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Identification
NameSirolimus
Accession NumberDB00877  (APRD00178, DB02439)
TypeSmall Molecule
GroupsApproved, Investigational
DescriptionA macrolide compound obtained from Streptomyces hygroscopicus that acts by selectively blocking the transcriptional activation of cytokines thereby inhibiting cytokine production. It is bioactive only when bound to immunophilins. Sirolimus is a potent immunosuppressant and possesses both antifungal and antineoplastic properties. [PubChem]
Structure
Thumb
Synonyms
(-)-Rapamycin
Rapamycin
External Identifiers Not Available
Approved Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing End
Gd-sirolimusTablet2 mgOralGenmed A Division Of Pfizer Canada IncNot applicableNot applicableCanada
Gd-sirolimusTablet5 mgOralGenmed A Division Of Pfizer Canada IncNot applicableNot applicableCanada
Gd-sirolimusSolution1.0 mgOralGenmed A Division Of Pfizer Canada IncNot applicableNot applicableCanada
Gd-sirolimusTablet1.0 mgOralGenmed A Division Of Pfizer Canada IncNot applicableNot applicableCanada
RapamuneTablet, sugar coated1 mg/1OralCardinal Health2001-07-01Not applicableUs
RapamuneTablet, coated0.5 mgOralPfizer Limited2001-03-13Not applicableEu
RapamuneTablet, coated1 mgOralPfizer Limited2001-03-13Not applicableEu
RapamuneTablet, sugar coated2 mg/1OralWyeth Pharmaceuticals Inc., a subsidiary of Pfizer Inc.2001-07-01Not applicableUs
RapamuneTablet5 mgOralPfizer Canada IncNot applicableNot applicableCanada
RapamuneSolution1 mg/mLOralWyeth Pharmaceuticals Inc., a subsidiary of Pfizer Inc.1999-09-01Not applicableUs
RapamuneTablet, coated2 mgOralPfizer Limited2001-03-13Not applicableEu
RapamuneSolution1 mg/mlOralPfizer Limited2001-03-13Not applicableEu
RapamuneTablet1.0 mgOralPfizer Canada Inc2003-03-25Not applicableCanada
RapamuneTablet, sugar coated.5 mg/1OralWyeth Pharmaceuticals Inc., a subsidiary of Pfizer Inc.2010-03-01Not applicableUs
RapamuneTablet, coated2 mgOralPfizer Limited2001-03-13Not applicableEu
RapamuneTablet, coated1 mgOralPfizer Limited2001-03-13Not applicableEu
RapamuneTablet2 mgOralPfizer Canada IncNot applicableNot applicableCanada
RapamuneTablet, sugar coated1 mg/1OralWyeth Pharmaceuticals Inc., a subsidiary of Pfizer Inc.2001-07-01Not applicableUs
RapamuneTablet, coated0.5 mgOralPfizer Limited2001-03-13Not applicableEu
Rapamune Oral SolutionSolution1.0 mgOralPfizer Canada Inc2001-05-15Not applicableCanada
SirolimusTablet, sugar coated2 mg/1OralGreenstone LLC2014-10-27Not applicableUs
SirolimusTablet, sugar coated.5 mg/1OralGreenstone LLC2014-01-07Not applicableUs
SirolimusTablet, sugar coated1 mg/1OralGreenstone LLC2014-10-27Not applicableUs
Approved Generic Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing End
SirolimusTablet1 mg/1OralDr. Reddy's Laboratories Limited2014-10-27Not applicableUs
SirolimusTablet, film coated.5 mg/1OralAmerican Health Packaging2015-03-31Not applicableUs
SirolimusTablet2 mg/1OralDr. Reddy's Laboratories Limited2014-10-27Not applicableUs
SirolimusTablet, film coated.5 mg/1OralZydus Pharmaceuticals (USA) Inc.2014-01-15Not applicableUs
SirolimusTablet, film coated.5 mg/1OralCadila Healthcare Limited2014-01-15Not applicableUs
SirolimusTablet1 mg/1OralAmerican Health Packaging2015-10-15Not applicableUs
Approved Over the Counter ProductsNot Available
Unapproved/Other Products Not Available
International BrandsNot Available
Brand mixturesNot Available
SaltsNot Available
Categories
UNIIW36ZG6FT64
CAS number53123-88-9
WeightAverage: 914.1719
Monoisotopic: 913.555141619
Chemical FormulaC51H79NO13
InChI KeyQFJCIRLUMZQUOT-KLHQEZAJSA-N
InChI
InChI=1S/C51H79NO13/c1-30-16-12-11-13-17-31(2)42(61-8)28-38-21-19-36(7)51(60,65-38)48(57)49(58)52-23-15-14-18-39(52)50(59)64-43(33(4)26-37-20-22-40(53)44(27-37)62-9)29-41(54)32(3)25-35(6)46(56)47(63-10)45(55)34(5)24-30/h11-13,16-17,25,30,32-34,36-40,42-44,46-47,53,56,60H,14-15,18-24,26-29H2,1-10H3/b13-11+,16-12+,31-17+,35-25+/t30-,32-,33+,34-,36-,37+,38+,39+,40-,42+,43+,44-,46-,47+,51-/m1/s1
IUPAC Name
(1R,9S,12S,15R,16E,18R,19R,21R,23S,24E,26E,28E,30S,32S,35R)-1,18-dihydroxy-12-[(2S)-1-[(1S,3R,4R)-4-hydroxy-3-methoxycyclohexyl]propan-2-yl]-19,30-dimethoxy-15,17,21,23,29,35-hexamethyl-11,36-dioxa-4-azatricyclo[30.3.1.0⁴,⁹]hexatriaconta-16,24,26,28-tetraene-2,3,10,14,20-pentone
SMILES
[H][C@@]1(C[[email protected]](C)[C@]2([H])CC(=O)[[email protected]](C)\C=C(C)\[C@@H](O)[C@@H](OC)C(=O)[[email protected]](C)C[[email protected]](C)\C=C\C=C\C=C(C)\[[email protected]](C[C@]3([H])CC[C@@H](C)[C@@](O)(O3)C(=O)C(=O)N3CCCC[C@@]3([H])C(=O)O2)OC)CC[C@@H](O)[C@@H](C1)OC
Pharmacology
IndicationFor the prophylaxis of organ rejection in patients receiving renal transplants.
Structured Indications
PharmacodynamicsSirolimus, a macrocyclic lactone produced by Streptomyces hygroscopicus, is an immunosuppressive agent indicated for the prophylaxis of organ rejection in patients receiving renal transplants. It is recommended that sirolimus be used in a regimen with cyclosporine and corticosteroids.
