus-host disease, and autoimmune uveoretinitis. Indications Sirolimus is indicated for the prophylaxis of organ rejection in patients aged 13 years or older receiving renal transplants. In patients at low-to moderate-immunologic risk, it is recommended that sirolimus be used initially in a regimen with [cyclosporine] and corticosteroids; cyclosporine should be withdrawn two to four months after transplantation. In patients at high-immunologic risk (defined as Black recipients and/or repeat renal transplant recipients who lost a previous allograft for immunologic reasons and/or patients with high panel-reactive antibodies [PRA; peak PRA level > 80%]), it is recommended that sirolimus be used in combination with cyclosporine and corticosteroids for the first year following transplantation. It is also used to treat lymphangioleiomyomatosis. In the US, albumin-bound sirolimus for intravenous injection is indicated for the treatment of adult patients with locally advanced unresectable or metastatic malignant perivascular epithelioid cell tumor (PEComa). In Europe, it is recommended that sirolimus for the prophylaxis of organ rejection in renal transplants is used in combination with cyclosporin microemulsion and corticosteroids for two to three months. Sirolimus may be continued as maintenance therapy with corticosteroids only if cyclosporin microemulsion can be progressively discontinued. Sirolimus is a macrocyclic antibiotic with potent immunosuppressive activity that is used alone or in combination with calcineurin inhibitors and corticosteroids to prevent cellular rejection after renal transplantation. Sirolimus protein-bound particles are approved to treat adults with: Perivascular epithelioid cell tumors that are metastatic or cannot be removed by surgery. Sirolimus protein-bound particles are a form of sirolimus contained in nanoparticles (very tiny particles of protein). The drug is also called nanoparticle albumin-bound rapamycin. This form may work better than other forms of sirolimus and have fewer side effects. Sirolimus protein-bound particles are also being studied in the treatment of other types of cancer. Rapamune is indicated for the prophylaxis of organ rejection in adult patients at low to the moderate immunological risk of receiving a renal transplant. It is recommended that Rapamune be used initially in combination with ciclosporin microemulsion and corticosteroids for 2 to 3 months. Rapamune may be continued as maintenance therapy with corticosteroids only if ciclosporin microemulsion can be progressively discontinued. Rapamune is indicated for the treatment of patients with sporadic lymphangioleiomyomatosis with moderate lung disease or declining lung function. Prevention of arteriovenous access dysfunction Treatment of chronic non-infectious uveitis Sirolimus is indicated for the prevention of rejection of transplanted kidney allografts. It is recommended that sirolimus be used in a regimen with cyclosporine and corticosteroids. Angiofibromas of the face Chordomas Graft Versus Host Disease (cGvHD) Heart Transplant Rejection Liver Transplant Rejection Lung Transplant Rejection Lymphangioleiomyomatosis (LAM) Renal Angiomyolipomas Transplanted Organ Rejection Metastatic malignant Perivascular Epithelioid Cell Neoplasms Unresectable, locally advanced malignant Perivascular Epithelioid Cell Neoplasms Use in Cancer Sirolimus protein-bound particles are approved to treat adults with: Perivascular epithelioid cell tumors that are metastatic or cannot be removed by surgery. Sirolimus protein-bound particles are a form of sirolimus contained in nanoparticles (very tiny particles of protein). The drug is also called nanoparticle albumin-bound rapamycin. This form may work better than other forms of sirolimus and have fewer side effects. Sirolimus protein-bound particles are also being studied in the treatment of other types of cancer. Contraindications an unusual viral infection called cytomegalovirus infection pneumonia with a fungus called Pneumocystis jirovecii a bad infection cancer or malignancy high cholesterol high amount of triglyceride in the blood excessive fat in the blood high blood pressure fluid in the covering of the heart or pericardium escape of fluid into the lungs liver problems decreased kidney function male infertility visible water retention fluid retention in the legs, feet, arms or hands ascites elevation of proteins in the urine impaired wound healing pregnancy a patient who is producing milk and breastfeeding malignant lymphoma liver transplant lung transplant a blood clot in the liver after a liver transplant a bronchial anastomotic dehiscence where the transplanted lung surgical connection comes apart lung tissue problem progressive multifocal leukoencephalopathy, a type of brain infection lymphedema, or swelling due to blockage of lymph nodes skin cancer kidney problems due to BK polyomavirus Ascites (fluid in the stomach) or Blood clotting problems (eg, thrombotic microangiopathy, thrombotic thrombocytopenic purpura) or Heart disease (eg, pericardial effusion) or Hyperlipidemia (high amount of cholesterol and fats in the blood) or Infection (eg, bacteria, fungus, virus) or Lung disease (eg, bronchiolitis obliterans organizing pneumonia [BOOP], pleural effusion, pneumonitis, pulmonary fibrosis) or Lymphoma (cancer of the lymph glands) or Peripheral edema (swelling of the hands, ankles, or feet) or Proteinuria (protein in the urine) or Skin cancer, history of—Use with caution. This may make these conditions worse. Liver disease—Use with caution. You may require a smaller dose. Liver transplantation or Lung transplantation—Use is not recommended in patients with these conditions. Dosage Strengths: 1 mg/mL; 1 mg; 2 mg; 0.5 mg Organ Transplant – Rejection Prophylaxis FOR PATIENTS AT LOW TO MODERATE IMMUNOLOGIC RISK: Dosing by body weight: Less than 40 kg: Loading dose: 3 mg/m2 on day 1 Maintenance: 1 mg/m2 once daily Greater than or equal to 40 kg: Loading dose: 6 mg orally on day 1 Maintenance: 2 mg orally once daily IN PATIENTS AT HIGH IMMUNOLOGIC RISK (defined as Black transplant recipients and/or repeat renal transplant recipients who lost a previous allograft for immunologic reason and/or patients with high-panel reactive antibodies [PRA; peak PRA level greater than 80%]): For patients receiving sirolimus with cyclosporine: Loading Dose: Up to 15 mg on day one post-transplantation Maintenance Dose: Beginning on day 2, an initial maintenance dose of 5 mg/day should be given. A trough level should be obtained between days 5 and 7, and the daily dose of sirolimus should be adjusted thereafter. Antibody induction therapy may be used. It is recommended that this sirolimus be used in a regimen with cyclosporine and corticosteroids. Sirolimus should be taken consistently with or without food. Once the sirolimus maintenance dose is adjusted, patients should continue on the new maintenance dose for at least 7 to 14 days before further dosage adjustment with concentration monitoring. MAINTENANCE THERAPY AFTER WITHDRAWAL OF CYCLOSPORINE: Cyclosporine withdrawal is not recommended in high-immunological risk patients. Following 2 to 4 months of combined therapy, withdrawal of cyclosporine may be considered in low-to-moderate-risk patients. Cyclosporine should be discontinued over 4 to 8 weeks, and a necessary increase in the dosage of sirolimus (up to 4-fold) should be anticipated due to the removal of metabolic inhibition by cyclosporine and to maintain of adequate immunosuppressive effects. -Dose-adjusted trough target concentrations are typically 16 to 24 ng/mL for the first year post-transplant and 12 to 20 ng/mL thereafter (measured by chromatographic methodology). Pulmonary Lymphangioleiomyomatosis Initial dose: 2 mg/day Sirolimus whole blood trough concentrations should be measured in 10 to 20 days, with dosage adjustment to maintain concentrations between 5 and 15 ng/mL. This drug should be taken consistently with or without food. Pediatric Dose for Organ Transplant – Rejection Prophylaxis FOR PATIENTS AT LOW TO MODERATE IMMUNOLOGIC RISK: Greater than or equal to 13 years of age: Dosing by body weight: Less than 40 kg: Loading dose: 3 mg/m2 on day 1 Maintenance: 1 mg/m2 once daily Greater than or equal to 40 kg: Loading dose: 6 mg orally on day 1 Maintenance: 2 mg orally once daily Dose Adjustments Sirolimus dosages should be adjusted to maintain trough concentrations within the desired range based on risk and concomitant therapy. Maximum daily dose: 40 mg. The dosage should be adjusted at intervals of 7 to 14 days to account for the long half-life of sirolimus. In general, dose proportionality may be assumed. The new sirolimus dose equals the current dose multiplied by (target concentration/current concentration). If a large dose increase is required, consider the loading dose calculated as: Loading dose equals (new maintenance dose minus current maintenance dose) multiplied by 3. The maximum dose in one day: is 40 mg If the required dose is greater than 40 mg (due to the loading dose), then the dose should be divided over 2 days. Serum concentrations should not be used as the sole basis for dosage adjustment. Clinical signs/symptoms, tissue biopsy, and laboratory parameters should also be monitored. Administration advice: This drug should be administered as soon as possible after transplantation. Tablets should be swallowed whole and not crushed, chewed, or split. This drug should be taken consistently with or without food. Patients unable to take oral tablets should be prescribed the oral solution. It is recommended that this drug be taken 4 hours after administration of cyclosporine. This drug should not be taken with grapefruit juice. Side Effects The Most Common stomach pain headache constipation diarrhea nausea joint pain unusual bleeding or bruising cough swollen, red, cracked, scaly skin hives rash itching difficulty breathing or swallowing swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs hoarseness More common Accumulation of pus anxiousness, unexplained backache black or red, tarry stools bleeding from the gums or nose blurred vision body aches or pain bone pain bruising burning or stinging of the skin burning while urinating burning, dry, or itching eyes burning, tingling, numbness, or pain in the hands, arms, feet, or legs change in mental status changes in skin color chest pain chills confusion cough dark or bloody urine deafness decreased urine output decreased vision difficulty with breathing or swallowing dilated neck veins discharge from the eyes dizziness drowsiness dry mouth earache excessive tearing eye pain facial hair growth in females faintness or lightheadedness when getting up from lying or sitting position fast, slow, or irregular heartbeat fever flushing or redness of the skin, especially on the face and neck general feeling of discomfort or illness increased hunger increased menstrual flow or vaginal bleeding itching, pain, redness, swelling, tenderness, or warmth on the skin lack or loss of appetite large, flat, blue, or purplish patches in the skin loss of sexual ability, desire, drive, or performance loss of voice muscle pain nasal congestion nausea or vomiting numbness or tingling around the lips, hands, or feet pain in the chest, groin, or legs, especially the calves painful cold sores or blisters on the lips, nose, eyes, or genitals pale skin prolonged bleeding from cuts rapid heartbeat rash red or dark brown urine redness or swelling in the ear redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid ringing in the ears runny nose seizures sensation of pins and needles severe constipation severe vomiting severe, sudden headache slurred speech sore throat sores or white spots on the lips or in the mouth stomach cramps, pain, or upset sudden decrease in the amount of urine sudden loss of coordination sudden, severe weakness or numbness in the arm or leg sweating swollen, painful, or tender lymph glands in the neck, armpit, or groin tenderness, pain, swelling, warmth, skin discoloration, and prominent superficial veins over the affected area tremor ulcers on the lips or in the mouth unusual tiredness or weakness vision changes weakness or heaviness of the legs white patches in the mouth or on the tongue yellow skin and eyes Rare Bloating change in size, shape, or color of an existing mole hoarseness a mole that leaks fluid or bleeds new mole pains in the stomach, side or abdomen, possibly radiating to the back skin ulcer or sores Abnormal wound healing headache hives or itching large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs nails lose or detached puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue swelling of the arms or legs yellow nails lacking a cuticle Abnormal vision acne belching blistering, crusting, irritation, itching, or reddening of the skin burning feeling in the chest or stomach burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feeling constipation continuing ringing or buzzing or other unexplained noise in the ears cracked, dry, or scaly skin crying decrease in frequency of urination degenerative disease of the joint depersonalization diarrhea difficulty with moving difficulty with passing urine (dribbling) dysphoria ear pain enlarged abdomen or stomach euphoria excess air or gas in the stomach or intestines excessive muscle tone, muscle tension or tightness fear feeling sad or empty hearing loss heartburn inability to have or keep an erection increase in heart rate increased hair growth, especially on the face increased urge to urinate during the night Drug interaction DRUG INTERACTION Abametapir The serum concentration of Sirolimus can be increased when it is combined with Abametapir. Abatacept The metabolism of Sirolimus can be increased when combined with Abatacept. Abciximab The risk or severity of bleeding can be increased when Abciximab is combined with Sirolimus. Abemaciclib The serum concentration of Abemaciclib can be increased when it is combined with Sirolimus. Abrocitinib The serum concentration of Sirolimus can be increased when it is combined with Abrocitinib. Acalabrutinib The metabolism of Sirolimus can be decreased when combined with Acalabrutinib. Acarbose The therapeutic efficacy of Acarbose can be decreased when used in combination with Sirolimus. Acenocoumarol The therapeutic efficacy of Acenocoumarol can be increased when used in combination with Sirolimus. Acetaminophen The metabolism of Sirolimus can be increased when combined with Acetaminophen. Acetazolamide The metabolism of Sirolimus can be decreased when combined with Acetazolamide. Acetohexamide The therapeutic efficacy of Acetohexamide can be decreased when used in combination with Sirolimus. Acetyldigitoxin The serum concentration of Acetyldigitoxin can be increased when it is combined with Sirolimus. Acetylsalicylic acid The risk or severity of angioedema can be increased when Sirolimus is combined with Acetylsalicylic acid. Adalimumab The metabolism of Sirolimus can be increased when combined with Adalimumab. Adenovirus typ The risk or severity of infection can be increased when Adenovirus type 7 vaccine live is combined with Sirolimus. Afatinib The serum concentration of Sirolimus can be increased when it is combined with Afatinib. Albendazole The metabolism of Sirolimus can be decreased when combined with Albendazole. Albiglutide The therapeutic efficacy of Albiglutide can be decreased when used in combination with Sirolimus. Aldesleukin