Letermovir Injection and Rapamune (Sirolimus Oral Solution)

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Letermovir may significantly increase the blood levels of sirolimus. This may increase the risk of serious side effects such as infections; lymphoma and other cancers; diabetes; kidney problems; various lung disorders; high blood pressure; high cholesterol and triglycerides; swelling of the face, eyes or mouth; and water retention, especially in the hands, feet, and various tissues such as the sac around the heart or lungs. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. Contact your doctor immediately if you develop signs and symptoms of infection such as fever, chills, diarrhea, sore throat, muscle aches, shortness of breath, blood in phlegm, weight loss, red or inflamed skin, body sores, and pain or burning during urination. You should also seek medical attention if you experience nausea, vomiting, loss of appetite, increased or decreased urination, sudden weight gain or weight loss, fluid retention, swelling, shortness of breath, muscle cramps, tiredness, weakness, dizziness, confusion, and irregular heart rhythm, as these may be signs and symptoms of kidney problems. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

MONITOR CLOSELY: Coadministration with letermovir may significantly increase the plasma concentrations of sirolimus. The proposed mechanism is letermovir inhibition of intestinal and hepatic CYP450 3A4, the isoenzyme responsible for the metabolic clearance of sirolimus. Enhanced sirolimus oral bioavailability due to inhibition of intestinal P-glycoprotein (P-gp) efflux transporter may also contribute. According to the product labeling, sirolimus peak plasma concentration (Cmax), systemic exposure (AUC) and concentration at 24 hours postdose (C24hr) increased by an average of 2.8-, 3.4- and 3.2-fold, respectively, when a single 2 mg dose of sirolimus was coadministered with letermovir 480 mg orally once daily. An increased risk of nephrotoxicity, as well as other adverse effects associated with sirolimus such as malignancies, infections, angioedema, fluid retention, interstitial lung disease (e.g., pneumonitis, bronchiolitis obliterans organizing pneumonia, pulmonary fibrosis), diabetes, hyperlipidemia and hypertension, may occur. Additional use of cyclosporine is likely to further increase the magnitude of interaction, since it is an inhibitor of CYP450 3A4 and a strong inhibitor of P-gp.

MANAGEMENT: Caution is advised when sirolimus is used with letermovir. Sirolimus blood levels and renal function should be checked frequently and the dosage adjusted accordingly, particularly following initiation or discontinuation of letermovir. When letermovir is coadministered with cyclosporine, please refer to the sirolimus prescribing information for specific sirolimus dosing recommendations. Patients should be advised to seek medical attention if they experience adverse effects such as fever, infection, diarrhea, stomatitis, decreased urination, angioedema, peripheral edema, shortness of breath, difficulty breathing, and changes in motor function or mental status.

Letermovir Injection

Generic Name: letermovir

Brand name: Prevymis

Synonyms: Letermovir (oral/injection), Letermovir

What is Letermovir Injection?

Rapamune (Sirolimus Oral Solution)

Generic Name: sirolimus

Brand name: Rapamune

Synonyms: Rapamune

What is Rapamune (Sirolimus Oral Solution)?