Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (369 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(seer-oh-lie′mus)
Rapamune
Func. class.:
Immunosuppressant
Chem. class.:
Macrolide
Produces immunosuppression by inhibiting T-lymphocyte activation and proliferation
Organ transplants to prevent rejection; recommended use is with cycloSPORINE and corticosteroids
Breastfeeding, hypersensitivity to this product, components of product
Precautions:
Pregnancy (C), children <13 yr, severe cardiac/renal/hepatic disease; diabetes mellitus, hyperkalemia, hyperuricemia, hypertension, interstitial lung disease, hyperlipidemia
Black Box Warning:
Lymphomas, infection, other malignancies
Calculator
• Adult/adolescent ≥40 kg:
PO
2 mg/day with 6 mg loading dose
• Child >13 yr weighing <40 kg (88 lb):
PO
1 mg/m
2
/day, 3 mg/m
2
loading dose
• Adult/child ≥13 yr/<40 kg:
PO
reduce by 33% for maintenance dose (mild to moderate hepatic impairment); reduce by 50% for maintenance dose (severe hepatic impairment)
Available forms:
Oral sol 1 mg/ml; tabs 0.5 mg, 1 mg, 2 mg
•
Prophylaxis for
Pneumocystis jiroveci
pneumonia for 1 yr after transplantation; prophylaxis for CMV is recommended for 90 days after transplantation in those at increased risk for CMV
•
All medications PO if possible, avoid IM inj; bleeding may occur
•
For 3 days before transplant surgery; patients should be placed in protective isolation; give at same time of day, give 4 hr after cycloSPORINE oral sol or caps; do not give with grapefruit juice
•
Use amber oral dose syringe and withdraw amount of oral sol needed from bottle, empty correct dose into plastic/glass container holding 60 ml of water/orange juice, stir vigorously and have patient drink at once, refill container with additional 120 ml water/orange juice, stir vigorously and have patient drink at once; if using a pouch, squeeze entire contents into container, follow above directions
•
Store protected from light, refrigerate; stable for 30 days after opening (sol)
•
Do not crush, chew; store tabs at room temp
CNS:
Tremors, headache, insomnia, paresthesia
, chills, fever
CV:
Hypertension,
atrial fibrillation, CHF, hypotension, palpitation, tachycardia
, peripheral edema,
thrombosis
EENT:
Blurred vision, photophobia
GI:
Nausea, vomiting, diarrhea, constipation,
hepatotoxicity
GU:
UTIs,
albuminuria, hematuria, proteinuria, renal failure, nephrotic syndrome,
increased creatinine
HEMA:
Anemia, leukopenia, thrombocytopenia, purpura, pancytopenia
INTEG:
Rash, acne
, photosensitivity
META:
Hyperglycemia, increased creatinine, edema, hypercholesterolemia,
hyperlipemia
, hypophosphatemia, weight gain, hypo/hyperkalemia, hyperuricemia, hypomagnesemia, hypertriglyceridemia
MS:
Arthralgia
RESP:
Pleural effusion, atelectasis,
dyspnea
, pneumonitis, pulmonary embolism/fibrosis
SYST:
Lymphoma, exfoliative dermatitis
Rapidly absorbed; peak 1 hr single dose, 2 hr multiple dosing; protein binding 92%; extensively metabolized by CYP3A4 enzyme system, half-life 57-63 hr
Increase:
angioedema—ACE inhibitors, angiotensin-II–receptor antagonists, cephalosporins, iodine-containing radiopaque contrast media, neuromuscular blockers, NSAIDs, penicillins, salicylates, thrombolytics
Increase:
blood levels—antifungals, calcium channel blockers, cimetidine, danazol, erythromycin, cycloSPORINE, metoclopramide, bromocriptine, HIV-protease inhibitors
Decrease:
blood levels—carBAMazepine, PHENobarbital, phenytoin, rifamycin, rifapentine
Decrease:
effect of vaccines
•
St. John’s wort: may decrease the effect of sirolimus
•
Alters bioavailability; use consistently with/without food; do not use with grapefruit juice
Increase:
LFTs, alk phos, lipids, triglycerides, total cholesterol, BUN, creatinine, LDH, phosphate
Decrease:
platelets, sodium
Increase or Decrease:
magnesium, glucose, calcium
•
Blood levels in patients who may have altered metabolism, trough level ≥15 ng/ml are associated with increased adverse reactions; monitor trough concentrations in all patients
•
Creatinine/BUN, CBC, serum potassium
•
Lipid profile:
cholesterol, triglycerides; lipid-lowering agent may be needed
Black Box Warning:
Infection and development of lymphoma; only those experienced in immunosuppressant therapy and organ transplantation should use this product; use only in renal transplant
•
High risk:
those with Baniff grade 3 acute rejection or vascular rejection before cycloSPORINE withdrawal, dialysis dependent, creatinine >4.5 mg/dl, African American patient, re-transplants, multiorgan transplant, high panel of reactive antibodies
•
Pulmonary fibrosis, pulmonary effusion, pneumonitis:
dyspnea, cough, hypoxia; some fatal cases have occurred
•
Wound dehiscence and anastomotic disruption:
wound, vascular, airway, ureteral, biliary, inhibition of growth factors; do not combine with corticosteroids
•
Anaphylaxis, angioedema, exfoliative dermatitis:
more common when given with ACE inhibitors; do not use if a hypersensitivity reaction occurs
Bone marrow suppression:
Hgb, WBC, platelets during treatment each mo; if leukocytes
<
3000/mm
3
or platelets
<
100,000/mm
3
, product should be discontinued or reduced; decreased hemoglobin level
Hepatotoxicity:
alk phos, AST, ALT, amylase, bilirubin, dark urine, jaundice, itching, light-colored stools; product should be discontinued
•
Therapeutic response: absence of graft rejection; immunosuppression with autoimmune disorders
To report fever, rash, severe diarrhea, chills, sore throat, fatigue; serious infections may occur; clay-colored stools, cramping
(hepatotoxicity)
•
To avoid crowds, persons with known infections to reduce risk for infection
•
To use contraception before, during, for 12 wk after product discontinued; to avoid breastfeeding
•
To use sunscreen, protective clothing to prevent burns, skin cancer
•
Not to use with grapefruit juice
•
To avoid vaccines
•
That lifelong use will be required to prevent rejection
•
That continuing follow-up exams and blood work will be required
•
Not to get on skin
•
How to use product
•
To take with or without regard to food, at same time, consistently
•
Take 4 hr after cycloSPORINE