Mechanism of actionSirolimus inhibits T lymphocyte activation and proliferation that occurs in response to antigenic and cytokine (Interleukin IL-2, IL-4, and IL-15) stimulation by a mechanism that is distinct from that of other immunosuppressants. Sirolimus also inhibits antibody production. In cells, sirolimus binds to the immunophilin, FK Binding Protein-12 (FKBP-12), to generate an immunosuppressive complex. The sirolimus:FKBP-12 complex has no effect on calcineurin activity. This complex binds to and inhibits the activation of the mammalian Target Of Rapamycin (mTOR), a key regulatory kinase. This inhibition suppresses cytokine-driven T-cell proliferation, inhibiting the progression from the G1 to the S phase of the cell cycle.
TargetKindPharmacological actionActionsOrganismUniProt ID
Serine/threonine-protein kinase mTORProteinyes
inhibitor
HumanP42345 details
Peptidyl-prolyl cis-trans isomerase FKBP1AProteinyes
other
HumanP62942 details
Fibroblast growth factor 2Proteinyes
other/unknown
HumanP09038 details
Related Articles
AbsorptionNot Available
Volume of distributionNot Available
Protein binding92%
Metabolism
SubstrateEnzymesProduct
Sirolimus
41-O-demethylrapamycinDetails
Route of eliminationNot Available
Half life57-63 hours
ClearanceNot Available
ToxicityNot Available
Affected organisms
  • Humans and other mammals
PathwaysNot Available
SNP Mediated EffectsNot Available
SNP Mediated Adverse Drug ReactionsNot Available
Interactions
Drug Interactions
DrugInteractionDrug group
AcarboseThe therapeutic efficacy of Acarbose can be decreased when used in combination with Sirolimus.Approved, Investigational
AcebutololThe serum concentration of Acebutolol can be decreased when it is combined with Sirolimus.Approved
AcetaminophenThe serum concentration of Acetaminophen can be decreased when it is combined with Sirolimus.Approved
AcetohexamideThe therapeutic efficacy of Acetohexamide can be decreased when used in combination with Sirolimus.Withdrawn
AcetyldigitoxinAcetyldigitoxin may decrease the cardiotoxic activities of Sirolimus.Approved
Acetylsalicylic acidThe serum concentration of Acetylsalicylic acid can be decreased when it is combined with Sirolimus.Approved, Vet Approved
AfatinibThe serum concentration of Afatinib can be decreased when it is combined with Sirolimus.Approved
AicarThe therapeutic efficacy of Aicar can be decreased when used in combination with Sirolimus.Experimental
AldosteroneThe serum concentration of Aldosterone can be decreased when it is combined with Sirolimus.Experimental
AlitretinoinThe serum concentration of Alitretinoin can be decreased when it is combined with Sirolimus.Approved, Investigational
AlogliptinThe therapeutic efficacy of Alogliptin can be decreased when used in combination with Sirolimus.Approved
ALT-110The risk or severity of adverse effects can be increased when Sirolimus is combined with ALT-110.Investigational
AmbrisentanThe serum concentration of Ambrisentan can be decreased when it is combined with Sirolimus.Approved, Investigational
AmiodaroneThe metabolism of Sirolimus can be decreased when combined with Amiodarone.Approved, Investigational
AmitriptylineThe serum concentration of Amitriptyline can be decreased when it is combined with Sirolimus.Approved
AmlodipineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Amlodipine.Approved
Amphotericin BThe therapeutic efficacy of Amphotericin B can be decreased when used in combination with Sirolimus.Approved, Investigational
AmrinoneThe risk or severity of adverse effects can be increased when Sirolimus is combined with Amrinone.Approved
AnvirzelAnvirzel may decrease the cardiotoxic activities of Sirolimus.Investigational
ApixabanThe serum concentration of Apixaban can be decreased when it is combined with Sirolimus.Approved
AprepitantThe serum concentration of Sirolimus can be increased when it is combined with Aprepitant.Approved, Investigational
Arsenic trioxideThe serum concentration of Arsenic trioxide can be decreased when it is combined with Sirolimus.Approved, Investigational
AtazanavirThe metabolism of Sirolimus can be decreased when combined with Atazanavir.Approved, Investigational
AtenololThe serum concentration of Atenolol can be decreased when it is combined with Sirolimus.Approved
AtomoxetineThe metabolism of Sirolimus can be decreased when combined with Atomoxetine.Approved
AxitinibThe serum concentration of Axitinib can be decreased when it is combined with Sirolimus.Approved, Investigational
AzelnidipineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Azelnidipine.Approved
AzimilideThe risk or severity of adverse effects can be increased when Sirolimus is combined with Azimilide.Investigational
BalaglitazoneThe therapeutic efficacy of Balaglitazone can be decreased when used in combination with Sirolimus.Investigational
BarnidipineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Barnidipine.Approved
BcgThe therapeutic efficacy of Bcg can be decreased when used in combination with Sirolimus.Investigational
BenazeprilThe risk or severity of adverse effects can be increased when Sirolimus is combined with Benazepril.Approved, Investigational
BenidipineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Benidipine.Approved
BepridilThe risk or severity of adverse effects can be increased when Sirolimus is combined with Bepridil.Approved, Withdrawn
BetamethasoneThe serum concentration of Betamethasone can be decreased when it is combined with Sirolimus.Approved, Vet Approved
BevacizumabBevacizumab may increase the cardiotoxic activities of Sirolimus.Approved, Investigational
BexaroteneThe serum concentration of Sirolimus can be decreased when it is combined with Bexarotene.Approved, Investigational
BoceprevirThe serum concentration of Sirolimus can be increased when it is combined with Boceprevir.Approved
BortezomibThe metabolism of Sirolimus can be decreased when combined with Bortezomib.Approved, Investigational
BosentanThe serum concentration of Sirolimus can be decreased when it is combined with Bosentan.Approved, Investigational
BosutinibThe serum concentration of Bosutinib can be increased when it is combined with Sirolimus.Approved
Brentuximab vedotinThe serum concentration of Brentuximab vedotin can be decreased when it is combined with Sirolimus.Approved
BromocriptineThe serum concentration of Bromocriptine can be decreased when it is combined with Sirolimus.Approved, Investigational
BuforminThe therapeutic efficacy of Buformin can be decreased when used in combination with Sirolimus.Withdrawn
BuspironeThe metabolism of Buspirone can be decreased when combined with Sirolimus.Approved, Investigational
BusulfanThe serum concentration of Busulfan can be increased when it is combined with Sirolimus.Approved, Investigational
CabazitaxelThe risk or severity of adverse effects can be increased when Cabazitaxel is combined with Sirolimus.Approved
CaffeineThe serum concentration of Caffeine can be decreased when it is combined with Sirolimus.Approved
CaiThe risk or severity of adverse effects can be increased when Sirolimus is combined with Cai.Investigational
