What does it do?

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

Before you start

• Sirolimus weakens your immune system, making it harder for your body to fight infections. You may need tests before you start to make sure you don't have any infections like tuberculosis (TB), HIV, or hepatitis B and C.
• Ask your doctor what vaccines you might need before you start and while you are taking sirolimus. You should not have a live vaccine while taking sirolimus.
• If you plan to become pregnant, or find you are pregnant, discuss this with your doctor. Use reliable contraception while taking sirolimus, and for 12 weeks after stopping. Tell your doctor if you are breastfeeding.

How should you take it?

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

What if you forget a dose?

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

Can you take other medicines?

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

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

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

What side effects might you notice?

Side Effects	Recommended action
Symptoms of allergy including: skin rash, itching, swelling, trouble breathing Swollen lips, tongue, throat or face Reduced number of blood cells that fight infections or help your blood to clot - symptoms include: fever, chills, sore throat or generally feeling unwell, or easy or unusual bruising or bleeding Persistent dry cough Symptoms of a blood clot including: sudden shortness of breath, swelling or pain in one leg	Tell your doctor immediately
Joint, muscle or bone aches and pains Peeing more often, feeling thirsty Swollen feet or legs Increased blood pressure	Tell your doctor
Headache, trouble sleeping Acne, nose bleeds Changes in periods Abdominal pain, constipation or diarrhoea, nausea	Tell your doctor if troublesome

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

Other information:

• Do not stop taking sirolimus unless your doctor at the transplant clinic tells you to. You may have to take sirolimus for the rest of your life.
• You will need regular blood tests to measure the amount of sirolimus in your blood. On the morning of the blood test, do not take your regular dose of sirolimus until after the blood has been taken. Other blood tests will monitor how your kidneys are working and your cholesterol levels (sirolimus can increase cholesterol).
• Protect yourself from too much sunlight while taking immunosuppressant medicines (they may increase your risk of skin cancer). Always cover up and apply a thick layer of broad spectrum sunscreen (at least SPF30) when outside. Do not use sunbeds.
• Women using sirolimus for a long time may need cervical screening more often. Discuss with your doctor.
• It is important to tell anyone who gives you medical or dental treatment that you are taking sirolimus.
• Grapefruit, grapefruit juice or sour/Seville oranges may react with sirolimus. Discuss with your pharmacist.
• Store sirolimus liquid in the fridge. It expires 30 days after you first open the bottle. If you have any liquid leftover after 30 days, take it back to your pharmacy.