At a glance
Also known as
Rapamune (brand name in Australia), rapamycin
Why get tested?
To determine the concentration of sirolimus in the blood in order to establish a dosing regimen, maintain therapeutic levels, and detect toxic levels
When to get tested?
Early in the course of sirolimus therapy and whenever the dose is changed; frequently at first, then at regular intervals to monitor concentrations over time; whenever excess or deficient levels are suspected
A blood sample drawn from a vein in your arm
Test preparation needed?
None. The sample is typically collected as a 'trough' level, just prior to the next dose- when the drug concentration in the blood is at its lowest, or as directed by your healthcare provider.
What is being tested?
Sirolimus is an drug that is given orally to patients who have had kidney transplants. Normally a person's immune system recognises a transplanted kidney as foreign and begins to attack it.Sirolimus limits this response and helps to prevent organ rejection by inhibiting T-lymphocyte activation and proliferation and antibody production.
When ingested, sirolimus is absorbed from the gastrointestinal tract. Concentrations peak in the blood within a couple of hours and then gradually decline. Only a small percentage of the dose taken is bioavailable - present in a form that the body can use. Sirolimus has a of about 60 hours. It is metabolised by the liver into several and is excreted from the body in the stool (more than 90%) and urine (less than 2%).
Sirolimus is currently under the Commonwealth/State Highly Specialised Drugs Program and approved for use in kidney transplant rejection. It appears to be less toxic to the kidneys than some other drugs and can be given in conjunction with the other immunosuppressants, cyclosporin and tacrolimus. There is insufficient data regarding its use in children and the elderly, and there are cautions against its use in pregnant and breastfeeding women. Like other immunosuppressive agents, sirolimus may cause side effects and adverse reactions and is associated with an increased risk of infection and the development of lymphoma.
Typically, sirolimus is given with cyclosporin and corticosteroids. Dosages must be tailored to the individual, and sirolimus and cyclosporin must be monitored. Often, patients will begin with a high dose of sirolimus which is tapered down to lower doses, which are adjusted based on the results of the sirolimus blood tests. In patients considered at low risk for complications, cyclosporin may be weaned after 2-4 months and sirolimus concentrations increased.
Sirolimus is usually taken once a day at set intervals, consistently with or without food. If cyclosporin is also being taken, then the dosages of both drugs should be separated by several hours.
How is the sample collected for testing?
A blood sample is obtained by inserting a needle into a vein in the arm.
Is any test preparation needed to ensure the quality of the sample?
No test preparation is needed; however, the sample is typically collected as a 'trough' level, just prior to the next dose- when the drug concentration in the blood is at its lowest, or as directed by your healthcare provider.