The metabolism of Sirolimus can be decreased when combined with Aldesleukin. Alefacept The risk or severity of adverse effects can be increased when Alefacept is combined with Sirolimus. Alemtuzumab The risk or severity of adverse effects can be increased when Alemtuzumab is combined with Sirolimus. Alfentanil The serum concentration of Alfentanil can be increased when it is combined with Sirolimus. Allogeneic The therapeutic efficacy of Allogeneic processed thymus tissue can be decreased when used in combination with Sirolimus. Allopurinol The risk or severity of adverse effects can be increased when Allopurinol is combined with Sirolimus. Alogliptin The therapeutic efficacy of Alogliptin can be decreased when used in combination with Sirolimus. Alpelisib The metabolism of Sirolimus can be increased when combined with Alpelisib. Alprazolam The serum concentration of Alprazolam can be increased when it is combined with Sirolimus. Alteplase The risk or severity of angioedema can be increased when Alteplase is combined with Sirolimus. Altretamine The risk or severity of adverse effects can be increased when Altretamine is combined with Sirolimus. Ambrisentan The metabolism of Sirolimus can be decreased when combined with Ambrisentan. Aminoglutethimide The metabolism of Sirolimus can be increased when combined with Aminoglutethimide. Aminophylline The metabolism of Aminophylline can be decreased when combined with Sirolimus. Amiodarone Amiodarone may increase the immunosuppressive activities of Sirolimus. Amitriptyline The metabolism of Sirolimus can be decreased when combined with Amitriptyline. Amlodipine Amlodipine may increase the immunosuppressive activities of Sirolimus. Amobarbital The metabolism of Sirolimus can be increased when combined with Amobarbital. Amprenavir The metabolism of Sirolimus can be decreased when combined with Amprenavir. Amsacrine The risk or severity of adverse effects can be increased when Amsacrine is combined with Sirolimus. Anagrelide The risk or severity of bleeding can be increased when Anagrelide is combined with Sirolimus. Anakinra The metabolism of Sirolimus can be increased when combined with Anakinra. Ancrod The risk or severity of bleeding can be increased when Ancrod is combined with Sirolimus. Anifrolumab The risk or severity of adverse effects can be increased when Sirolimus is combined with Anifrolumab. Anistreplase The risk or severity of angioedema can be increased when Anistreplase is combined with Sirolimus. Anthrax immune The therapeutic efficacy of Anthrax immune globulin human can be decreased when used in combination with Sirolimus. Anthrax vaccine The risk or severity of infection can be increased when Anthrax vaccine is combined with Sirolimus. Antilymphocyte The risk or severity of adverse effects can be increased when Sirolimus is combined with Antilymphocyte immunoglobulin (horse). Antithrombin Alfa The risk or severity of bleeding can be increased when Antithrombin Alfa is combined with Sirolimus. Antithrombin III The risk or severity of bleeding can be increased when Antithrombin III human is combined with Sirolimus. Antithymocyte The risk or severity of adverse effects can be increased when Antithymocyte immunoglobulin (rabbit) is combined with Sirolimus. Apalutamide The serum concentration of Sirolimus can be decreased when it is combined with Apalutamide. Apixaban The metabolism of Sirolimus can be decreased when combined with Apixaban. Apomorphine The metabolism of Sirolimus can be decreased when combined with Apomorphine. Apremilast The metabolism of Sirolimus can be increased when combined with Apremilast. Aprepitant The metabolism of Sirolimus can be decreased when combined with Aprepitant. Ardeparin The risk or severity of bleeding can be increased when Ardeparin is combined with Sirolimus. Argatroban The risk or severity of bleeding can be increased when Argatroban is combined with Sirolimus. Aripiprazole The metabolism of Sirolimus can be decreased when combined with Aripiprazole. Aripiprazole lauroxil The metabolism of Sirolimus can be decreased when combined with Aripiprazole lauroxil. Armodafinil The metabolism of Sirolimus can be increased when combined with Armodafinil. Arsenic trioxide The serum concentration of Sirolimus can be increased when it is combined with Arsenic trioxide. Artemether The metabolism of Sirolimus can be decreased when combined with Artemether. Articaine The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Articaine. Asciminib The serum concentration of Sirolimus can be increased when it is combined with Asciminib. Astemizole The metabolism of Sirolimus can be decreased when combined with Astemizole. COVID-19 Vaccine The therapeutic efficacy of AstraZeneca COVID-19 Vaccine can be decreased when used in combination with Sirolimus. Asunaprevir The serum concentration of Sirolimus can be increased when it is combined with Asunaprevir. Atazanavir The metabolism of Sirolimus can be decreased when combined with Atazanavir. Atogepant The serum concentration of Atogepant can be increased when it is combined with Sirolimus. Atorvastatin The risk or severity of adverse effects can be increased when Sirolimus is combined with Atorvastatin. Avacopan The metabolism of Sirolimus can be decreased when combined with Avacopan. Avanafil The serum concentration of Avanafil can be increased when it is combined with Sirolimus. Avatrombopag The serum concentration of Sirolimus can be increased when it is combined with Avatrombopag. Axitinib The metabolism of Axitinib can be decreased when combined with Sirolimus. Azacitidine The risk or severity of adverse effects can be increased when Sirolimus is combined with Azacitidine. Azathioprine The risk or severity of adverse effects can be increased when Sirolimus is combined with Azathioprine. Azelastine The metabolism of Sirolimus can be decreased when combined with Azelastine. Azilsartan medoxomil The risk or severity of angioedema can be increased when Sirolimus is combined with Azilsartan medoxomil. Azithromycin The metabolism of Sirolimus can be decreased when combined with Azithromycin. Bacillus The risk or severity of infection can be increased when Bacillus calmette-guerin substrain connaught live antigen is combined with Sirolimus. Bacillus antigen The therapeutic efficacy of Bacillus calmette-guerin substrain russian BCG-I live antigen can be decreased when used in combination with Sirolimus. Bacillus calmette The risk or severity of infection can be increased when Bacillus calmette-guerin substrain tice live antigen is combined with Sirolimus. Baricitinib The risk or severity of adverse effects can be increased when Sirolimus is combined with Baricitinib. Basiliximab The risk or severity of adverse effects can be increased when Basiliximab is combined with Sirolimus. BCG vaccine The therapeutic efficacy of BCG vaccine can be decreased when used in combination with Sirolimus. Beclomethasone The metabolism of Sirolimus can be increased when combined with Beclomethasone dipropionate. Belantamab The serum concentration of Sirolimus can be increased when it is combined with Belantamab mafodotin. Belatacept The risk or severity of adverse effects can be increased when Sirolimus is combined with Belatacept. Belimumab The risk or severity of adverse effects can be increased when Sirolimus is combined with Belimumab. Belinostat The risk or severity of adverse effects can be increased when Sirolimus is combined with Belinostat. Belumosudil The serum concentration of Sirolimus can be increased when it is combined with Belumosudil. Belzutifan The serum concentration of Sirolimus can be decreased when it is combined with Belzutifan. Bemiparin The risk or severity of bleeding can be increased when Bemiparin is combined with Sirolimus. Benazepril The risk or severity of adverse effects can be increased when Sirolimus is combined with Benazepril. Bendamustine The risk or severity of adverse effects can be increased when Sirolimus is combined with Bendamustine. Bendroflumethiazide The risk or severity of neutropenia and thrombocytopenia can be increased when Bendroflumethiazide is combined with Sirolimus. Benzocaine The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Benzocaine. Benzthiazide The risk or severity of neutropenia and thrombocytopenia can be increased when Benzthiazide is combined with Sirolimus. Benzyl alcohol The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Benzyl alcohol. Benzylpenicillin The excretion of Benzylpenicillin can be decreased when combined with Sirolimus. Bepridil Bepridil may increase the immunosuppressive activities of Sirolimus. Berotralstat The serum concentration of Sirolimus can be increased when it is combined with Berotralstat. Betamethasone The serum concentration of Betamethasone can be increased when it is combined with Sirolimus. Betamethasone The metabolism of Sirolimus can be increased when combined with Betamethasone phosphate. Betrixaban The serum concentration of Sirolimus can be increased when it is combined with Betrixaban. Bexarotene The metabolism of Sirolimus can be increased when combined with Bexarotene. Bicalutamide The metabolism of Sirolimus can be decreased when combined with Bicalutamide. Bifonazole The metabolism of Sirolimus can be decreased when combined with Bifonazole. Bimekizumab The metabolism of Sirolimus can be increased when combined with Bimekizumab. Binimetinib The serum concentration of Binimetinib can be increased when it is combined with Sirolimus. Bioallethrin Bioallethrin may increase the immunosuppressive activities of Sirolimus. Bisoprolol The serum concentration of Sirolimus can be increased when it is combined with Bisoprolol. Bivalirudin The risk or severity of bleeding can be increased when Bivalirudin is combined with Sirolimus. Bleomycin The risk or severity of adverse effects can be increased when Bleomycin is combined with Sirolimus. Blinatumomab The risk or severity of adverse effects can be increased when Sirolimus is combined with Blinatumomab. Boceprevir The metabolism of Sirolimus can be decreased when combined with Boceprevir. Bordetella The therapeutic efficacy of Bordetella pertussis toxoid antigen (formaldehyde, glutaraldehyde inactivated) can be decreased when used in combination with Sirolimus. Bortezomib The risk or severity of adverse effects can be increased when Bortezomib is combined with Sirolimus. Bosentan The metabolism of Sirolimus can be increased when combined with Bosentan. Bosutinib The metabolism of Sirolimus can be decreased when combined with Bosutinib. Brentuximab vedotin The metabolism of Sirolimus can be decreased when combined with Brentuximab vedotin. Brincidofovir The serum concentration of Brincidofovir can be increased when it is combined with Sirolimus. Brodalumab The risk or severity of adverse effects can be increased when Sirolimus is combined with Brodalumab. Bromocriptine The serum concentration of Bromocriptine can be increased when it is combined with Sirolimus. Bromotheophylline The metabolism of Bromotheophylline can be decreased when combined with Sirolimus. Budesonide The serum concentration of Budesonide can be increased when it is combined with Sirolimus. Bupivacaine The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Bupivacaine. Buprenorphine The metabolism of Sirolimus can be decreased when combined with Buprenorphine. Buspirone The metabolism of Buspirone can be decreased when combined with Sirolimus. Busulfan The risk or severity of adverse effects can be increased when Sirolimus is combined with Busulfan. Butacaine The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Butacaine. Butalbital The metabolism of Sirolimus can be increased when combined with Butalbital. Butamben The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Butamben. Cabazitaxel The metabolism of Cabazitaxel can be decreased when combined with Sirolimus. Cabergoline The serum concentration of Cabergoline can be increased when it is combined with Sirolimus. Caffeine The metabolism of Caffeine can be decreased when combined with Sirolimus. Calcitriol The metabolism of Sirolimus can be increased when combined with Calcitriol. Canagliflozin The serum concentration of Sirolimus can be increased when it is combined with Canagliflozin. Canakinumab The metabolism of Sirolimus can be increased when combined with Canakinumab. Candicidin The metabolism of Sirolimus can be decreased when combined with Candicidin. Cangrelor The risk or severity of bleeding can be increased when Cangrelor is combined with Sirolimus. Cannabidiol The serum concentration of Sirolimus can be increased when it is combined with Cannabidiol. Capecitabine The risk or severity of adverse effects can be increased when Sirolimus is combined with Capecitabine. Caplacizumab The risk or severity of bleeding can be increased when Caplacizumab is combined with Sirolimus. Capmatinib The serum concentration of Sirolimus can be increased when it is combined with Capmatinib. Capsaicin The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Capsaicin. Captopril The risk or severity of adverse effects can be increased when Sirolimus is combined with Captopril. Carbamazepine The metabolism of Carbamazepine can be decreased when combined with Sirolimus. Carboplatin The risk or severity of adverse effects can be increased when Sirolimus is combined with Carboplatin. Carfilzomib The serum concentration of Sirolimus can be increased when it is combined with Carfilzomib. Carmustine The risk or severity of adverse effects can be increased when Carmustine is combined with Sirolimus. Carvedilol Carvedilol may increase the immunosuppressive activities of Sirolimus. Caspofungin The excretion of Caspofungin can be decreased when combined with Sirolimus. Cefradine The metabolism of Sirolimus can be increased when combined with Cefradine. Cenobamate The serum concentration of Sirolimus can be decreased when it is combined with Cenobamate. Cephalexin The metabolism of Sirolimus can be decreased when combined with Cephalexin. Ceritinib The metabolism of Sirolimus can be decreased when combined with Ceritinib. Cerivastatin The metabolism of Sirolimus can be increased when combined with Cerivastatin. Certolizumab pegol The metabolism of Sirolimus can be increased when combined with Certolizumab pegol. Chlorambucil The risk or severity of adverse effects can be increased when Chlorambucil is combined with Sirolimus. Chloramphenicol The metabolism of Sirolimus can be decreased when combined with Chloramphenicol. Chloroprocaine The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Chloroprocaine. Chloroquine The metabolism of Sirolimus can be decreased when combined with Chloroquine. Chlorothiazide The risk or severity of neutropenia and thrombocytopenia can be increased when Chlorothiazide is combined with Sirolimus. Chlorpheniramine The metabolism of Sirolimus can be decreased when combined with Chlorpheniramine. Chlorpromazine The metabolism of Sirolimus can be increased when combined with Chlorpromazine. Chlorpropamide The therapeutic efficacy of Chlorpropamide can be decreased when used in combination with Sirolimus. Cholecystokinin The excretion of Cholecystokinin can be decreased when combined with Sirolimus. Cholic Acid The excretion of Cholic Acid can be decreased when combined with Sirolimus. Ciclesonide The risk or severity of adverse effects can be increased when Sirolimus is combined with Ciclesonide. Cilazapril The risk or severity