CamptothecinThe serum concentration of Camptothecin can be decreased when it is combined with Sirolimus.Experimental
CanagliflozinThe serum concentration of Canagliflozin can be decreased when it is combined with Sirolimus.Approved
CandoxatrilThe risk or severity of adverse effects can be increased when Sirolimus is combined with Candoxatril.Experimental
CaptoprilThe risk or severity of adverse effects can be increased when Sirolimus is combined with Captopril.Approved
CarbamazepineThe metabolism of Sirolimus can be increased when combined with Carbamazepine.Approved, Investigational
CarbomycinThe metabolism of Sirolimus can be decreased when combined with Carbomycin.Vet Approved
CarfilzomibThe serum concentration of Carfilzomib can be decreased when it is combined with Sirolimus.Approved
CastanospermineThe therapeutic efficacy of Castanospermine can be decreased when used in combination with Sirolimus.Experimental
CDX-110The risk or severity of adverse effects can be increased when Sirolimus is combined with CDX-110.Investigational
CeritinibThe serum concentration of Sirolimus can be increased when it is combined with Ceritinib.Approved
CerivastatinThe serum concentration of Cerivastatin can be decreased when it is combined with Sirolimus.Withdrawn
ChlorpromazineThe serum concentration of Chlorpromazine can be decreased when it is combined with Sirolimus.Approved, Vet Approved
ChlorpropamideThe therapeutic efficacy of Chlorpropamide can be decreased when used in combination with Sirolimus.Approved
CiglitazoneThe therapeutic efficacy of Ciglitazone can be decreased when used in combination with Sirolimus.Experimental
CilazaprilThe risk or severity of adverse effects can be increased when Sirolimus is combined with Cilazapril.Approved
CilnidipineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Cilnidipine.Approved
CimetidineThe serum concentration of Cimetidine can be decreased when it is combined with Sirolimus.Approved
CinnarizineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Cinnarizine.Approved
CiprofloxacinThe serum concentration of Ciprofloxacin can be decreased when it is combined with Sirolimus.Approved, Investigational
CisaprideThe serum concentration of Cisapride can be increased when it is combined with Sirolimus.Approved, Investigational, Withdrawn
CisplatinThe serum concentration of Cisplatin can be decreased when it is combined with Sirolimus.Approved
CitalopramThe serum concentration of Citalopram can be decreased when it is combined with Sirolimus.Approved
ClarithromycinThe metabolism of Sirolimus can be decreased when combined with Clarithromycin.Approved
ClemastineThe metabolism of Sirolimus can be decreased when combined with Clemastine.Approved
ClevidipineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Clevidipine.Approved
ClobazamThe serum concentration of Clobazam can be decreased when it is combined with Sirolimus.Approved, Illicit
ClomifeneThe serum concentration of Clomifene can be decreased when it is combined with Sirolimus.Approved, Investigational
ClonidineThe serum concentration of Clonidine can be decreased when it is combined with Sirolimus.Approved
ClopidogrelThe serum concentration of Clopidogrel can be decreased when it is combined with Sirolimus.Approved, Nutraceutical
ClotrimazoleThe metabolism of Sirolimus can be decreased when combined with Clotrimazole.Approved, Vet Approved
ClotrimazoleThe serum concentration of Sirolimus can be increased when it is combined with Clotrimazole.Approved, Vet Approved
ClozapineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Clozapine.Approved
CobicistatThe metabolism of Sirolimus can be decreased when combined with Cobicistat.Approved
CobimetinibThe serum concentration of Cobimetinib can be decreased when it is combined with Sirolimus.Approved
ColchicineThe serum concentration of Colchicine can be increased when it is combined with Sirolimus.Approved
ConivaptanThe metabolism of Conivaptan can be decreased when combined with Sirolimus.Approved, Investigational
Conjugated Equine EstrogensThe serum concentration of Conjugated Equine Estrogens can be decreased when it is combined with Sirolimus.Approved
CrizotinibThe serum concentration of Sirolimus can be increased when it is combined with Crizotinib.Approved
CyclophosphamideCyclophosphamide may increase the cardiotoxic activities of Sirolimus.Approved, Investigational
CyclosporineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Cyclosporine.Approved, Investigational, Vet Approved
CyclosporineThe metabolism of Sirolimus can be decreased when combined with Cyclosporine.Approved, Investigational, Vet Approved
Dabigatran etexilateThe serum concentration of Dabigatran etexilate can be decreased when it is combined with Sirolimus.Approved
DabrafenibThe serum concentration of Sirolimus can be decreased when it is combined with Dabrafenib.Approved
DactinomycinThe serum concentration of Dactinomycin can be decreased when it is combined with Sirolimus.Approved
DapagliflozinThe serum concentration of Dapagliflozin can be decreased when it is combined with Sirolimus.Approved
DarodipineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Darodipine.Experimental
DarunavirThe metabolism of Sirolimus can be decreased when combined with Darunavir.Approved
DasabuvirThe serum concentration of Sirolimus can be increased when it is combined with Dasabuvir.Approved
DasatinibThe serum concentration of Sirolimus can be increased when it is combined with Dasatinib.Approved, Investigational
DaunorubicinThe serum concentration of Daunorubicin can be decreased when it is combined with Sirolimus.Approved
DebrisoquinThe serum concentration of Debrisoquin can be decreased when it is combined with Sirolimus.Approved
DeferasiroxThe serum concentration of Sirolimus can be decreased when it is combined with Deferasirox.Approved, Investigational
DelavirdineThe metabolism of Sirolimus can be decreased when combined with Delavirdine.Approved
DenosumabThe risk or severity of adverse effects can be increased when Denosumab is combined with Sirolimus.Approved
DeoxyspergualinThe therapeutic efficacy of Deoxyspergualin can be decreased when used in combination with Sirolimus.Investigational
DeslanosideDeslanoside may decrease the cardiotoxic activities of Sirolimus.Approved
DexamethasoneThe serum concentration of Sirolimus can be decreased when it is combined with Dexamethasone.Approved, Investigational, Vet Approved
DiazepamThe serum concentration of Diazepam can be decreased when it is combined with Sirolimus.Approved, Illicit, Vet Approved
DidanosineDidanosine can cause a decrease in the absorption of Sirolimus resulting in a reduced serum concentration and potentially a decrease in efficacy.Approved
DiethylstilbestrolThe serum concentration of Diethylstilbestrol can be decreased when it is combined with Sirolimus.Approved
DigitoxinDigitoxin may decrease the cardiotoxic activities of Sirolimus.Approved
DigoxinDigoxin may decrease the cardiotoxic activities of Sirolimus.Approved
