Sirolimus 4- .Amiodarone

Nalli N, Stewart-Texeira L, Dipchand AI. Amiodarone-sirolimus/tacrolimus interaction in a pediatric heart transplant patient Pediatr Transplant (2006) 10, 736-739. 

Drugs that may affect nelfinavir include anticonvulsants, azithromycin, azole antifungals, efavirenz, delavirdine, HMG-CoA reductase inhibitors, indinavir, interleukins, nevirapine, rifabutin, rifampin, ritonavir, saquinavir, St. John s wort. Drugs that may be affected by nelfinavir include amiodarone, antiarrhythmics (amiodarone, quinidine), azithromycin, benzodiazepines, efavirenz, ergot alkaloids, delavirdine, didanosine, fentanyl, indinavir, lamivudine methadone, nonsedating antihistamines, oral contraceptives, phenytoin, pimozide, quinidine, rifabutin, saquinavir, sildenafil, sirolimus, tacrolimus, zidovudine. 

Transporter efflux transporter effects predominant Examples Amiodarone Atorvastatin Azithromycin Carbamazepine Carvediioi Chlorpromazine Ciprofloxacin Cisapride Cyciosporine Danazoi Dapsone Diclofenac Diflunisal Digoxin Erythromycin Flurbiprofen Glipizide Glyburide Griseofulvin Ibuprofen Indinavir Indomethacin Itraconazole Ketoconazole Lansoprazole Lovastatin Mebendazole Naproxen Nelfinavir Ofloxacin Oxaprozin Phenazopyridine Phenytoin Piroxicam Raloxifene Ritonavir Saquinavir Saquinavir Sirolimus Sirolimus Spironolactone Spironolactone Tacrolimus Tacrolimus ... 

There is an isolated case report of increased sirolimus and tacrolimus levels associated with the concurrent use of amiodarone in a paediatric patient. 

A 2-year-old heart transplant patient given tacrolimus 0.02 mg/kg daily was given amiodarone to control ventricular arrhythmias. Her tacrolimus trough levels were reported as within target range of 8 to 10 micrograms/L on both day 1 and day 3 after starting the amiodarone. She was then switched from tacrolimus to sirolimus 0.06 mg/kg daily, increased to... 

The authors of this report advise that, because of the long half-life of sirolimus, and the difficulty in reducing elevated levels quickly, prescrib-ers should consider reducing the sirolimus and tacrolimus doses before starting amiodarone rather than waiting for the interaction to occur. They also advise more frequent monitoring of sirolimus and tacrolimus levels if amiodarone is also given. This appears to be the only published report of this interaction at present. 

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