of adverse effects can be increased when Sirolimus is combined with Cilazapril. Cilostazol The metabolism of Sirolimus can be decreased when combined with Cilostazol. Cimetidine The metabolism of Sirolimus can be decreased when combined with Cimetidine. Cinchocaine The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Cinchocaine. Cinnarizine Cinnarizine may increase the immunosuppressive activities of Sirolimus. Ciprofloxacin The metabolism of Sirolimus can be decreased when combined with Ciprofloxacin. Cisapride The serum concentration of Cisapride can be increased when it is combined with Sirolimus. Cisatracurium Sirolimus may increase the neuromuscular blocking activities of Cisatracurium. Cisplatin The risk or severity of adverse effects can be increased when Cisplatin is combined with Sirolimus. Citalopram The metabolism of Sirolimus can be decreased when combined with Citalopram. Cladribine The risk or severity of adverse effects can be increased when Cladribine is combined with Sirolimus. Clarithromycin The metabolism of Sirolimus can be decreased when combined with Clarithromycin. Clevidipine Clevidipine may increase the immunosuppressive activities of Sirolimus. Clindamycin The metabolism of Sirolimus can be decreased when combined with Clindamycin. Clobazam The metabolism of Sirolimus can be increased when combined with Clobazam. Clobetasol The metabolism of Sirolimus can be increased when combined with Clobetasol propionate. Clofarabine The risk or severity of adverse effects can be increased when Clofarabine is combined with Sirolimus. Clofazimine The serum concentration of Sirolimus can be increased when it is combined with Clofazimine. Clofibrate The metabolism of Sirolimus can be increased when combined with Clofibrate. Clomifene The serum concentration of Sirolimus can be increased when it is combined with Clomifene. Clonidine The metabolism of Sirolimus can be decreased when combined with Clonidine. Clopidogrel The metabolism of Sirolimus can be decreased when combined with Clopidogrel. Clostridium The therapeutic efficacy of Clostridium tetani toxoid antigen (formaldehyde inactivated) can be decreased when used in combination with Sirolimus. Clotrimazole The serum concentration of Sirolimus can be increased when it is combined with Clotrimazole. Clozapine The risk or severity of neutropenia can be increased when Sirolimus is combined with Clozapine. Cobicistat The metabolism of Sirolimus can be decreased when combined with Cobicistat. Cobimetinib The metabolism of Sirolimus can be decreased when combined with Cobimetinib. Cocaine The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Cocaine. Colchicine The serum concentration of Sirolimus can be increased when it is combined with Colchicine. Conivaptan The metabolism of Sirolimus can be decreased when combined with Conivaptan. Conjugated estrogens The risk or severity of angioedema can be increased when Conjugated estrogens is combined with Sirolimus. You Might Also Read Belantamab mafodotin - Uses, Dosage, Side Effects, Interactions Copanlisib The metabolism of Copanlisib can be decreased when combined with Sirolimus. Corticotropin The serum concentration of Corticotropin can be increased when it is combined with Sirolimus. Cortisone acetate The serum concentration of Cortisone acetate can be increased when it is combined with Sirolimus. Corynebacterium The therapeutic efficacy of Corynebacterium diphtheriae toxoid antigen (formaldehyde inactivated) can be decreased when used in combination with Sirolimus. Crizotinib The metabolism of Sirolimus can be decreased when combined with Crizotinib. Curcumin The metabolism of Sirolimus can be decreased when combined with Curcumin. Cyanocobalamin The therapeutic efficacy of Cyanocobalamin can be decreased when used in combination with Sirolimus. Cyclandelate Cyclandelate may increase the immunosuppressive activities of Sirolimus. Cyclopenthiazide The risk or severity of neutropenia and thrombocytopenia can be increased when Cyclopenthiazide is combined with Sirolimus. Cyclophosphamide The metabolism of Sirolimus can be increased when combined with Cyclophosphamide. Cyclosporine Sirolimus may increase the immunosuppressive activities of Cyclosporine. Cyclothiazide The risk or severity of neutropenia and thrombocytopenia can be increased when Cyclothiazide is combined with Sirolimus. Cyproterone acetate The metabolism of Sirolimus can be decreased when combined with Cyproterone acetate. Cytarabine The risk or severity of adverse effects can be increased when Sirolimus is combined with Cytarabine. Dabigatran The risk or severity of bleeding can be increased when Dabigatran is combined with Sirolimus. Dabigatran etexilate The serum concentration of Sirolimus can be increased when it is combined with Dabigatran etexilate. Dabrafenib The serum concentration of Sirolimus can be decreased when it is combined with Dabrafenib. Dacarbazine The risk or severity of adverse effects can be increased when Dacarbazine is combined with Sirolimus. Daclatasvir The serum concentration of Sirolimus can be increased when it is combined with Daclatasvir. Dacomitinib The serum concentration of Sirolimus can be increased when it is combined with Dacomitinib. Dactinomycin The risk or severity of adverse effects can be increased when Sirolimus is combined with Dactinomycin. Dalfopristin The metabolism of Sirolimus can be decreased when combined with Dalfopristin. Dalteparin The risk or severity of bleeding can be increased when Dalteparin is combined with Sirolimus. Danaparoid The risk or severity of bleeding can be increased when Danaparoid is combined with Sirolimus. Danazol The metabolism of Sirolimus can be decreased when combined with Danazol. Dapagliflozin The therapeutic efficacy of Dapagliflozin can be decreased when used in combination with Sirolimus. Dapsone The metabolism of Sirolimus can be decreased when combined with Dapsone. Daptomycin The serum concentration of Sirolimus can be increased when it is combined with Daptomycin. Darolutamide The serum concentration of Sirolimus can be increased when it is combined with Darolutamide. Darunavir The serum concentration of Sirolimus can be increased when it is combined with Darunavir. Dasabuvir The serum concentration of Sirolimus can be increased when it is combined with Dasabuvir. Dasatinib The metabolism of Sirolimus can be decreased when combined with Dasatinib. Daunorubicin The metabolism of Sirolimus can be decreased when combined with Daunorubicin. Decitabine The risk or severity of adverse effects can be increased when Sirolimus is combined with Decitabine. Deferasirox The metabolism of Sirolimus can be increased when combined with Deferasirox. Defibrotide The risk or severity of bleeding can be increased when Defibrotide is combined with Sirolimus. Deflazacort The serum concentration of Deflazacort can be increased when it is combined with Sirolimus. Delavirdine The metabolism of Sirolimus can be decreased when combined with Delavirdine. Denosumab The risk or severity of adverse effects can be increased when Denosumab is combined with Sirolimus. Desipramine The metabolism of Sirolimus can be decreased when combined with Desipramine. Desirudin The risk or severity of bleeding can be increased when Desirudin is combined with Sirolimus. Deslanoside The serum concentration of Deslanoside can be increased when it is combined with Sirolimus. Desoximetasone The risk or severity of adverse effects can be increased when Desoximetasone is combined with Sirolimus. Desvenlafaxine The metabolism of Sirolimus can be decreased when combined with Desvenlafaxine. Deucravacitinib The risk or severity of adverse effects can be increased when Sirolimus is combined with Deucravacitinib. Deutetrabenazine The metabolism of Sirolimus can be decreased when combined with Deutetrabenazine. Dexamethasone The serum concentration of Dexamethasone can be increased when it is combined with Sirolimus. Dexamethasone acetate The serum concentration of Sirolimus can be decreased when it is combined with Dexamethasone acetate. Dexrazoxane The risk or severity of adverse effects can be increased when Dexrazoxane is combined with Sirolimus. Dextran The risk or severity of bleeding can be increased when Dextran is combined with Sirolimus. Dextromethorphan The metabolism of Sirolimus can be decreased when combined with Dextromethorphan. Dextropropoxyphene The metabolism of Sirolimus can be decreased when combined with Dextropropoxyphene. Diazepam The metabolism of Sirolimus can be decreased when combined with Diazepam. Diclofenac The risk or severity of angioedema can be increased when Diclofenac is combined with Sirolimus. Dicloxacillin The metabolism of Sirolimus can be increased when combined with Dicloxacillin. Dicoumarol The therapeutic efficacy of Dicoumarol can be increased when used in combination with Sirolimus. Diethylstilbestrol The metabolism of Sirolimus can be decreased when combined with Diethylstilbestrol. Difluocortolone The metabolism of Sirolimus can be increased when combined with Difluocortolone. Digitoxin The serum concentration of Digitoxin can be increased when it is combined with Sirolimus. Digoxin The serum concentration of Digoxin can be increased when it is combined with Sirolimus. Dihydroergocornine The serum concentration of Dihydroergocornine can be increased when it is combined with Sirolimus. Dihydroergocristine The serum concentration of Dihydroergocristine can be increased when it is combined with Sirolimus. Dihydroergotamine The metabolism of Sirolimus can be decreased when combined with Dihydroergotamine. Diltiazem Diltiazem may increase the immunosuppressive activities of Sirolimus. Dimethyl fumarate The risk or severity of adverse effects can be increased when Sirolimus is combined with Dimethyl fumarate. Dimethyl sulfoxide The metabolism of Sirolimus can be decreased when combined with Dimethyl sulfoxide. Dinoprostone The excretion of Dinoprostone can be decreased when combined with Sirolimus. Dinutuximab The risk or severity of adverse effects can be increased when Sirolimus is combined with Dinutuximab. Diosmin The serum concentration of Sirolimus can be increased when it is combined with Diosmin. Diphenhydramine The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Diphenhydramine. Dipyridamole The risk or severity of bleeding can be increased when Dipyridamole is combined with Sirolimus. Diroximel fumarate The risk or severity of adverse effects can be increased when Sirolimus is combined with Diroximel fumarate. Disopyramide Sirolimus may increase the QTc-prolonging activities of Disopyramide. Disulfiram The metabolism of Sirolimus can be decreased when combined with Disulfiram. Docetaxel The metabolism of Sirolimus can be decreased when combined with Docetaxel. Dolutegravir The serum concentration of Sirolimus can be increased when it is combined with Dolutegravir. Domperidone The metabolism of Sirolimus can be decreased when combined with Domperidone. Doravirine The metabolism of Sirolimus can be decreased when combined with Doravirine. Doxazosin The metabolism of Sirolimus can be decreased when combined with Doxazosin. Doxorubicin The metabolism of Sirolimus can be decreased when combined with Doxorubicin. Dronedarone The serum concentration of Sirolimus can be increased when it is combined with Dronedarone. Drospirenone The metabolism of Sirolimus can be decreased when combined with Drospirenone. Drotrecogin alfa The risk or severity of bleeding can be increased when Drotrecogin alfa is combined with Sirolimus. Dulaglutide The therapeutic efficacy of Dulaglutide can be decreased when used in combination with Sirolimus. Dutasteride The metabolism of Sirolimus can be decreased when combined with Dutasteride. Duvelisib The metabolism of Sirolimus can be decreased when combined with Duvelisib. Dyclonine The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Dyclonine. Ebastine The metabolism of Sirolimus can be decreased when combined with Ebastine. Ebola Zaire The therapeutic efficacy of Ebola Zaire vaccine (live, attenuated) can be decreased when used in combination with Sirolimus. Echinacea The metabolism of Sirolimus can be increased when combined with Echinacea. Eculizumab The risk or severity of adverse effects can be increased when Sirolimus is combined with Eculizumab. Edetic acid The risk or severity of bleeding can be increased when Edetic acid is combined with Sirolimus. Edoxaban The serum concentration of Sirolimus can be increased when it is combined with Edoxaban. Efalizumab The risk or severity of adverse effects can be increased when Efalizumab is combined with Sirolimus. Efavirenz The metabolism of Sirolimus can be decreased when combined with Efavirenz. Elagolix The serum concentration of Sirolimus can be increased when it is combined with Elagolix. Elbasvir The metabolism of Sirolimus can be decreased when combined with Elbasvir. Elexacaftor The metabolism of Sirolimus can be decreased when combined with Elexacaftor. Eliglustat The serum concentration of Sirolimus can be increased when it is combined with Eliglustat. Eluxadoline The serum concentration of Eluxadoline can be increased when it is combined with Sirolimus. Elvitegravir The metabolism of Sirolimus can be decreased when combined with Elvitegravir. Emapalumab The metabolism of Sirolimus can be increased when combined with Emapalumab. Empagliflozin The therapeutic efficacy of Empagliflozin can be decreased when used in combination with Sirolimus. Enalapril The risk or severity of adverse effects can be increased when Sirolimus is combined with Enalapril. Enalaprilat The risk or severity of adverse effects can be increased when Sirolimus is combined with Enalaprilat. Enasidenib The serum concentration of Sirolimus can be increased when it is combined with Enasidenib. Enfortumab The serum concentration of Sirolimus can be increased when it is combined with Enfortumab vedotin. Enoxaparin The risk or severity of bleeding can be increased when Enoxaparin is combined with Sirolimus. Entrectinib The serum concentration of Sirolimus can be increased when it is combined with Entrectinib. Enzalutamide The serum concentration of Sirolimus can be decreased when it is combined with Enzalutamide. Epinephrine The metabolism of Sirolimus can be decreased when combined with Epinephrine. Epirubicin The risk or severity of adverse effects can be increased when Epirubicin is combined with Sirolimus. Eplerenone The metabolism of Sirolimus can be decreased when combined with Eplerenone. Epoprostenol The risk or severity of bleeding can be increased when Epoprostenol is combined with Sirolimus. Eprosartan The risk or severity of angioedema can be increased when Eprosartan is combined with Sirolimus. Eptifibatide The risk or severity of bleeding can be increased when Eptifibatide is combined with Sirolimus. Erdafitinib The serum concentration of Sirolimus can be increased when it is combined with Erdafitinib. Ergoloid mesylate The serum concentration of Ergoloid mesylate can be increased when it is combined with Sirolimus. Ergometrine The serum concentration of Ergometrine can be increased when it is combined with Sirolimus. Ergotamine The metabolism of Sirolimus can be decreased when combined with Ergotamine. Eribulin The risk or severity of adverse effects can be increased when Sirolimus is combined with Eribulin. Erlotinib The metabolism of Sirolimus can be decreased when combined with Erlotinib. Ertugliflozin