DihydroergotamineThe metabolism of Sirolimus can be decreased when combined with Dihydroergotamine.Approved
DihydrotestosteroneThe serum concentration of Dihydrotestosterone can be decreased when it is combined with Sirolimus.Illicit
DiltiazemThe risk or severity of adverse effects can be increased when Sirolimus is combined with Diltiazem.Approved
DipyridamoleThe serum concentration of Dipyridamole can be decreased when it is combined with Sirolimus.Approved
DocetaxelThe metabolism of Docetaxel can be decreased when combined with Sirolimus.Approved, Investigational
DofetilideThe metabolism of Dofetilide can be decreased when combined with Sirolimus.Approved
DomperidoneThe serum concentration of Domperidone can be decreased when it is combined with Sirolimus.Approved, Investigational, Vet Approved
DotarizineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Dotarizine.Investigational
DoxorubicinThe serum concentration of Doxorubicin can be increased when it is combined with Sirolimus.Approved, Investigational
DoxorubicinThe serum concentration of Doxorubicin can be decreased when it is combined with Sirolimus.Approved, Investigational
DoxycyclineThe metabolism of Sirolimus can be decreased when combined with Doxycycline.Approved, Investigational, Vet Approved
DronedaroneThe metabolism of Sirolimus can be decreased when combined with Dronedarone.Approved
DulaglutideThe therapeutic efficacy of Dulaglutide can be decreased when used in combination with Sirolimus.Approved
EdoxabanThe serum concentration of Edoxaban can be increased when it is combined with Sirolimus.Approved
EfavirenzThe serum concentration of Sirolimus can be decreased when it is combined with Efavirenz.Approved, Investigational
EfonidipineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Efonidipine.Approved
EletriptanThe serum concentration of Eletriptan can be decreased when it is combined with Sirolimus.Approved, Investigational
EmpagliflozinThe therapeutic efficacy of Empagliflozin can be decreased when used in combination with Sirolimus.Approved
EnalaprilThe risk or severity of adverse effects can be increased when Sirolimus is combined with Enalapril.Approved, Vet Approved
EnalaprilatThe risk or severity of adverse effects can be increased when Sirolimus is combined with Enalaprilat.Approved
EnzalutamideThe serum concentration of Sirolimus can be decreased when it is combined with Enzalutamide.Approved
EperisoneThe risk or severity of adverse effects can be increased when Sirolimus is combined with Eperisone.Approved, Investigational
EpinastineThe serum concentration of Epinastine can be decreased when it is combined with Sirolimus.Approved, Investigational
ErlotinibThe serum concentration of Erlotinib can be decreased when it is combined with Sirolimus.Approved, Investigational
ErythromycinThe metabolism of Sirolimus can be decreased when combined with Erythromycin.Approved, Vet Approved
Eslicarbazepine acetateThe serum concentration of Sirolimus can be decreased when it is combined with Eslicarbazepine acetate.Approved
EstradiolThe serum concentration of Estradiol can be decreased when it is combined with Sirolimus.Approved, Investigational, Vet Approved
EstriolThe serum concentration of Estriol can be decreased when it is combined with Sirolimus.Approved, Vet Approved
EstroneThe serum concentration of Estrone can be decreased when it is combined with Sirolimus.Approved
Ethinyl EstradiolThe serum concentration of Ethinyl Estradiol can be decreased when it is combined with Sirolimus.Approved
EtoposideThe serum concentration of Etoposide can be decreased when it is combined with Sirolimus.Approved
EtravirineThe serum concentration of Etravirine can be increased when it is combined with Sirolimus.Approved
EverolimusThe serum concentration of Everolimus can be increased when it is combined with Sirolimus.Approved
ExenatideThe therapeutic efficacy of Exenatide can be decreased when used in combination with Sirolimus.Approved, Investigational
EzetimibeThe serum concentration of Ezetimibe can be decreased when it is combined with Sirolimus.Approved
FelodipineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Felodipine.Approved, Investigational
FendilineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Fendiline.Withdrawn
FesoterodineThe serum concentration of Fesoterodine can be decreased when it is combined with Sirolimus.Approved
FexofenadineThe serum concentration of Fexofenadine can be decreased when it is combined with Sirolimus.Approved
FidaxomicinThe serum concentration of Fidaxomicin can be decreased when it is combined with Sirolimus.Approved
FingolimodSirolimus may increase the immunosuppressive activities of Fingolimod.Approved, Investigational
FluconazoleThe serum concentration of Sirolimus can be increased when it is combined with Fluconazole.Approved
FlunarizineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Flunarizine.Approved
Fluticasone furoateThe serum concentration of Fluticasone furoate can be decreased when it is combined with Sirolimus.Approved
FluvoxamineThe metabolism of Sirolimus can be decreased when combined with Fluvoxamine.Approved, Investigational
FosamprenavirThe metabolism of Sirolimus can be decreased when combined with Fosamprenavir.Approved
FosaprepitantThe serum concentration of Sirolimus can be increased when it is combined with Fosaprepitant.Approved
FosinoprilThe risk or severity of adverse effects can be increased when Sirolimus is combined with Fosinopril.Approved
FosphenytoinThe serum concentration of Sirolimus can be decreased when it is combined with Fosphenytoin.Approved
Fusidic AcidThe serum concentration of Sirolimus can be increased when it is combined with Fusidic Acid.Approved
G17DTThe risk or severity of adverse effects can be increased when Sirolimus is combined with G17DT.Investigational
GabapentinThe risk or severity of adverse effects can be increased when Sirolimus is combined with Gabapentin.Approved, Investigational
GallopamilThe risk or severity of adverse effects can be increased when Sirolimus is combined with Gallopamil.Investigational
GefitinibThe serum concentration of Gefitinib can be decreased when it is combined with Sirolimus.Approved, Investigational
GemcitabineThe serum concentration of Gemcitabine can be decreased when it is combined with Sirolimus.Approved
GI-5005The risk or severity of adverse effects can be increased when Sirolimus is combined with GI-5005.Investigational
GlibornurideThe therapeutic efficacy of Glibornuride can be decreased when used in combination with Sirolimus.Withdrawn
GliclazideThe therapeutic efficacy of Gliclazide can be decreased when used in combination with Sirolimus.Approved
GlimepirideThe therapeutic efficacy of Glimepiride can be decreased when used in combination with Sirolimus.Approved
GlipizideThe therapeutic efficacy of Glipizide can be decreased when used in combination with Sirolimus.Approved
GliquidoneThe therapeutic efficacy of Gliquidone can be decreased when used in combination with Sirolimus.Approved