The therapeutic efficacy of Ertugliflozin can be decreased when used in combination with Sirolimus. Erythromycin The metabolism of Sirolimus can be decreased when combined with Erythromycin. Esketamine The metabolism of Sirolimus can be increased when combined with Esketamine. Eslicarbazepine The metabolism of Sirolimus can be increased when combined with Eslicarbazepine. Eslicarbazepine The metabolism of Sirolimus can be increased when combined with Eslicarbazepine acetate. Estazolam The serum concentration of Estazolam can be increased when it is combined with Sirolimus. Estetrol The therapeutic efficacy of Estetrol can be decreased when used in combination with Sirolimus. Estradiol The metabolism of Sirolimus can be decreased when combined with Estradiol. Estradiol acetate The metabolism of Sirolimus can be increased when combined with Estradiol acetate. Estradiol benzoate The metabolism of Sirolimus can be increased when combined with Estradiol benzoate. Estradiol cypionate The metabolism of Sirolimus can be increased when combined with Estradiol cypionate. Estradiol dienanthate The metabolism of Sirolimus can be increased when combined with Estradiol dienanthate. Estradiol valerate The metabolism of Sirolimus can be increased when combined with Estradiol valerate. Estramustine The risk or severity of adverse effects can be increased when Sirolimus is combined with Estramustine. Etanercept The metabolism of Sirolimus can be increased when combined with Etanercept. Ethambutol The metabolism of Sirolimus can be decreased when combined with Ethambutol. Ethanol The metabolism of Sirolimus can be increased when combined with Ethanol. Ethinylestradiol The metabolism of Sirolimus can be decreased when combined with Ethinylestradiol. Ethosuximide Ethosuximide may increase the immunosuppressive activities of Sirolimus. Ethyl chloride The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Ethyl chloride. Etidocaine The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Etidocaine. Etoposide The metabolism of Sirolimus can be decreased when combined with Etoposide. Etoricoxib The metabolism of Sirolimus can be decreased when combined with Etoricoxib. Etravirine The metabolism of Sirolimus can be increased when combined with Etravirine. Everolimus The metabolism of Sirolimus can be decreased when combined with Everolimus. Exenatide The therapeutic efficacy of Exenatide can be decreased when used in combination with Sirolimus. Ezetimibe The excretion of Ezetimibe can be decreased when combined with Sirolimus. Famtozinameran The therapeutic efficacy of Famtozinameran can be decreased when used in combination with Sirolimus. Favipiravir The serum concentration of Sirolimus can be increased when it is combined with Favipiravir. Fedratinib The serum concentration of Sirolimus can be increased when it is combined with Fedratinib. Felbamate The metabolism of Sirolimus can be increased when combined with Felbamate. Felodipine Felodipine may increase the immunosuppressive activities of Sirolimus. Fenofibrate The metabolism of Sirolimus can be decreased when combined with Fenofibrate. Fentanyl The metabolism of Sirolimus can be decreased when combined with Fentanyl. Fexinidazole The metabolism of Sirolimus can be decreased when combined with Fexinidazole. Fexofenadine The serum concentration of Sirolimus can be increased when it is combined with Fexofenadine. Filgotinib The serum concentration of Sirolimus can be increased when it is combined with Filgotinib. Finasteride The metabolism of Sirolimus can be decreased when combined with Finasteride. Fingolimod Sirolimus may increase the immunosuppressive activities of Fingolimod. Fish oil Fish oil may increase the immunosuppressive activities of Sirolimus. Flibanserin The serum concentration of Sirolimus can be increased when it is combined with Flibanserin. Floxuridine The risk or severity of adverse effects can be increased when Floxuridine is combined with Sirolimus. Flucloxacillin The metabolism of Sirolimus can be increased when combined with Flucloxacillin. Fluconazole The serum concentration of Sirolimus can be increased when it is combined with Fluconazole. Flucytosine The risk or severity of adverse effects can be increased when Sirolimus is combined with Flucytosine. Fludarabine The risk or severity of adverse effects can be increased when Sirolimus is combined with Fludarabine. Fludrocortisone The serum concentration of Fludrocortisone can be increased when it is combined with Sirolimus. Fluindione The therapeutic efficacy of Fluindione can be increased when used in combination with Sirolimus. Flunarizine Flunarizine may increase the immunosuppressive activities of Sirolimus. Flunisolide The serum concentration of Flunisolide can be increased when it is combined with Sirolimus. Fluocinolone The metabolism of Sirolimus can be increased when combined with Fluocinolone acetonide. Fluocinonide The metabolism of Sirolimus can be increased when combined with Fluocinonide. Fluocortolone The metabolism of Sirolimus can be increased when combined with Fluocortolone. Fluorometholone The risk or severity of adverse effects can be increased when Fluorometholone is combined with Sirolimus. Fluorouracil The risk or severity of adverse effects can be increased when Fluorouracil is combined with Sirolimus. Fluoxetine The metabolism of Sirolimus can be decreased when combined with Fluoxetine. Flupentixol The risk or severity of myelosuppression can be increased when Flupentixol is combined with Sirolimus. Fluprednisolone The serum concentration of Fluprednisolone can be increased when it is combined with Sirolimus. Fluspirilene Fluspirilene may increase the immunosuppressive activities of Sirolimus. Flutamide The metabolism of Sirolimus can be decreased when combined with Flutamide. Fluticasone The metabolism of Sirolimus can be increased when combined with Fluticasone. Fluticasone furoate The metabolism of Sirolimus can be increased when combined with Fluticasone furoate. Fluticasone The metabolism of Sirolimus can be decreased when combined with Fluticasone propionate. Fluvastatin The metabolism of Sirolimus can be decreased when combined with Fluvastatin. Fluvoxamine The metabolism of Sirolimus can be decreased when combined with Fluvoxamine. Fondaparinux The risk or severity of bleeding can be increased when Fondaparinux is combined with Sirolimus. Formestane The metabolism of Sirolimus can be increased when combined with Formestane. Fosamprenavir The metabolism of Sirolimus can be decreased when combined with Fosamprenavir. Fosaprepitant The metabolism of Sirolimus can be increased when combined with Fosaprepitant. Fosinopril The risk or severity of adverse effects can be increased when Sirolimus is combined with Fosinopril. Fosnetupitant The metabolism of Sirolimus can be decreased when combined with Fosnetupitant. Fosphenytoin The metabolism of Sirolimus can be increased when combined with Fosphenytoin. Fostamatinib The metabolism of Sirolimus can be decreased when combined with Fostamatinib. Fostemsavir The serum concentration of Sirolimus can be increased when it is combined with Fostemsavir. Fusidic acid The metabolism of Sirolimus can be decreased when combined with Fusidic acid. Futibatinib The serum concentration of Sirolimus can be increased when it is combined with Futibatinib. Gadoxetic acid The excretion of Gadoxetic acid can be decreased when combined with Sirolimus. Gallium nitrate The risk or severity of adverse effects can be increased when Sirolimus is combined with Gallium nitrate. Gefitinib The metabolism of Sirolimus can be decreased when combined with Gefitinib. Gemcitabine The risk or severity of adverse effects can be increased when Gemcitabine is combined with Sirolimus. Gemtuzumab The risk or severity of adverse effects can be increased when Gemtuzumab ozogamicin is combined with Sirolimus. Gilteritinib The metabolism of Sirolimus can be decreased when combined with Gilteritinib. Ginkgo biloba The metabolism of Sirolimus can be decreased when combined with Ginkgo biloba. Glasdegib The serum concentration of Sirolimus can be increased when it is combined with Glasdegib. Glatiramer The risk or severity of adverse effects can be increased when Sirolimus is combined with Glatiramer. Glecaprevir The serum concentration of Sirolimus can be increased when it is combined with Glecaprevir. Gliclazide The therapeutic efficacy of Gliclazide can be decreased when used in combination with Sirolimus. Glimepiride The therapeutic efficacy of Glimepiride can be decreased when used in combination with Sirolimus. Glipizide The therapeutic efficacy of Glipizide can be decreased when used in combination with Sirolimus. Gliquidone The therapeutic efficacy of Gliquidone can be decreased when used in combination with Sirolimus. Glyburide The metabolism of Sirolimus can be decreased when combined with Glyburide. Glycerol phenylbutyrate The metabolism of Sirolimus can be increased when combined with Glycerol phenylbutyrate. Glymidine The therapeutic efficacy of Glymidine can be decreased when used in combination with Sirolimus. Golimumab The metabolism of Sirolimus can be increased when combined with Golimumab. Grazoprevir The serum concentration of Sirolimus can be increased when it is combined with Grazoprevir. Griseofulvin The metabolism of Sirolimus can be increased when combined with Griseofulvin. Guselkumab The risk or severity of adverse effects can be increased when Sirolimus is combined with Guselkumab. Haemophilus The therapeutic efficacy of Haemophilus influenzae type B strain 20752 capsular polysaccharide tetanus toxoid conjugate antigen can be decreased when used in combination with Sirolimus. Halofantrine The metabolism of Sirolimus can be decreased when combined with Halofantrine. Haloperidol The serum concentration of Haloperidol can be increased when it is combined with Sirolimus. Heparin The risk or severity of bleeding can be increased when Heparin is combined with Sirolimus. Hepatitis A Vaccine The therapeutic efficacy of Hepatitis A Vaccine can be decreased when used in combination with Sirolimus. Hepatitis B The therapeutic efficacy of Hepatitis B Vaccine (Recombinant) can be decreased when used in combination with Sirolimus. Human adenovirus The risk or severity of infection can be increased when Human adenovirus e serotype 4 strain cl-68578 antigen is combined with Sirolimus. Hydralazine The metabolism of Sirolimus can be decreased when combined with Hydralazine. Hydrochlorothiazide The risk or severity of neutropenia and thrombocytopenia can be increased when Hydrochlorothiazide is combined with Sirolimus. Hydrocortamate The metabolism of Sirolimus can be increased when combined with Hydrocortamate. Hydrocortisone The serum concentration of Hydrocortisone can be increased when it is combined with Sirolimus. Hydrocortisone acetate The metabolism of Sirolimus can be increased when combined with Hydrocortisone acetate. Hydrocortisone butyrate The metabolism of Sirolimus can be increased when combined with Hydrocortisone butyrate. Hydrocortisone cypionate The metabolism of Sirolimus can be decreased when combined with Hydrocortisone cypionate. Hydrocortisone The metabolism of Sirolimus can be decreased when combined with Hydrocortisone phosphate. Hydrocortisone The metabolism of Sirolimus can be increased when combined with Hydrocortisone succinate. Hydroflumethiazide The risk or severity of neutropenia and thrombocytopenia can be increased when Hydroflumethiazide is combined with Sirolimus. Hydroxychloroquine The risk or severity of adverse effects can be increased when Sirolimus is combined with Hydroxychloroquine. Hydroxyprogesterone The metabolism of Sirolimus can be decreased when combined with Hydroxyprogesterone caproate. Hydroxyurea The risk or severity of adverse effects can be increased when Sirolimus is combined with Hydroxyurea. Hydroxyzine The metabolism of Sirolimus can be decreased when combined with Hydroxyzine. Ibritumomab tiuxetan The risk or severity of adverse effects can be increased when Ibritumomab tiuxetan is combined with Sirolimus. Ibrutinib The metabolism of Sirolimus can be decreased when combined with Ibrutinib. Ibuprofen The risk or severity of angioedema can be increased when Sirolimus is combined with Ibuprofen. Icatibant The risk or severity of angioedema can be increased when Sirolimus is combined with Icatibant. Icosapent ethyl The risk or severity of bleeding can be increased when Icosapent ethyl is combined with Sirolimus. Idarubicin The risk or severity of adverse effects can be increased when Sirolimus is combined with Idarubicin. Idelalisib The risk or severity of adverse effects can be increased when Sirolimus is combined with Idelalisib. Ifosfamide The metabolism of Sirolimus can be increased when combined with Ifosfamide. Iloperidone The metabolism of Sirolimus can be decreased when combined with Iloperidone. Iloprost The risk or severity of bleeding can be increased when Iloprost is combined with Sirolimus. Imatinib The serum concentration of Sirolimus can be increased when it is combined with Imatinib. Imipramine The metabolism of Sirolimus can be decreased when combined with Imipramine. Indacaterol The serum concentration of Sirolimus can be increased when it is combined with Indacaterol. Indinavir The metabolism of Sirolimus can be decreased when combined with Indinavir. Indomethacin The risk or severity of adverse effects can be increased when Indomethacin is combined with Sirolimus. Inebilizumab The risk or severity of infection can be increased when Sirolimus is combined with Inebilizumab. Infigratinib The metabolism of Sirolimus can be decreased when combined with Infigratinib. Infliximab The metabolism of Sirolimus can be increased when combined with Infliximab. You Might Also Read Dibucaine Hydrochloride - Uses, Dosage, Side Effects Ketazolam The metabolism of Sirolimus can be decreased when combined with Ketazolam. Ketoconazole The serum concentration of the active metabolites of Sirolimus can be increased when Sirolimus is used in combination with Ketoconazole. Lacidipine Lacidipine may increase the immunosuppressive activities of Sirolimus. Lacosamide The metabolism of Sirolimus can be decreased when combined with Lacosamide. Lactulose The therapeutic efficacy of Lactulose can be decreased when used in combination with Sirolimus. Lanreotide The metabolism of Sirolimus can be decreased when combined with Lanreotide. Lapatinib The serum concentration of Sirolimus can be increased when it is combined with Lapatinib. Larotrectinib The serum concentration of Sirolimus can be increased when it is combined with Larotrectinib. Lasmiditan The serum concentration of Sirolimus can be increased when it is combined with Lasmiditan. Ledipasvir The serum concentration of Sirolimus can be increased when it is combined with Ledipasvir. Lefamulin The serum concentration of Sirolimus can be increased when it is combined with Lefamulin. Leflunomide The risk or severity of adverse effects can be increased when Sirolimus is combined with Leflunomide. Lemborexant The metabolism of Sirolimus can be decreased when combined with Lemborexant. Lenalidomide The risk or severity of adverse effects can be increased when Lenalidomide is combined with Sirolimus. Lenvatinib The serum concentration of Sirolimus can be increased when it is combined with Lenvatinib. Lepirudin The risk or severity of bleeding can be increased when Lepirudin is combined with Sirolimus. Lercanidipine Lercanidipine may increase the immunosuppressive activities of Sirolimus. Lesinurad The metabolism of Sirolimus can be increased when combined with Lesinurad. Letermovir The serum concentration of Sirolimus can be increased when it is combined with Letermovir. Levacetylmethadol The metabolism of Sirolimus can be decreased when combined with Levacetylmethadol. Levamlodipine Levamlodipine may increase the immunosuppressive activities of Sirolimus. Levobupivacaine The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Levobupivacaine. Levoketoconazole The metabolism of Sirolimus can be decreased when combined with Levoketoconazole. Levonorgestrel The metabolism of Sirolimus can be decreased when combined with Levonorgestrel. Levosalbutamol The excretion of Levosalbutamol can be decreased when combined with Sirolimus. Levothyroxine The serum concentration of Sirolimus can be decreased when it is combined with Levothyroxine. Lidocaine The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Lidocaine. Lidoflazine Lidoflazine may increase the immunosuppressive activities of Sirolimus. Linagliptin The serum concentration of Sirolimus can be increased when it is combined with Linagliptin. Linezolid The risk or severity of adverse effects can be increased when Linezolid is combined with Sirolimus. Liothyronine The excretion of Liothyronine can be decreased when combined with Sirolimus. Liotrix The excretion of Liotrix can be decreased when combined with Sirolimus. Lipegfilgrastim Sirolimus may increase the myelosuppressive activities of Lipegfilgrastim. Liraglutide The therapeutic efficacy of Liraglutide can be decreased when used in combination with Sirolimus. Lisinopril The risk or severity of adverse effects can be increased when Sirolimus is combined with Lisinopril. Lisuride The serum concentration of Lisuride can be increased when it is combined with Sirolimus. Lixisenatide The therapeutic efficacy of Lixisenatide can be decreased when used in combination with Sirolimus. Lomitapide The serum concentration of Sirolimus can be increased when it is combined with Lomitapide. Lomustine The risk or severity of adverse effects can be increased when Sirolimus is combined with Lomustine. Lonafarnib The metabolism of Sirolimus can be decreased when combined with Lonafarnib. Loncastuximab The serum concentration of Sirolimus can be increased when it is combined with Loncastuximab tesirine. Loperamide Loperamide may increase the immunosuppressive activities of Sirolimus. Lopinavir The serum concentration of Sirolimus can be increased when it is combined with Lopinavir. Lorlatinib The serum concentration of Sirolimus can be decreased when it is combined with Lorlatinib. Losartan The metabolism of Sirolimus can be decreased when combined with Losartan. Lovastatin The metabolism of Sirolimus can be decreased when combined with Lovastatin. Loxapine The serum concentration of Sirolimus can be increased when it is combined with Loxapine. Lumacaftor The serum concentration of Sirolimus can be decreased when it is combined with Lumacaftor. Lusutrombopag The serum concentration of Sirolimus can be increased when it is combined with Lusutrombopag. Magnesium The serum concentration of Magnesium can be decreased when it is combined with Sirolimus. Magnesium sulfate Magnesium sulfate may increase the immunosuppressive activities of Sirolimus. Manidipine Manidipine may increase the immunosuppressive activities of Sirolimus. Mannitol The serum concentration of Sirolimus can be increased when it is combined with Mannitol. Maribavir The serum concentration of Sirolimus can be increased when it is combined with Maribavir. Mavacamten The serum concentration of Sirolimus can be decreased when it is combined with Mavacamten. Measles virus The therapeutic efficacy of Measles virus vaccine live attenuated can be decreased when used in combination with Sirolimus. Mecasermin The therapeutic efficacy of Mecasermin can be decreased when used in combination with Sirolimus. Mechlorethamine The risk or severity of adverse effects can be increased when Sirolimus is combined with Mechlorethamine. Medroxyprogeste The metabolism of Sirolimus can be increased when combined with Medroxyprogesterone acetate. Mefloquine The serum concentration of Sirolimus can be increased when it is combined with Mefloquine. Meloxicam The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Meloxicam. Melphalan The risk or severity of adverse effects can be increased when Sirolimus is combined with Melphalan. Meningococcal The therapeutic efficacy of Meningococcal (groups A, C, Y and W-135) oligosaccharide diphtheria CRM197 conjugate vaccine can be decreased when used in combination with Sirolimus. Meperidine The metabolism of Sirolimus can be decreased when combined with Meperidine. Mepivacaine The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Mepivacaine. Mepolizumab The risk or severity of adverse effects can be increased when Sirolimus is combined with Mepolizumab. Meprednisone The serum concentration of Meprednisone can be increased when it is combined with Sirolimus. Mercaptopurine The risk or severity of adverse effects can be increased when Sirolimus is combined with Mercaptopurine. Metamizole The risk or severity of myelosuppression can be increased when Metamizole is combined with Sirolimus. Metergoline The serum concentration of Metergoline can be increased when it is combined with Sirolimus. Metformin The therapeutic efficacy of Metformin can be decreased when used in combination with Sirolimus. Methadone The metabolism of Sirolimus can be decreased when combined with Methadone. Methimazole The metabolism of Sirolimus can be decreased when combined with Methimazole. Methotrexate The risk or severity of adverse effects can be increased when Methotrexate is combined with Sirolimus. Methsuximide Methsuximide may increase the immunosuppressive activities of Sirolimus. Methylene blue The serum concentration of Sirolimus can be increased when it is combined with Methylene blue. Methylergometrine The metabolism of Sirolimus can be decreased when combined with Methylergometrine. Methylphenobarbital The metabolism of Sirolimus can be increased when combined with Methylphenobarbital. Methylprednisolone The serum concentration of Methylprednisolone can be increased when it is combined with Sirolimus. Methylprednisone The metabolism of Sirolimus can be decreased when combined with Methylprednisone. Methysergide The serum concentration of Methysergide can be increased when it is combined with Sirolimus. Metreleptin The metabolism of Sirolimus can be increased when combined with Metreleptin. Metronidazole The metabolism of Sirolimus can be decreased when combined with Metronidazole. Metyrapone The metabolism of Sirolimus can be increased when combined with Metyrapone. Micafungin The metabolism of Sirolimus can be decreased when combined with Micafungin. Miconazole The metabolism of Sirolimus can be decreased when combined with Miconazole. Midazolam The serum concentration of Midazolam can be increased when it is combined with Sirolimus. Midostaurin The metabolism of Sirolimus can be decreased when combined with Midostaurin. Mifepristone The serum concentration of Sirolimus can be increased when it is combined with Mifepristone. Miglitol The therapeutic efficacy of Miglitol can be decreased when used in combination with Sirolimus. Milnacipran The metabolism of Sirolimus can be decreased when combined with Milnacipran. Miocamycin The metabolism of Sirolimus can be decreased when combined with Miocamycin. Mirabegron The serum concentration of Sirolimus can be increased when it is combined with Mirabegron. Mirtazapine The metabolism of Sirolimus can be decreased when combined with Mirtazapine. Mitapivat The metabolism of Sirolimus can be increased when combined with Mitapivat. Mitomycin The risk or severity of adverse effects can be increased when Mitomycin is combined with Sirolimus. Mitotane The metabolism of Sirolimus can be increased when combined with Mitotane. Mitoxantrone The risk or severity of adverse effects can be increased when Sirolimus is combined with Mitoxantrone. Mobocertinib The serum concentration of Sirolimus can be decreased when it is combined with Mobocertinib. Modafinil The metabolism of Sirolimus can be increased when combined with Modafinil. MCOVID-19 Vaccine The therapeutic efficacy of Moderna COVID-19 Vaccine can be decreased when used in combination with Sirolimus. Modified vaccinia The therapeutic efficacy of Modified vaccinia ankara can be decreased when used in combination with Sirolimus. Moexipril The risk or severity of adverse effects can be increased when Sirolimus is combined with Moexipril. Mometasone furoate The metabolism of Sirolimus can be increased when combined with Mometasone furoate. Monomethyl fumarate The risk or severity of adverse effects can be increased when Sirolimus is combined with Monomethyl fumarate. Morphine The serum concentration of Sirolimus can be increased when it is combined with Morphine. Mosunetuzumab The metabolism of Sirolimus can be decreased when combined with Mosunetuzumab. Mumps virus The therapeutic efficacy of Mumps virus strain B level jeryl lynn live antigen can be decreased when used in combination with Sirolimus. Muromonab The risk or severity of adverse effects can be increased when Muromonab is combined with Sirolimus. Mycophenolate The metabolism of Sirolimus can be decreased when combined with Mycophenolate mofetil. Mycophenolic acid The risk or severity of adverse effects can be increased when Sirolimus is combined with Mycophenolic acid. Nadroparin The risk or severity of bleeding can be increased when Nadroparin is combined with Sirolimus. Nafcillin The metabolism of Sirolimus can be increased when combined with Nafcillin. Naloxone The metabolism of Sirolimus can be decreased when combined with Naloxone. Natalizumab The risk or severity of adverse effects can be increased when Sirolimus is combined with Natalizumab. Nateglinide The metabolism of Sirolimus can be decreased when combined with Nateglinide. Nefazodone The metabolism of Sirolimus can be decreased when combined with Nefazodone. Nelarabine The risk or severity of adverse effects can be increased when Sirolimus is combined with Nelarabine. Nelfinavir The metabolism of Sirolimus can be decreased when combined with Nelfinavir. Neratinib The serum concentration of Sirolimus can be increased when it is combined with Neratinib. Netupitant The serum concentration of Sirolimus can be increased when it is combined with Netupitant. Nevirapine The metabolism of Sirolimus can be decreased when combined with Nevirapine. Niacin The metabolism of Sirolimus can be decreased when combined with Niacin. Nicardipine Nicardipine may increase the immunosuppressive activities of Sirolimus. Nicergoline The serum concentration of Nicergoline can be increased when it is combined with Sirolimus. Nifedipine Nifedipine may increase the immunosuppressive activities of Sirolimus. Nilotinib The metabolism of Sirolimus can be decreased when combined with Nilotinib. Nilvadipine Nilvadipine may increase the immunosuppressive activities of Sirolimus. Nimesulide Nimesulide may increase the immunosuppressive activities of Sirolimus. Nimodipine Nimodipine may increase the immunosuppressive activities of Sirolimus. Nintedanib The metabolism of Sirolimus can be decreased when combined with Nintedanib. Nisoldipine Nisoldipine may increase the immunosuppressive activities of Sirolimus. Nitrendipine Nitrendipine may increase the immunosuppressive activities of Sirolimus. Norethisterone The metabolism of Sirolimus can be decreased when combined with Norethisterone. Norgestimate The serum concentration of Sirolimus can be increased when it is combined with Norgestimate. Nortriptyline The serum concentration of Nortriptyline can be increased when it is combined with Sirolimus. Noscapine The metabolism of Sirolimus can be decreased when combined with Noscapine. Nuvaxovid The therapeutic efficacy of Nuvaxovid can be decreased when used in combination with Sirolimus. Nylidrin Nylidrin may increase the immunosuppressive activities of Sirolimus. Obinutuzumab The risk or severity of adverse effects can be increased when Sirolimus is combined with Obinutuzumab. Ocrelizumab Ocrelizumab may increase the immunosuppressive activities of Sirolimus. Octreotide The serum concentration of Sirolimus can be increased when it is combined with Octreotide. Ofatumumab The risk or severity of adverse effects can be increased when Sirolimus is combined with Ofatumumab. Olaparib The metabolism of Sirolimus can be decreased when combined with Olaparib. Omadacycline The serum concentration of Sirolimus can be increased when it is combined with Omadacycline. Ombitasvir The serum concentration of Sirolimus can be increased when it is combined with Ombitasvir. Omeprazole The metabolism of Sirolimus can be increased when combined with Omeprazole. Ondansetron The metabolism of Sirolimus can be decreased when combined with Ondansetron. Oritavancin The metabolism of Sirolimus can be increased when combined with Oritavancin. Orphenadrine The metabolism of Sirolimus can be decreased when combined with Orphenadrine. Osilodrostat The metabolism of Sirolimus can be decreased when combined with Osilodrostat. Osimertinib The metabolism of Sirolimus can be decreased when combined with Osimertinib. Ouabain The serum concentration of Ouabain can be increased when it is combined with Sirolimus. Oxaliplatin The risk or severity of adverse effects can be increased when Oxaliplatin is combined with Sirolimus. Oxcarbazepine The metabolism of Sirolimus can be increased when combined with Oxcarbazepine. Oxetacaine The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Oxetacaine. Oxtriphylline The metabolism of Oxtriphylline can be decreased when combined with Sirolimus. Oxybuprocaine The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Oxybuprocaine. Oxybutynin The metabolism of Sirolimus can be decreased when combined with Oxybutynin. Oxycodone The metabolism of Sirolimus can be decreased when combined with Oxycodone. Ozanimod The risk or severity of adverse effects can be increased when Sirolimus is combined with Ozanimod. Paclitaxel The metabolism of Sirolimus can be increased when combined with Paclitaxel. Pacritinib The serum concentration of Sirolimus can be increased when it is combined with Pacritinib. Palbociclib The serum concentration of Sirolimus can be increased when it is combined with Palbociclib. Palifermin The therapeutic efficacy of Palifermin can be decreased when used in combination with Sirolimus. Paliperidone The serum concentration of Sirolimus can be increased when it is combined with Paliperidone. Panobinostat The risk or severity of adverse effects can be increased when Sirolimus is combined with Panobinostat. Paritaprevir The metabolism of Sirolimus can be decreased when combined with Paritaprevir. Parnaparin The risk or severity of bleeding can be increased when Parnaparin is combined with Sirolimus. Pasireotide The metabolism of Sirolimus can be decreased when combined with Pasireotide. Pazopanib The metabolism of Sirolimus can be decreased when combined with Pazopanib. Pegaspargase The risk or severity of adverse effects can be increased when Pegaspargase is combined with Sirolimus. Pegcetacoplan The risk or severity of adverse effects can be increased when Sirolimus is combined with