GlyburideThe therapeutic efficacy of Glyburide can be decreased when used in combination with Sirolimus.Approved
GrazoprevirThe serum concentration of Grazoprevir can be decreased when it is combined with Sirolimus.Approved
GrepafloxacinThe serum concentration of Grepafloxacin can be decreased when it is combined with Sirolimus.Withdrawn
GusperimusThe therapeutic efficacy of Gusperimus can be decreased when used in combination with Sirolimus.Investigational
HaloperidolThe serum concentration of Haloperidol can be decreased when it is combined with Sirolimus.Approved
HydrocortisoneThe serum concentration of Hydrocortisone can be decreased when it is combined with Sirolimus.Approved, Vet Approved
IbuprofenThe serum concentration of Ibuprofen can be decreased when it is combined with Sirolimus.Approved
IdelalisibThe serum concentration of Sirolimus can be increased when it is combined with Idelalisib.Approved
ImatinibThe metabolism of Sirolimus can be decreased when combined with Imatinib.Approved
ImidaprilThe risk or severity of adverse effects can be increased when Sirolimus is combined with Imidapril.Investigational
ImipramineThe serum concentration of Imipramine can be decreased when it is combined with Sirolimus.Approved
IndacaterolThe serum concentration of Indacaterol can be decreased when it is combined with Sirolimus.Approved
IndinavirThe metabolism of Sirolimus can be decreased when combined with Indinavir.Approved
IndomethacinThe serum concentration of Indomethacin can be decreased when it is combined with Sirolimus.Approved, Investigational
INGN 201The risk or severity of adverse effects can be increased when Sirolimus is combined with INGN 201.Investigational
INGN 225The risk or severity of adverse effects can be increased when Sirolimus is combined with INGN 225.Investigational
Insulin AspartThe therapeutic efficacy of Insulin Aspart can be decreased when used in combination with Sirolimus.Approved
Insulin DetemirThe therapeutic efficacy of Insulin Detemir can be decreased when used in combination with Sirolimus.Approved
Insulin GlargineThe therapeutic efficacy of Insulin Glargine can be decreased when used in combination with Sirolimus.Approved
Insulin GlulisineThe therapeutic efficacy of Insulin Glulisine can be decreased when used in combination with Sirolimus.Approved
Insulin LisproThe therapeutic efficacy of Insulin Lispro can be decreased when used in combination with Sirolimus.Approved
Insulin PorkThe therapeutic efficacy of Insulin Pork can be decreased when used in combination with Sirolimus.Approved
IrinotecanThe serum concentration of Irinotecan can be decreased when it is combined with Sirolimus.Approved, Investigational
IsavuconazoniumThe metabolism of Sirolimus can be decreased when combined with Isavuconazonium.Approved, Investigational
IsradipineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Isradipine.Approved
ItraconazoleThe serum concentration of Sirolimus can be increased when it is combined with Itraconazole.Approved, Investigational
IvacaftorThe serum concentration of Sirolimus can be increased when it is combined with Ivacaftor.Approved
IvermectinThe serum concentration of Ivermectin can be decreased when it is combined with Sirolimus.Approved, Vet Approved
JosamycinThe metabolism of Sirolimus can be decreased when combined with Josamycin.Approved
KetazolamThe serum concentration of Ketazolam can be decreased when it is combined with Sirolimus.Approved
KetoconazoleThe serum concentration of Sirolimus can be increased when it is combined with Ketoconazole.Approved, Investigational
KetoconazoleThe metabolism of Sirolimus can be decreased when combined with Ketoconazole.Approved, Investigational
KitasamycinThe metabolism of Sirolimus can be decreased when combined with Kitasamycin.Experimental
LacidipineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Lacidipine.Approved
LamivudineThe serum concentration of Lamivudine can be decreased when it is combined with Sirolimus.Approved, Investigational
LamotrigineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Lamotrigine.Approved, Investigational
LansoprazoleThe serum concentration of Lansoprazole can be decreased when it is combined with Sirolimus.Approved, Investigational
LedipasvirThe serum concentration of Ledipasvir can be decreased when it is combined with Sirolimus.Approved
LeflunomideThe risk or severity of adverse effects can be increased when Sirolimus is combined with Leflunomide.Approved, Investigational
LenalidomideThe serum concentration of Lenalidomide can be decreased when it is combined with Sirolimus.Approved
LenvatinibThe serum concentration of Lenvatinib can be decreased when it is combined with Sirolimus.Approved
LercanidipineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Lercanidipine.Approved, Investigational
LevetiracetamThe serum concentration of Levetiracetam can be decreased when it is combined with Sirolimus.Approved, Investigational
LevofloxacinThe serum concentration of Levofloxacin can be decreased when it is combined with Sirolimus.Approved, Investigational
LevomilnacipranThe serum concentration of Levomilnacipran can be decreased when it is combined with Sirolimus.Approved
LinagliptinThe serum concentration of Linagliptin can be decreased when it is combined with Sirolimus.Approved
LiraglutideThe therapeutic efficacy of Liraglutide can be decreased when used in combination with Sirolimus.Approved
LisinoprilThe risk or severity of adverse effects can be increased when Sirolimus is combined with Lisinopril.Approved, Investigational
LoperamideThe serum concentration of Loperamide can be decreased when it is combined with Sirolimus.Approved
LopinavirThe metabolism of Sirolimus can be decreased when combined with Lopinavir.Approved
LosartanThe metabolism of Losartan can be decreased when combined with Sirolimus.Approved
LovastatinThe metabolism of Sirolimus can be decreased when combined with Lovastatin.Approved, Investigational
LuliconazoleThe serum concentration of Sirolimus can be increased when it is combined with Luliconazole.Approved
LumacaftorThe metabolism of Sirolimus can be increased when combined with Lumacaftor.Approved
Magnesium SulfateThe risk or severity of adverse effects can be increased when Sirolimus is combined with Magnesium Sulfate.Approved, Vet Approved
ManidipineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Manidipine.Approved
MannitolThe serum concentration of Mannitol can be decreased when it is combined with Sirolimus.Approved, Investigational
MetamizoleThe risk or severity of adverse effects can be increased when Metamizole is combined with Sirolimus.Withdrawn
MetforminThe therapeutic efficacy of Metformin can be decreased when used in combination with Sirolimus.Approved
MethotrexateThe serum concentration of Methotrexate can be decreased when it is combined with Sirolimus.Approved
MethylprednisoloneThe serum concentration of Methylprednisolone can be decreased when it is combined with Sirolimus.Approved, Vet Approved
MetoprololThe serum concentration of Metoprolol can be decreased when it is combined with Sirolimus.Approved, Investigational