Pegcetacoplan. Peginterferon alfa The risk or severity of adverse effects can be increased when Peginterferon alfa-2a is combined with Sirolimus. Peginterferon alf The risk or severity of adverse effects can be increased when Peginterferon alfa-2b is combined with Sirolimus. Peginterferon The risk or severity of adverse effects can be increased when Sirolimus is combined with Peginterferon beta-1a. Pemetrexed The risk or severity of adverse effects can be increased when Pemetrexed is combined with Sirolimus. Penicillamine The risk or severity of adverse effects can be increased when Penicillamine is combined with Sirolimus. Pentamidine The metabolism of Sirolimus can be decreased when combined with Pentamidine. Pentobarbital The metabolism of Sirolimus can be increased when combined with Pentobarbital. Pentosan polysulfate The risk or severity of bleeding can be increased when Pentosan polysulfate is combined with Sirolimus. Pentostatin The risk or severity of adverse effects can be increased when Pentostatin is combined with Sirolimus. Pentoxifylline The metabolism of Pentoxifylline can be decreased when combined with Sirolimus. Perampanel The metabolism of Sirolimus can be increased when combined with Perampanel. Pergolide The serum concentration of Pergolide can be increased when it is combined with Sirolimus. Perhexiline Perhexiline may increase the immunosuppressive activities of Sirolimus. Perindopril The risk or severity of adverse effects can be increased when Sirolimus is combined with Perindopril. Pertussis vaccine The therapeutic efficacy of Pertussis vaccine can be decreased when used in combination with Sirolimus. Phenformin The therapeutic efficacy of Phenformin can be decreased when used in combination with Sirolimus. Phenindione The therapeutic efficacy of Phenindione can be increased when used in combination with Sirolimus. Phenobarbital The metabolism of Sirolimus can be increased when combined with Phenobarbital. Phenol The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Phenol. Phenprocoumon The therapeutic efficacy of Phenprocoumon can be increased when used in combination with Sirolimus. Phenylalanine The risk or severity of adverse effects can be increased when Phenylalanine is combined with Sirolimus. Phenylbutazone The metabolism of Sirolimus can be increased when combined with Phenylbutazone. Phenytoin The metabolism of Sirolimus can be increased when combined with Phenytoin. Pibrentasvir The serum concentration of Sirolimus can be increased when it is combined with Pibrentasvir. Picosulfuric acid The therapeutic efficacy of Picosulfuric acid can be decreased when used in combination with Sirolimus. Pimavanserin The metabolism of Sirolimus can be decreased when combined with Pimavanserin. Pimecrolimus The risk or severity of adverse effects can be increased when Pimecrolimus is combined with Sirolimus. Pimozide The metabolism of Pimozide can be decreased when combined with Sirolimus. Pinaverium Pinaverium may increase the immunosuppressive activities of Sirolimus. Pioglitazone The therapeutic efficacy of Pioglitazone can be decreased when used in combination with Sirolimus. Piperaquine The metabolism of Sirolimus can be decreased when combined with Piperaquine. Pirfenidone The risk or severity of adverse effects can be increased when Sirolimus is combined with Pirfenidone. Pitavastatin The excretion of Pitavastatin can be decreased when combined with Sirolimus. Pitolisant The serum concentration of Sirolimus can be decreased when it is combined with Pitolisant. Polythiazide The risk or severity of neutropenia and thrombocytopenia can be increased when Polythiazide is combined with Sirolimus. Pomalidomide The risk or severity of adverse effects can be increased when Sirolimus is combined with Pomalidomide. Ponatinib The serum concentration of Sirolimus can be increased when it is combined with Ponatinib. Ponesimod The metabolism of Sirolimus can be decreased when combined with Ponesimod. Posaconazole The metabolism of Sirolimus can be decreased when combined with Posaconazole. Pralatrexate The risk or severity of adverse effects can be increased when Sirolimus is combined with Pralatrexate. Pralsetinib The serum concentration of Sirolimus can be increased when it is combined with Pralsetinib. Pramlintide The therapeutic efficacy of Pramlintide can be decreased when used in combination with Sirolimus. Pramocaine The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Pramocaine. Prasugrel The risk or severity of bleeding can be increased when Prasugrel is combined with Sirolimus. Pravastatin The serum concentration of Sirolimus can be increased when it is combined with Pravastatin. Praziquantel The metabolism of Sirolimus can be decreased when combined with Praziquantel. Prednisolone The serum concentration of Prednisolone can be increased when it is combined with Sirolimus. Prednisolone acetate The metabolism of Sirolimus can be increased when combined with Prednisolone acetate. Prednisolone The serum concentration of Sirolimus can be decreased when it is combined with Prednisolone phosphate. Prednisone The serum concentration of Prednisone can be increased when it is combined with Sirolimus. Prednisone acetate The metabolism of Sirolimus can be increased when combined with Prednisone acetate. Pregabalin The risk or severity of angioedema can be increased when Pregabalin is combined with Sirolimus. Prenylamine Prenylamine may increase the immunosuppressive activities of Sirolimus. Pretomanid The metabolism of Sirolimus can be decreased when combined with Pretomanid. Prilocaine The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Prilocaine. Primaquine The metabolism of Sirolimus can be decreased when combined with Primaquine. Primidone The metabolism of Sirolimus can be increased when combined with Primidone. Probenecid The metabolism of Sirolimus can be increased when combined with Probenecid. Procaine The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Procaine. Procarbazine The risk or severity of adverse effects can be increased when Sirolimus is combined with Procarbazine. Progesterone The metabolism of Sirolimus can be decreased when combined with Progesterone. Propafenone The serum concentration of Sirolimus can be increased when it is combined with Propafenone. Proparacaine The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Proparacaine. Propofol The metabolism of Sirolimus can be decreased when combined with Propofol. Propoxycaine The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Propoxycaine. Propranolol The metabolism of Sirolimus can be decreased when combined with Propranolol. Propylthiouracil The risk or severity of adverse effects can be increased when Propylthiouracil is combined with Sirolimus. Protein C The risk or severity of bleeding can be increased when Protein C is combined with Sirolimus. Protein S human The risk or severity of bleeding can be increased when Protein S human is combined with Sirolimus. Quetiapine The metabolism of Sirolimus can be decreased when combined with Quetiapine. Quinapril The risk or severity of adverse effects can be increased when Sirolimus is combined with Quinapril. Quinidine The serum concentration of Quinidine can be increased when it is combined with Sirolimus. Quinine The serum concentration of Quinine can be increased when it is combined with Sirolimus. Quinupristin The metabolism of Sirolimus can be decreased when combined with Quinupristin. Rabies immune glob The therapeutic efficacy of Rabies immune globulin, human can be decreased when used in combination with Sirolimus. Rabies antigen, A The therapeutic efficacy of Rabies virus inactivated antigen, A can be decreased when used in combination with Sirolimus. Rabies , B The therapeutic efficacy of Rabies virus inactivated antigen, B can be decreased when used in combination with Sirolimus. Raloxifene The metabolism of Sirolimus can be decreased when combined with Raloxifene. Raltitrexed The risk or severity of adverse effects can be increased when Raltitrexed is combined with Sirolimus. Ramipril The risk or severity of adverse effects can be increased when Sirolimus is combined with Ramipril. Ranolazine The serum concentration of Sirolimus can be increased when it is combined with Ranolazine. Ravulizumab The risk or severity of adverse effects can be increased when Sirolimus is combined with Ravulizumab. Regorafenib The serum concentration of Sirolimus can be increased when it is combined with Regorafenib. Relugolix The metabolism of Sirolimus can be decreased when combined with Relugolix. Remdesivir The metabolism of Sirolimus can be decreased when combined with Remdesivir. Repaglinide The serum concentration of Repaglinide can be increased when it is combined with Sirolimus. Rescinnamine The risk or severity of adverse effects can be increased when Sirolimus is combined with Rescinnamine. Reserpine The serum concentration of Sirolimus can be increased when it is combined with Reserpine. Reteplase The risk or severity of angioedema can be increased when Reteplase is combined with Sirolimus. Revefenacin Sirolimus may decrease the excretion rate of Revefenacin which could result in a higher serum level. Reviparin The risk or severity of bleeding can be increased when Reviparin is combined with Sirolimus. Ribociclib The metabolism of Sirolimus can be decreased when combined with Ribociclib. Rifabutin The metabolism of Sirolimus can be increased when combined with Rifabutin. Rifampicin The serum concentration of Sirolimus can be decreased when it is combined with Rifampicin. Rifamycin The serum concentration of Sirolimus can be increased when it is combined with Rifamycin. Rifapentine The metabolism of Sirolimus can be increased when combined with Rifapentine. Rilonacept The metabolism of Sirolimus can be increased when combined with Rilonacept. Rilpivirine The metabolism of Sirolimus can be decreased when combined with Rilpivirine. Rimegepant The serum concentration of Sirolimus can be increased when it is combined with Rimegepant. Riociguat The serum concentration of Sirolimus can be increased when it is combined with Riociguat. Ripretinib The serum concentration of Sirolimus can be increased when it is combined with Ripretinib. Risankizumab The risk or severity of adverse effects can be increased when Sirolimus is combined with Risankizumab. Risperidone The metabolism of Sirolimus can be decreased when combined with Risperidone. Ritonavir The serum concentration of Sirolimus can be increased when it is combined with Ritonavir. Rituximab The risk or severity of adverse effects can be increased when Rituximab is combined with Sirolimus. Rivaroxaban The metabolism of Sirolimus can be decreased when combined with Rivaroxaban. Rofecoxib The metabolism of Sirolimus can be increased when combined with Rofecoxib. Roflumilast Roflumilast may increase the immunosuppressive activities of Sirolimus. Rolapitant The serum concentration of Sirolimus can be increased when it is combined with Rolapitant. Romidepsin The metabolism of Sirolimus can be decreased when combined with Romidepsin. Ropeginterferon alf The risk or severity of adverse effects can be increased when Sirolimus is combined with Ropeginterferon alfa-2b. Ropivacaine The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Ropivacaine. Rosiglitazone The therapeutic efficacy of Rosiglitazone can be decreased when used in combination with Sirolimus. Rosuvastatin The metabolism of Sirolimus can be decreased when combined with Rosuvastatin. Rotavirus vaccine The therapeutic efficacy of Rotavirus vaccine can be decreased when used in combination with Sirolimus. Roxithromycin The metabolism of Sirolimus can be decreased when combined with Roxithromycin. Rubella virus vaccine The risk or severity of infection can be increased when Rubella virus vaccine is combined with Sirolimus. Rucaparib The metabolism of Sirolimus can be decreased when combined with Rucaparib. Rufinamide The metabolism of Sirolimus can be increased when combined with Rufinamide. Ruxolitinib The risk or severity of adverse effects can be increased when Sirolimus is combined with Ruxolitinib. Sacubitril The risk or severity of angioedema can be increased when Sirolimus is combined with Sacubitril. Salmeterol The metabolism of Sirolimus can be decreased when combined with Salmeterol. Sapropterin The serum concentration of Sirolimus can be increased when it is combined with Sapropterin. Saquinavir The metabolism of Sirolimus can be decreased when combined with Saquinavir. Sarecycline The serum concentration of Sirolimus can be increased when it is combined with Sarecycline. Sarilumab The metabolism of Sirolimus can be increased when combined with Sarilumab. Satralizumab The serum concentration of Sirolimus can be decreased when it is combined with Satralizumab. Saxagliptin The metabolism of Sirolimus can be decreased when combined with Saxagliptin. Secobarbital The metabolism of Sirolimus can be increased when combined with Secobarbital. Secukinumab The metabolism of Sirolimus can be increased when combined with Secukinumab. Selexipag The serum concentration of Sirolimus can be increased when it is combined with Selexipag. Selumetinib The metabolism of Sirolimus can be decreased when combined with Selumetinib. Semaglutide The therapeutic efficacy of Semaglutide can be decreased when used in combination with Sirolimus. Sildenafil The serum concentration of Sirolimus can be increased when it is combined with Sildenafil. Silodosin The serum concentration of Sirolimus can be increased when it is combined with Silodosin. Siltuximab The metabolism of Sirolimus can be increased when combined with Siltuximab. Simeprevir The serum concentration of Sirolimus can be increased when it is combined with Simeprevir. Simvastatin The serum concentration of Sirolimus can be increased when it is combined with Simvastatin. Siponimod The risk or severity of adverse effects can be increased when Sirolimus is combined with Siponimod. Sipuleucel-T The therapeutic efficacy of Sipuleucel-T can be decreased when used in combination with Sirolimus. Sitagliptin The therapeutic efficacy of Sitagliptin can be decreased when used in combination with Sirolimus. Sitaxentan The metabolism of Sirolimus can be decreased when combined with Sitaxentan. Smallpox (Vaccinia) The therapeutic efficacy of Smallpox (Vaccinia) Vaccine, Live can be decreased when used in combination with Sirolimus. Sodium citrate The risk or severity of bleeding can be increased when Sodium citrate is combined with Sirolimus. Sofosbuvir The serum concentration of Sirolimus can be increased when it is combined with Sofosbuvir. Somatostatin The metabolism of Sirolimus can be decreased when combined with Somatostatin. Somatrogon The metabolism of Sirolimus can be increased when combined with Somatrogon. Sorafenib The serum concentration of Sirolimus can be increased when it is combined with Sorafenib. Sotagliflozin The serum concentration of Sirolimus can be increased when it is combined with Sotagliflozin. Sotorasib The serum concentration of Sirolimus can be decreased when it is combined with Sotorasib. Spesolimab The risk or severity of adverse effects can be increased when Sirolimus is combined with Spesolimab. Spirapril The risk or severity of adverse effects can be increased when Sirolimus is combined with Spirapril. St. John’s Wort The serum concentration of Sirolimus can be decreased when it is combined with St. John’s