MibefradilThe risk or severity of adverse effects can be increased when Sirolimus is combined with Mibefradil.Withdrawn
MidazolamThe serum concentration of Midazolam can be decreased when it is combined with Sirolimus.Approved, Illicit
MifepristoneThe serum concentration of Sirolimus can be increased when it is combined with Mifepristone.Approved, Investigational
MiglitolThe therapeutic efficacy of Miglitol can be decreased when used in combination with Sirolimus.Approved
MiglustatThe therapeutic efficacy of Miglustat can be decreased when used in combination with Sirolimus.Approved
MirabegronThe serum concentration of Mirabegron can be decreased when it is combined with Sirolimus.Approved
MitiglinideThe therapeutic efficacy of Mitiglinide can be decreased when used in combination with Sirolimus.Approved, Investigational
MitotaneThe serum concentration of Sirolimus can be decreased when it is combined with Mitotane.Approved
MitoxantroneThe serum concentration of Mitoxantrone can be decreased when it is combined with Sirolimus.Approved, Investigational
ModafinilThe serum concentration of Sirolimus can be decreased when it is combined with Modafinil.Approved, Investigational
MoexiprilThe risk or severity of adverse effects can be increased when Sirolimus is combined with Moexipril.Approved
MorphineThe serum concentration of Morphine can be decreased when it is combined with Sirolimus.Approved, Investigational
Mycophenolate mofetilThe serum concentration of Mycophenolate mofetil can be decreased when it is combined with Sirolimus.Approved, Investigational
NadololThe serum concentration of Nadolol can be decreased when it is combined with Sirolimus.Approved
NafcillinThe serum concentration of Sirolimus can be decreased when it is combined with Nafcillin.Approved
NaftopidilThe risk or severity of adverse effects can be increased when Sirolimus is combined with Naftopidil.Investigational
NaloxegolThe serum concentration of Naloxegol can be increased when it is combined with Sirolimus.Approved
NaloxoneThe serum concentration of Naloxone can be decreased when it is combined with Sirolimus.Approved, Vet Approved
NatalizumabThe risk or severity of adverse effects can be increased when Sirolimus is combined with Natalizumab.Approved, Investigational
NateglinideThe therapeutic efficacy of Nateglinide can be decreased when used in combination with Sirolimus.Approved, Investigational
NefazodoneThe metabolism of Sirolimus can be decreased when combined with Nefazodone.Approved, Withdrawn
NelfinavirThe serum concentration of Sirolimus can be increased when it is combined with Nelfinavir.Approved
NetupitantThe serum concentration of Sirolimus can be increased when it is combined with Netupitant.Approved
NevirapineThe metabolism of Sirolimus can be increased when combined with Nevirapine.Approved
NicardipineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Nicardipine.Approved
NifedipineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Nifedipine.Approved
NiguldipineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Niguldipine.Experimental
NilotinibThe metabolism of Sirolimus can be decreased when combined with Nilotinib.Approved, Investigational
NiludipineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Niludipine.Experimental
NilvadipineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Nilvadipine.Approved
NimesulideThe risk or severity of adverse effects can be increased when Sirolimus is combined with Nimesulide.Approved, Withdrawn
NimodipineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Nimodipine.Approved
NintedanibThe serum concentration of Nintedanib can be increased when it is combined with Sirolimus.Approved
NisoldipineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Nisoldipine.Approved
NitrendipineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Nitrendipine.Approved
NizatidineThe serum concentration of Nizatidine can be decreased when it is combined with Sirolimus.Approved
OlanzapineThe serum concentration of Olanzapine can be decreased when it is combined with Sirolimus.Approved, Investigational
OlaparibThe metabolism of Sirolimus can be decreased when combined with Olaparib.Approved
OleandomycinThe metabolism of Sirolimus can be decreased when combined with Oleandomycin.Vet Approved
OmapatrilatThe risk or severity of adverse effects can be increased when Sirolimus is combined with Omapatrilat.Investigational
OmbitasvirThe serum concentration of Sirolimus can be increased when it is combined with Ombitasvir.Approved
OsimertinibThe serum concentration of Sirolimus can be increased when it is combined with Osimertinib.Approved
OuabainOuabain may decrease the cardiotoxic activities of Sirolimus.Approved
PaclitaxelThe risk or severity of adverse effects can be increased when Paclitaxel is combined with Sirolimus.Approved, Vet Approved
PalbociclibThe serum concentration of Sirolimus can be increased when it is combined with Palbociclib.Approved
PanobinostatThe serum concentration of Panobinostat can be decreased when it is combined with Sirolimus.Approved, Investigational
ParitaprevirThe serum concentration of Sirolimus can be increased when it is combined with Paritaprevir.Approved
PazopanibThe serum concentration of Pazopanib can be increased when it is combined with Sirolimus.Approved
PentobarbitalThe metabolism of Sirolimus can be increased when combined with Pentobarbital.Approved, Vet Approved
PerhexilineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Perhexiline.Approved
PerindoprilThe risk or severity of adverse effects can be increased when Sirolimus is combined with Perindopril.Approved
PhenforminThe therapeutic efficacy of Phenformin can be decreased when used in combination with Sirolimus.Approved, Withdrawn
PhenobarbitalThe metabolism of Sirolimus can be increased when combined with Phenobarbital.Approved
PhenytoinThe serum concentration of Sirolimus can be decreased when it is combined with Phenytoin.Approved, Vet Approved
Picosulfuric acidThe therapeutic efficacy of Picosulfuric acid can be decreased when used in combination with Sirolimus.Approved
PimecrolimusThe risk or severity of adverse effects can be increased when Pimecrolimus is combined with Sirolimus.Approved, Investigational
PimozideSirolimus may increase the arrhythmogenic activities of Pimozide.Approved
PinaveriumThe risk or severity of adverse effects can be increased when Sirolimus is combined with Pinaverium.Approved
PioglitazoneThe therapeutic efficacy of Pioglitazone can be decreased when used in combination with Sirolimus.Approved, Investigational
PitavastatinThe serum concentration of Pitavastatin can be decreased when it is combined with Sirolimus.Approved
PomalidomideThe serum concentration of Pomalidomide can be decreased when it is combined with Sirolimus.Approved
PonatinibThe serum concentration of Ponatinib can be decreased when it is combined with Sirolimus.Approved
PosaconazoleThe serum concentration of Sirolimus can be increased when it is combined with Posaconazole.Approved, Investigational, Vet Approved
PramlintideThe therapeutic efficacy of Pramlintide can be decreased when used in combination with Sirolimus.Approved, Investigational
PravastatinThe serum concentration of Pravastatin can be decreased when it is combined with Sirolimus.Approved
PrazosinThe serum concentration of Prazosin can be decreased when it is combined with Sirolimus.Approved
PrednisoloneThe serum concentration of Prednisolone can be decreased when it is combined with Sirolimus.Approved, Vet Approved
PrednisoneThe serum concentration of Prednisone can be decreased when it is combined with Sirolimus.Approved, Vet Approved
PregabalinThe risk or severity of adverse effects can be increased when Sirolimus is combined with Pregabalin.Approved, Illicit, Investigational
PrenylamineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Prenylamine.Withdrawn
PrimidoneThe metabolism of Sirolimus can be increased when combined with Primidone.Approved, Vet Approved
ProgesteroneThe therapeutic efficacy of Progesterone can be decreased when used in combination with Sirolimus.Approved, Vet Approved
PropranololThe serum concentration of Propranolol can be decreased when it is combined with Sirolimus.Approved, Investigational
PrucaloprideThe serum concentration of Prucalopride can be increased when it is combined with Sirolimus.Approved
QuetiapineThe serum concentration of Quetiapine can be decreased when it is combined with Sirolimus.Approved
QuinaprilThe risk or severity of adverse effects can be increased when Sirolimus is combined with Quinapril.Approved, Investigational
QuinidineThe metabolism of Quinidine can be decreased when combined with Sirolimus.Approved
QuinineThe serum concentration of Quinine can be decreased when it is combined with Sirolimus.Approved
Rabies vaccineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Rabies vaccine.Approved
Rabies vaccineThe therapeutic efficacy of Rabies vaccine can be decreased when used in combination with Sirolimus.Approved
RamiprilThe risk or severity of adverse effects can be increased when Sirolimus is combined with Ramipril.Approved
RanitidineThe serum concentration of Ranitidine can be decreased when it is combined with Sirolimus.Approved
RanolazineThe metabolism of Ranolazine can be decreased when combined with Sirolimus.Approved, Investigational
RepaglinideThe therapeutic efficacy of Repaglinide can be decreased when used in combination with Sirolimus.Approved, Investigational
RescinnamineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Rescinnamine.Approved
ReserpineThe serum concentration of Reserpine can be decreased when it is combined with Sirolimus.Approved
RifabutinThe metabolism of Sirolimus can be increased when combined with Rifabutin.Approved
RifampicinThe metabolism of Sirolimus can be increased when combined with Rifampicin.Approved
RifapentineThe metabolism of Sirolimus can be increased when combined with Rifapentine.Approved
RifaximinThe serum concentration of Rifaximin can be increased when it is combined with Sirolimus.Approved, Investigational
RisedronateThe risk or severity of adverse effects can be increased when Sirolimus is combined with Risedronate.Approved, Investigational
RisperidoneThe serum concentration of Risperidone can be decreased when it is combined with Sirolimus.Approved, Investigational
RitonavirThe serum concentration of Sirolimus can be increased when it is combined with Ritonavir.Approved, Investigational
RivaroxabanThe serum concentration of Rivaroxaban can be decreased when it is combined with Sirolimus.Approved
RoflumilastRoflumilast may increase the immunosuppressive activities of Sirolimus.Approved
RomidepsinThe serum concentration of Romidepsin can be decreased when it is combined with Sirolimus.Approved, Investigational
RosiglitazoneThe therapeutic efficacy of Rosiglitazone can be decreased when used in combination with Sirolimus.Approved, Investigational
Salicylic acidThe serum concentration of Salicylic acid can be decreased when it is combined with Sirolimus.Approved, Vet Approved
SaquinavirThe metabolism of Sirolimus can be decreased when combined with Saquinavir.Approved, Investigational
SaxagliptinThe therapeutic efficacy of Saxagliptin can be decreased when used in combination with Sirolimus.Approved
SelexipagThe serum concentration of Selexipag can be decreased when it is combined with Sirolimus.Approved
SildenafilThe metabolism of Sirolimus can be decreased when combined with Sildenafil.Approved, Investigational
SilodosinThe serum concentration of Silodosin can be increased when it is combined with Sirolimus.Approved
SiltuximabThe serum concentration of Sirolimus can be decreased when it is combined with Siltuximab.Approved
SimeprevirThe serum concentration of Sirolimus can be increased when it is combined with Simeprevir.Approved
Sipuleucel-TThe therapeutic efficacy of Sipuleucel-T can be decreased when used in combination with Sirolimus.Approved
SitagliptinThe serum concentration of Sitagliptin can be decreased when it is combined with Sirolimus.Approved, Investigational
SofosbuvirThe serum concentration of Sofosbuvir can be decreased when it is combined with Sirolimus.Approved
SolifenacinThe metabolism of Solifenacin can be decreased when combined with Sirolimus.Approved
SolithromycinThe metabolism of Sirolimus can be decreased when combined with Solithromycin.Investigational
SorafenibThe serum concentration of Sorafenib can be decreased when it is combined with Sirolimus.Approved, Investigational
SparfloxacinThe serum concentration of Sparfloxacin can be decreased when it is combined with Sirolimus.Approved
SphingosineThe serum concentration of Sphingosine can be decreased when it is combined with Sirolimus.Experimental
SpiraprilThe risk or severity of adverse effects can be increased when Sirolimus is combined with Spirapril.Approved
SRP 299The risk or severity of adverse effects can be increased when Sirolimus is combined with SRP 299.Investigational
St. John's WortThe serum concentration of Sirolimus can be decreased when it is combined with St. John's Wort.Nutraceutical
StiripentolThe serum concentration of Sirolimus can be increased when it is combined with Stiripentol.Approved
SucralfateSucralfate can cause a decrease in the absorption of Sirolimus resulting in a reduced serum concentration and potentially a decrease in efficacy.Approved
SulfisoxazoleThe metabolism of Sirolimus can be decreased when combined with Sulfisoxazole.Approved, Vet Approved
SulodexideThe therapeutic efficacy of Sulodexide can be decreased when used in combination with Sirolimus.Approved, Investigational
SunitinibThe metabolism of Sunitinib can be decreased when combined with Sirolimus.Approved, Investigational
TacrolimusThe risk or severity of adverse effects can be increased when Tacrolimus is combined with Sirolimus.Approved, Investigational
TacrolimusThe serum concentration of Tacrolimus can be decreased when it is combined with Sirolimus.Approved, Investigational
TamoxifenThe serum concentration of Tamoxifen can be decreased when it is combined with Sirolimus.Approved