Wort. Stiripentol The metabolism of Sirolimus can be decreased when combined with Stiripentol. Streptokinase The risk or severity of angioedema can be increased when Streptokinase is combined with Sirolimus. Streptozocin The risk or severity of adverse effects can be increased when Streptozocin is combined with Sirolimus. Sulfadiazine The therapeutic efficacy of Sulfadiazine can be decreased when used in combination with Sirolimus. Sulfamethoxazole The risk or severity of myelosuppression can be increased when Sulfamethoxazole is combined with Sirolimus. Sulfasalazine The risk or severity of adverse effects can be increased when Sulfasalazine is combined with Sirolimus. Sulfinpyrazone The metabolism of Sirolimus can be increased when combined with Sulfinpyrazone. Sulfisoxazole The therapeutic efficacy of Sulfisoxazole can be decreased when used in combination with Sirolimus. Sulodexide The risk or severity of bleeding can be increased when Sulodexide is combined with Sirolimus. Sumatriptan The excretion of Sumatriptan can be decreased when combined with Sirolimus. Sunitinib The metabolism of Sunitinib can be decreased when combined with Sirolimus. Suvorexant The serum concentration of Sirolimus can be increased when it is combined with Suvorexant. Tacrolimus The risk or severity of adverse effects can be increased when Tacrolimus is combined with Sirolimus. Tadalafil The metabolism of Sirolimus can be decreased when combined with Tadalafil. Talazoparib The serum concentration of Talazoparib can be increased when it is combined with Sirolimus. Tamoxifen The serum concentration of Sirolimus can be increased when it is combined with Tamoxifen. Tasimelteon The metabolism of Sirolimus can be decreased when combined with Tasimelteon. Taurocholic acid The excretion of Taurocholic acid can be decreased when combined with Sirolimus. Tazemetostat The metabolism of Sirolimus can be decreased when combined with Tazemetostat. Technetium The excretion of Technetium Tc-99m mebrofenin can be decreased when combined with Sirolimus. Technetium The serum concentration of Sirolimus can be increased when it is combined with Technetium Tc-99m sestamibi. Tecovirimat The metabolism of Sirolimus can be increased when combined with Tecovirimat. Tedizolid The risk or severity of myelosuppression can be increased when Sirolimus is combined with Tedizolid phosphate. Tegafur The metabolism of Tegafur can be decreased when combined with Sirolimus. Tegaserod The serum concentration of Sirolimus can be increased when it is combined with Tegaserod. Telaprevir The serum concentration of Telaprevir can be increased when it is combined with Sirolimus. Telithromycin The metabolism of Sirolimus can be decreased when combined with Telithromycin. Telmisartan The risk or severity of angioedema can be increased when Sirolimus is combined with Telmisartan. Telotristat ethyl The serum concentration of Sirolimus can be decreased when it is combined with Telotristat ethyl. Temozolomide The risk or severity of adverse effects can be increased when Temozolomide is combined with Sirolimus. Temsirolimus The metabolism of Temsirolimus can be decreased when combined with Sirolimus. Tenecteplase The risk or severity of angioedema can be increased when Tenecteplase is combined with Sirolimus. Teniposide The metabolism of Sirolimus can be decreased when combined with Teniposide. Tenofovir The metabolism of Sirolimus can be decreased when combined with Tenofovir alafenamide. Tenofovir disoproxil The serum concentration of Sirolimus can be increased when it is combined with Tenofovir disoproxil. Tepotinib The serum concentration of Sirolimus can be increased when it is combined with Tepotinib. Teprotumumab The risk or severity of adverse effects can be increased when Sirolimus is combined with Teprotumumab. Terbinafine The metabolism of Sirolimus can be increased when combined with Terbinafine. Terfenadine The serum concentration of Terfenadine can be increased when it is combined with Sirolimus. Teriflunomide The risk or severity of adverse effects can be increased when Sirolimus is combined with Teriflunomide. Testosterone The metabolism of Sirolimus can be increased when combined with Testosterone. Testosterone The metabolism of Sirolimus can be decreased when combined with Testosterone cypionate. Testosterone The metabolism of Sirolimus can be decreased when combined with Testosterone enanthate. Tetracaine The risk or severity of methemoglobinemia can be increased when Sirolimus is combined with Tetracaine. Tetracycline The metabolism of Sirolimus can be decreased when combined with Tetracycline. Tezacaftor The metabolism of Sirolimus can be decreased when combined with Tezacaftor. Thalidomide The risk or severity of adverse effects can be increased when Sirolimus is combined with Thalidomide. Theophylline The metabolism of Theophylline can be decreased when combined with Sirolimus. Thiamylal The metabolism of Sirolimus can be increased when combined with Thiamylal. Thiotepa The risk or severity of adverse effects can be increased when Sirolimus is combined with Thiotepa. Ticagrelor The serum concentration of Sirolimus can be increased when it is combined with Ticagrelor. Tick encephalitis The therapeutic efficacy of Tick-borne encephalitis vaccine (whole virus, inactivated) can be decreased when used in combination with Sirolimus. Ticlopidine The risk or severity of bleeding can be increased when Ticlopidine is combined with Sirolimus. Tinzaparin The risk or severity of bleeding can be increased when Tinzaparin is combined with Sirolimus. Tioguanine The risk or severity of adverse effects can be increased when Tioguanine is combined with Sirolimus. Tipranavir The metabolism of Sirolimus can be decreased when combined with Tipranavir. Tirofiban The risk or severity of bleeding can be increased when Tirofiban is combined with Sirolimus. Tirzepatide The therapeutic efficacy of Tirzepatide can be decreased when used in combination with Sirolimus. Tivozanib The serum concentration of Sirolimus can be increased when it is combined with Tivozanib. Tixocortol The risk or severity of adverse effects can be increased when Sirolimus is combined with Tixocortol. Tocilizumab The metabolism of Sirolimus can be increased when combined with Tocilizumab. Tofacitinib Sirolimus may increase the immunosuppressive activities of Tofacitinib. Tolazamide The therapeutic efficacy of Tolazamide can be decreased when used in combination with Sirolimus. Tolbutamide The therapeutic efficacy of Tolbutamide can be decreased when used in combination with Sirolimus. Tolvaptan The serum concentration of Tolvaptan can be increased when it is combined with Sirolimus. Topiramate The metabolism of Sirolimus can be increased when combined with Topiramate. Topotecan The risk or severity of adverse effects can be increased when Sirolimus is combined with Topotecan. Torasemide The excretion of Torasemide can be decreased when combined with Sirolimus. Toremifene The serum concentration of Sirolimus can be increased when it is combined with Toremifene. Tositumomab The risk or severity of adverse effects can be increased when Tositumomab is combined with Sirolimus. Trabectedin The risk or severity of adverse effects can be increased when Sirolimus is combined with Trabectedin. Trandolapril The risk or severity of adverse effects can be increased when Sirolimus is combined with Trandolapril. You Might Also Read Sunitinib; Uses, Dosage, Side Effects, Interactions, Pregnancy Trastuzumab Trastuzumab may increase the neutropenic activities of Sirolimus. Trastuzumab The metabolism of Trastuzumab emtansine can be decreased when combined with Sirolimus. Trazodone The serum concentration of Sirolimus can be decreased when it is combined with Trazodone. Tretinoin The metabolism of Sirolimus can be decreased when combined with Tretinoin. Triamcinolone Sirolimus may decrease the excretion rate of Triamcinolone which could result in a higher serum level. Triazolam The serum concentration of Triazolam can be increased when it is combined with Sirolimus. Trichlormethiazide The risk or severity of neutropenia and thrombocytopenia can be increased when Trichlormethiazide is combined with Sirolimus. Triclabendazole The metabolism of Sirolimus can be decreased when combined with Triclabendazole. Trifluridine The risk or severity of adverse effects can be increased when Trifluridine is combined with Sirolimus. Triflusal The risk or severity of bleeding can be increased when Triflusal is combined with Sirolimus. Trilaciclib The serum concentration of Sirolimus can be increased when it is combined with Trilaciclib. Trilostane The serum concentration of Trilostane can be increased when it is combined with Sirolimus. Trimebutine Trimebutine may increase the immunosuppressive activities of Sirolimus. Trimethadione Trimethadione may increase the immunosuppressive activities of Sirolimus. Trimipramine The serum concentration of Trimipramine can be increased when it is combined with Sirolimus. Troglitazone The metabolism of Sirolimus can be increased when combined with Troglitazone. Troleandomycin The metabolism of Sirolimus can be decreased when combined with Troleandomycin. Tucatinib Tucatinib may decrease the excretion rate of Sirolimus which could result in a higher serum level. Typhoid vaccine The therapeutic efficacy of Typhoid vaccine can be decreased when used in combination with Sirolimus. Typhoid Vaccine The risk or severity of infection can be increased when Typhoid Vaccine Live is combined with Sirolimus. Typhoid vaccine The therapeutic efficacy of Typhoid Vi polysaccharide vaccine can be decreased when used in combination with Sirolimus. Ubrogepant The serum concentration of Sirolimus can be increased when it is combined with Ubrogepant. Udenafil The metabolism of Sirolimus can be decreased when combined with Udenafil. Umbralisib The serum concentration of Sirolimus can be increased when it is combined with Umbralisib. Umeclidinium The serum concentration of Sirolimus can be increased when it is combined with Umeclidinium. Upadacitinib The risk or severity of adverse effects can be increased when Sirolimus is combined with Upadacitinib. Urokinase The risk or severity of angioedema can be increased when Urokinase is combined with Sirolimus. Valentine The metabolism of Sirolimus can be decreased when combined with Valbenazine. Valproic acid The metabolism of Sirolimus can be decreased when combined with Valproic acid. Valsartan The risk or severity of angioedema can be increased when Valsartan is combined with Sirolimus. Vandetanib The serum concentration of Sirolimus can be increased when it is combined with Vandetanib. Vardenafil The serum concentration of Sirolimus can be increased when it is combined with Vardenafil. Varicella zoster The risk or severity of infection can be increased when Varicella zoster vaccine (live/attenuated) is combined with Sirolimus. Varicella zoster The therapeutic efficacy of Varicella zoster vaccine (recombinant) can be decreased when used in combination with Sirolimus. Vedolizumab The risk or severity of adverse effects can be increased when Sirolimus is combined with Vedolizumab. Velpatasvir The serum concentration of Sirolimus can be increased when it is combined with Velpatasvir. Vemurafenib The serum concentration of Sirolimus can be increased when it is combined with Vemurafenib. Venetoclax The serum concentration of Sirolimus can be increased when it is combined with Venetoclax. Verapamil The serum concentration of Sirolimus can be increased when it is combined with Verapamil. Vibrioantigen The therapeutic efficacy of Vibrio cholerae CVD 103-HgR strain live antigen can be decreased when used in combination with Sirolimus. Vilanterol The risk or severity of adverse effects can be increased when Sirolimus is combined with Vilanterol. Vildagliptin The therapeutic efficacy of Vildagliptin can be decreased when used in combination with Sirolimus. Viloxazine The metabolism of Sirolimus can be decreased when combined with Viloxazine. Vinblastine The metabolism of Sirolimus can be increased when combined with Vinblastine. Vincristine The metabolism of Sirolimus can be decreased when combined with Vincristine. Vindesine The risk or severity of adverse effects can be increased when Vindesine is combined with Sirolimus. Vinflunine The serum concentration of Vinflunine can be increased when it is combined with Sirolimus. Vinorelbine The risk or severity of adverse effects can be increased when Vinorelbine is combined with Sirolimus. Vitamin E The metabolism of Sirolimus can be increased when combined with Vitamin E. Voclosporin The serum concentration of Sirolimus can be increased when it is combined with Voclosporin. Vonoprazan The metabolism of Sirolimus can be decreased when combined with Vonoprazan. Vorapaxar The serum concentration of Sirolimus can be increased when it is combined with Vorapaxar. Voriconazole The serum concentration of Sirolimus can be increased when it is combined with Voriconazole. Vorinostat The risk or severity of adverse effects can be increased when Sirolimus is combined with Vorinostat. Vortioxetine The metabolism of Sirolimus can be decreased when combined with Vortioxetine. Voxelotor The serum concentration of Sirolimus can be increased when it is combined with Voxelotor. Voxilaprevir The serum concentration of Sirolimus can be increased when it is combined with Voxilaprevir. Warfarin The therapeutic efficacy of Warfarin can be increased when used in combination with Sirolimus. Ximelagatran The risk or severity of bleeding can be increased when Ximelagatran is combined with Sirolimus. Xylometazoline Xylometazoline may increase the immunosuppressive activities of Sirolimus. Yellow fever vaccine The risk or severity of infection can be increased when Yellow fever vaccine is combined with Sirolimus. Zafirlukast The metabolism of Sirolimus can be decreased when combined with Zafirlukast. Zaleplon The metabolism of Sirolimus can be decreased when combined with Zaleplon. Ziconotide Ziconotide may increase the immunosuppressive activities of Sirolimus. Zidovudine The risk or severity of adverse effects can be increased when Zidovudine is combined with Sirolimus. Zimelidine The metabolism of Sirolimus can be decreased when combined with Zimelidine. Ziprasidone The metabolism of Sirolimus can be decreased when combined with Ziprasidone. Zofenopril The risk or severity of adverse effects can be increased when Sirolimus is combined with Zofenopril. Zonisamide Zonisamide may increase the immunosuppressive activities of Sirolimus. Zuclopenthixol The metabolism of Sirolimus can be decreased when combined with Zuclopenthixol. Pregnancy and Lactation AU TGA pregnancy category: C US FDA pregnancy category: C Pregnancy Based on animal studies and the mechanism of action, FYARRO can cause fetal harm when administered to a pregnant woman [see Clinical Pharmacology (12.1)]. Although there are no data on the use of FYARRO in pregnant women, there are limited data on the use of sirolimus during pregnancy. In animal studies, oral sirolimus was embryo/fetotoxic in rats [see Data] at sub-therapeutic doses. Advise pregnant women of the potential risk to a fetus. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively. Lactation There are no data on the presence of FYARRO in human milk or its effects on the breastfed child or on milk production. It is not known whether sirolimus is present in human milk. There are no data on its effects on the breastfed infant or milk production. The pharmacokinetic and safety profiles of sirolimus in infants are not known. Sirolimus is present in the milk of lactating rats. There is potential for serious adverse effects from sirolimus in breastfed infants based on the mechanism of action [see Clinical Pharmacology. Because of the potential for serious adverse reactions in breastfed infants from FYARRO, advise women not to breastfeed during treatment with FYARRO and for 2 weeks after the last dose. To use the bottles of solution, follow these steps: Open the solution bottle. On first use, insert the plastic tube with stopper tightly into the bottle until it is even with the top of the bottle. Do not remove from the bottle once inserted. For each use, tightly insert one of the amber syringes, with the plunger fully pushed in, into the opening in the plastic tube. Draw up the amount of solution your doctor has prescribed by gently pulling out the plunger of the syringe until the bottom of the black line of the plunger is even with the correct mark on the syringe. Keep the bottle upright. If bubbles form in the syringe, empty the syringe into the bottle and repeat this step. Empty the syringe into a glass or plastic cup containing at least 2 ounces (60 milliliters [1/4 cup]) of water or orange juice. Do not use apple juice, grapefruit juice, or other liquids. Stir vigorously for 1 minute and drink immediately. Refill the cup with at least 4 ounces (120 milliliters [1/2 cup]) of water or orange juice. Stir vigorously and drink the rinse solution. Dispose of the used syringe. If you need to carry a filled syringe with you, snap a cap onto the syringe and put the syringe in the carrying case. Use the medication in the syringe within 24 hours. Precautions It is very important that your doctor check your or your child’s progress at regular visits to make sure that this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects. Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant, and keep using it for at least 12 weeks after you stop taking sirolimus. If you think you have become pregnant while using the medicine, tell your doctor right away. If you are planning to have children, talk with your doctor before using this medicine. Some men and women using this medicine have become infertile (unable to have children). Using this medicine may increase your risk of getting skin cancer or cancer of the lymph system (lymphoma). Talk to your doctor if you have concerns about this risk. This medicine may increase your risk of developing infections. Avoid being near people who are sick while you are using this medicine. Wash your hands often. Tell your doctor if you have any kind of infection before you start using this medicine. Tell your doctor if you have ever had an infection that would not go away or an infection that kept coming back. Sirolimus may cause serious types of allergic reactions, including anaphylaxis,, which can be life-threatening and require immediate medical attention. Call your doctor right away if you or your child has a rash, itching, red, swollen skin, trouble breathing, trouble swallowing, or chest tightness while you are using this medicine. Sirolimus may cause a serious type of allergic reaction called angioedema. This may occur more often when it is used with certain heart and blood pressure medicines called ACE inhibitors (eg, captopril [Capoten®], enalapril [Vasotec®], fosinopril [Monopril®], quinapril [Accupril®], ramipril [Altace®]). Check with your doctor right away if you have a rash, itching, a large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals, trouble breathing, or chest tightness while you are using this medicine. This medicine may also increase your risk of bleeding and cause delay in wound healing. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Brush and floss your teeth gently. Be careful when using sharp objects, including razors and fingernail clippers. Check with your doctor immediately if you or your child notice any unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin. This medicine may increase your cholesterol and fats in the blood. If this condition occurs, your doctor may give you or your child some medicines that can lower the amount of cholesterol and fats in the blood. This medicine may increase your risk of developing a rare and serious virus infection called BK virus-associated nephropathy (BKVAN). The BK virus may affect how your kidneys work and cause a transplanted kidney to fail. Check with your doctor right away if you or your child has bloody urine, a decreased frequency or amount of urine, increased thirst, loss of appetite, lower back or side pain, nausea, swelling of the face, fingers, or lower legs, trouble breathing, unusual tiredness or weakness, vomiting, or weight gain. This medicine may cause a serious lung problem called interstitial lung disease or non-infectious pneumonitis. Check with your doctor right away if you have chest pain, chills, cough, fever, or trouble breathing. This medicine may increase your risk of developing a serious and rare brain infection called progressive multifocal leukoencephalopathy (PML). Check with your doctor right away if you or your child has vision changes, loss of coordination, clumsiness, confusion, memory loss, difficulty speaking or understanding what others say, and weakness in the legs. This medicine may make your skin more sensitive to sunlight and can increase your risk of having skin cancer. Use a sunscreen when you are outdoors and avoid sunlamps and tanning beds. While you are being treated with sirolimus, and after you stop treatment with it, it is important to see your doctor about the immunizations (vaccinations) you should receive. Do not get any immunizations (vaccines) without your doctor’s approval. Sirolimus may lower your body’s resistance and there is a chance you might get the infection the vaccine is meant to prevent. In addition, you should not be around other persons living in your household who receive live virus vaccines because there is a chance they could pass the virus on to you. Some examples of live vaccines include measles, mumps, influenza (nasal flu vaccine), poliovirus (oral form), rotavirus, and rubella. Do not get close to them and do not stay in the same room with them for very long. If you have questions about this, talk to your doctor. Check with your doctor right away if you notice a new mole, a change in size, shape or color of an existing mole, or a mole that leaks fluid or bleeds. While you are taking sirolimus, it is important to maintain good dental hygiene and see a dentist regularly for teeth cleaning. Raw oysters or other shellfish may contain bacteria that can cause serious illness and possibly death. This is more likely to be a problem if these foods are eaten by patients with certain medical conditions. Even eating oysters from “clean” water or good restaurants does not guarantee that the oysters do not contain the bacteria. Eating raw shellfish is not a problem for most healthy people, however, patients with the following conditions may be at greater risk: cancer, immune disorders, organ transplantation, long-term corticosteroid use (as for asthma, arthritis, or organ transplantation), liver disease (including viral hepatitis), excess alcohol intake (2 to 3 drinks or more per day), diabetes, stomach problems (including stomach surgery and low stomach acid), and hemochromatosis (an iron disorder). Do not eat raw oysters or other shellfish while you are taking sirolimus. Be sure oysters and shellfish are fully cooked. Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John’s wort) or vitamin supplements. What special precautions should I follow? Before taking sirolimus, tell your doctor and pharmacist if you are allergic to sirolimus, any other medications, or any of the ingredients in sirolimus tablets or solution. Ask your pharmacist for a list of the ingredients. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking. Be sure to mention any of the following: aminoglycoside antibiotics such as amikacin, gentamicin, kanamycin, neomycin (Neo-Fradin, Neo-Rx), streptomycin, and tobramycin (Tobi); amphotericin B (Abelcet, AmBisome, Amphocin, Fungizone); angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik); antifungals such as clotrimazole (Lotrimin), fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral), and voriconazole (Vfend); bromocriptine (Cycloset, Parlodel); cimetidine (Tagamet); cisapride (Propulsid) (not available in the U.S.); clarithromycin (Biaxin); danazol (Danocrine); diltiazem (Cardizem, Dilacor, Tiazac); erythromycin (E.E.S., E-Mycin, Erythrocin); HIV protease inhibitors such as indinavir (Crixivan) and ritonavir (Norvir, in Kaletra); certain medications for cholesterol; medications for seizures such as carbamazepine (Tegretol), phenobarbital (Luminal), and phenytoin (Dilantin); metoclopramide (Reglan); nicardipine (Cardene); rifabutin (Mycobutin); rifampin (Rifadin, Rimactane); rifapentine (Priftin); telithromycin (Ketek); troleandomycin (TAO) (not available in the U.S.); and verapamil (Calan, Covera, Isoptin, Verelan). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. if you are taking cyclosporine (Neoral) soft gelatin capsules or solution, take them 4 hours before sirolimus. tell your doctor what herbal products you are taking, especially St. John’s wort. tell your doctor if you have or have ever had high cholesterol or triglycerides or liver disease. tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. You should use an effective method of birth control before starting to take sirolimus, while taking sirolimus, and for 12 weeks after stopping sirolimus. If you become pregnant while taking sirolimus, call your doctor. if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking sirolimus. do not have any vaccinations without talking to your doctor. 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Classes https://www.fda.gov/about-fda/about-website/website-policies#linking SIROLIMUS https://dailymed.nlm.nih.gov/dailymed/browse-drug-classes.cfm FDA Pharmacological Classification https://www.fda.gov/ForIndustry/DataStandards/StructuredProductLabeling/ucm162549.htm LiverTox LICENSE https://www.nlm.nih.gov/copyright.html Sirolimus https://www.ncbi.nlm.nih.gov/books/n/livertox/Sirolimus/ LOTUS – the natural products occurrence database https://lotus.nprod.net/ sirolimus https://www.wikidata.org/wiki/Q32089 LOTUS Tree https://lotus.naturalproducts.net/ NCI Thesaurus (NCIt) https://www.cancer.gov/policies/copyright-reuse https://ncithesaurus.nci.nih.gov/ncitbrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&ns=ncit&code=C1212 NCI Thesaurus Tree https://ncit.nci.nih.gov NORMAN Suspect List Exchange https://creativecommons.org/licenses/by/4.0/ https://www.norman-network.com/nds/SLE/ ClinicalTrials.gov https://clinicaltrials.gov/ct2/about-site/terms-conditions#Use https://clinicaltrials.gov/ DailyMed LICENSE https://www.nlm.nih.gov/copyright.html SIROLIMUS https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=SIROLIMUS Nature Chemical Biology https://pubchem.ncbi.nlm.nih.gov/substance/7982025 https://pubchem.ncbi.nlm.nih.gov/substance/24430811 https://pubchem.ncbi.nlm.nih.gov/substance/26701762 https://pubchem.ncbi.nlm.nih.gov/substance/49635682 https://pubchem.ncbi.nlm.nih.gov/substance/49815675 https://pubchem.ncbi.nlm.nih.gov/substance/441325678 https://pubchem.ncbi.nlm.nih.gov/substance/445470554 The Natural Products Atlas https://www.npatlas.org/terms Rapamycin https://www.npatlas.org/explore/compounds/NPA000414 The Natural Products Atlas Classification https://www.npatlas.org/ European Medicines Agency (EMA) https://www.ema.europa.eu/en/about-us/legal-notice Rapamune (EMEA/H/C/000273) https://www.ema.europa.eu/en/medicines/human/EPAR/rapamune Sirolimus (P/0395/2017) https://www.ema.europa.eu/en/medicines/human/paediatric-investigation-plans/emea-002213-pip01-17 Sirolimus (P/0336/2021) https://www.ema.europa.eu/en/medicines/human/paediatric-investigation-plans/emea-001416-pip01-12-m03 EU Clinical Trials Register https://www.clinicaltrialsregister.eu/ FDA Orange Book https://www.fda.gov/about-fda/about-website/website-policies#linking https://www.fda.gov/drugs/drug-approvals-and-databases/approved-drug-products-therapeutic-equivalence-evaluations-orange-book LIPID MAPS Sirolimus https://lipidmaps.org/databases/lmsd/LMPK06000003 Lipid Classification https://www.lipidmaps.org/ WHO Anatomical Therapeutic Chemical (ATC) Classification https://www.whocc.no/copyright_disclaimer/ https://www.whocc.no/atc/ ATC Code https://www.whocc.no/atc_ddd_index/ FDA Medication Guides https://www.fda.gov/about-fda/about-website/website-policies#linking Rapamune https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=medguide.page National Drug Code (NDC) Directory https://www.fda.gov/about-fda/about-website/website-policies#linking SIROLIMUS https://www.fda.gov/drugs/drug-approvals-and-databases/national-drug-code-directory Haz-Map, Information on Hazardous Chemicals and Occupational Diseases https://haz-map.com/About Sirolimus https://haz-map.com/Agents/7046 NCI Cancer Drugs LICENSE https://www.cancer.gov/policies/copyright-reuse Fyarro (Sirolimus Protein-Bound Particles) https://www.cancer.gov/about-cancer/treatment/drugs/sirolimus-protein-bound-particles NIPH Clinical Trials Search of Japan https://rctportal.niph.go.jp/en/ NLM RxNorm Terminology https://www.nlm.nih.gov/research/umls/rxnorm/docs/termsofservice.html sirolimus https://rxnav.nlm.nih.gov/id/rxnorm/35302 Protein Data Bank in Europe (PDBe) http://www.ebi.ac.uk/pdbe-srv/pdbechem/chemicalCompound/show/RAP PubChem https://pubchem.ncbi.nlm.nih.gov RCSB Protein Data Bank (RCSB PDB) https://www.rcsb.org/pages/policies https://www.rcsb.org/ SpectraBase RAPAMYCIN https://spectrabase.com/spectrum/BVHjlBzTHPp RAPA;RAPAMYCIN https://spectrabase.com/spectrum/CbAW6qd556R Springer Nature https://pubchem.ncbi.nlm.nih.gov/substance/?source=15745&sourceid=65063664-384305690 https://pubchem.ncbi.nlm.nih.gov/substance/?source=15745&sourceid=65063664-384374043 The Cambridge Structural Database https://www.ccdc.cam.ac.uk/structures/Search?Ccdcid=838233 Thieme Chemistry https://creativecommons.org/licenses/by-nc-nd/4.0/ https://pubchem.ncbi.nlm.nih.gov/substance/?source=22163&sourceid=65063664-384306109 https://pubchem.ncbi.nlm.nih.gov/substance/?source=22163&sourceid=65063664-384378232 Wikidata https://creativecommons.org/publicdomain/zero/1.0/ Sirolimus https://www.wikidata.org/wiki/Q32089 Wiley https://pubchem.ncbi.nlm.nih.gov/substance/?source=wiley&sourceid=118681 Medical Subject Headings (MeSH) https://www.nlm.nih.gov/copyright.html Sirolimus https://www.ncbi.nlm.nih.gov/mesh/68020123 MeSH Tree http://www.nlm.nih.gov/mesh/meshhome.html Antibiotics, Antineoplastic https://www.ncbi.nlm.nih.gov/mesh/68000903 Anti-Bacterial Agents https://www.ncbi.nlm.nih.gov/mesh/68000900 Antifungal Agents https://www.ncbi.nlm.nih.gov/mesh/68000935 Immunosuppressive Agents https://www.ncbi.nlm.nih.gov/mesh/68007166 UN Globally Harmonized System of Classification and Labelling of Chemicals (GHS) GHS Classification Tree http://www.unece.org/trans/danger/publi/ghs/ghs_welcome_e.html PATENTSCOPE (WIPO) SID 388369079 https://pubchem.ncbi.nlm.nih.gov/substance/388369079 SID 426926627 https://pubchem.ncbi.nlm.nih.gov/substance/426926627 NCBI https://www.ncbi.nlm.nih.gov/projects/linkout Show More