Taurocholic AcidThe serum concentration of Taurocholic Acid can be decreased when it is combined with Sirolimus.Experimental
Technetium Tc-99m sestamibiThe serum concentration of Technetium Tc-99m sestamibi can be decreased when it is combined with Sirolimus.Approved
TelaprevirThe serum concentration of Sirolimus can be increased when it is combined with Telaprevir.Approved
TelithromycinThe metabolism of Sirolimus can be decreased when combined with Telithromycin.Approved
TemocaprilThe risk or severity of adverse effects can be increased when Sirolimus is combined with Temocapril.Experimental, Investigational
TemsirolimusThe serum concentration of Temsirolimus can be decreased when it is combined with Sirolimus.Approved
TG4010The risk or severity of adverse effects can be increased when Sirolimus is combined with TG4010.Investigational
ThiazolidinedioneThe therapeutic efficacy of Thiazolidinedione can be decreased when used in combination with Sirolimus.Investigational
TicagrelorThe serum concentration of Ticagrelor can be decreased when it is combined with Sirolimus.Approved
TiclopidineThe metabolism of Sirolimus can be decreased when combined with Ticlopidine.Approved
TimololThe serum concentration of Timolol can be decreased when it is combined with Sirolimus.Approved
TocilizumabThe serum concentration of Sirolimus can be decreased when it is combined with Tocilizumab.Approved
TofacitinibSirolimus may increase the immunosuppressive activities of Tofacitinib.Approved, Investigational
TolazamideThe therapeutic efficacy of Tolazamide can be decreased when used in combination with Sirolimus.Approved
TolbutamideThe therapeutic efficacy of Tolbutamide can be decreased when used in combination with Sirolimus.Approved
Tolfenamic AcidThe risk or severity of adverse effects can be increased when Sirolimus is combined with Tolfenamic Acid.Approved
TolvaptanThe serum concentration of Tolvaptan can be decreased when it is combined with Sirolimus.Approved
TopotecanThe serum concentration of Topotecan can be increased when it is combined with Sirolimus.Approved, Investigational
ToremifeneThe serum concentration of Toremifene can be decreased when it is combined with Sirolimus.Approved, Investigational
TrandolaprilThe risk or severity of adverse effects can be increased when Sirolimus is combined with Trandolapril.Approved
TranilastThe risk or severity of adverse effects can be increased when Sirolimus is combined with Tranilast.Approved, Investigational
TrastuzumabTrastuzumab may increase the cardiotoxic activities of Sirolimus.Approved, Investigational
Trastuzumab emtansineThe serum concentration of Trastuzumab emtansine can be decreased when it is combined with Sirolimus.Approved
TroglitazoneThe therapeutic efficacy of Troglitazone can be decreased when used in combination with Sirolimus.Withdrawn
TroleandomycinThe metabolism of Sirolimus can be decreased when combined with Troleandomycin.Approved
TylosinThe metabolism of Sirolimus can be decreased when combined with Tylosin.Vet Approved
UlipristalThe serum concentration of Ulipristal can be decreased when it is combined with Sirolimus.Approved
UmeclidiniumThe serum concentration of Umeclidinium can be decreased when it is combined with Sirolimus.Approved
VecuroniumThe serum concentration of Vecuronium can be decreased when it is combined with Sirolimus.Approved
VenetoclaxThe serum concentration of Venetoclax can be decreased when it is combined with Sirolimus.Approved
VenlafaxineThe metabolism of Sirolimus can be decreased when combined with Venlafaxine.Approved
VerapamilThe risk or severity of adverse effects can be increased when Sirolimus is combined with Verapamil.Approved
VildagliptinThe therapeutic efficacy of Vildagliptin can be decreased when used in combination with Sirolimus.Approved, Investigational
VinblastineThe serum concentration of Vinblastine can be decreased when it is combined with Sirolimus.Approved
VincristineThe serum concentration of Vincristine can be decreased when it is combined with Sirolimus.Approved, Investigational
VinpocetineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Vinpocetine.Investigational
VismodegibThe serum concentration of Vismodegib can be decreased when it is combined with Sirolimus.Approved
VogliboseThe therapeutic efficacy of Voglibose can be decreased when used in combination with Sirolimus.Approved, Investigational
VoriconazoleThe serum concentration of Sirolimus can be increased when it is combined with Voriconazole.Approved, Investigational
XylometazolineThe risk or severity of adverse effects can be increased when Sirolimus is combined with Xylometazoline.Approved
ZiconotideThe risk or severity of adverse effects can be increased when Sirolimus is combined with Ziconotide.Approved
ZidovudineThe serum concentration of Zidovudine can be decreased when it is combined with Sirolimus.Approved
ZiprasidoneThe metabolism of Sirolimus can be decreased when combined with Ziprasidone.Approved
ZolpidemThe serum concentration of Zolpidem can be increased when it is combined with Sirolimus.Approved
Food InteractionsNot Available
References
Synthesis Reference

Madhup K. Dhaon, Chi-nung Hsiao, Subhash R. Patel, Peter J. Bonk, Sanjay R. Chemburkar, Yong Y. Chen, “One pot synthesis of tetrazole derivatives of sirolimus.” U.S. Patent US20080167335, issued July 10, 2008.

US20080167335
General References
  1. Pritchard DI: Sourcing a chemical succession for cyclosporin from parasites and human pathogens. Drug Discov Today. 2005 May 15;10(10):688-91. [PubMed:15896681 ]
  2. Shuchman M: Trading restenosis for thrombosis? New questions about drug-eluting stents. N Engl J Med. 2006 Nov 9;355(19):1949-52. [PubMed:17093244 ]
  3. Sun SY, Rosenberg LM, Wang X, Zhou Z, Yue P, Fu H, Khuri FR: Activation of Akt and eIF4E survival pathways by rapamycin-mediated mammalian target of rapamycin inhibition. Cancer Res. 2005 Aug 15;65(16):7052-8. [PubMed:16103051 ]
  4. Chan S: Targeting the mammalian target of rapamycin (mTOR): a new approach to treating cancer. Br J Cancer. 2004 Oct 18;91(8):1420-4. [PubMed:15365568 ]
  5. Graziani EI: Recent advances in the chemistry, biosynthesis and pharmacology of rapamycin analogs. Nat Prod Rep. 2009 May;26(5):602-9. doi: 10.1039/b804602f. Epub 2009 Mar 5. [PubMed:19387497 ]
External Links
ATC CodesS01XA23L04AA10
AHFS Codes
  • 92:00.00
PDB Entries
FDA labelDownload (480 KB)
MSDSNot Available
ADMET
Predicted ADMET features
PropertyValueProbability
Human Intestinal Absorption-0.7841
Blood Brain Barrier-0.9599
Caco-2 permeable-0.6341
P-glycoprotein substrateSubstrate0.8052
P-glycoprotein inhibitor IInhibitor0.8564
P-glycoprotein inhibitor IIInhibitor0.8021
Renal organic cation transporterNon-inhibitor0.8116
CYP450 2C9 substrateNon-substrate0.878
CYP450 2D6 substrateNon-substrate0.9138
CYP450 3A4 substrateSubstrate0.7776
CYP450 1A2 substrateNon-inhibitor0.9007
CYP450 2C9 inhibitorNon-inhibitor0.9125
CYP450 2D6 inhibitorNon-inhibitor0.9414
CYP450 2C19 inhibitorNon-inhibitor0.9158
CYP450 3A4 inhibitorNon-inhibitor0.9333
CYP450 inhibitory promiscuityLow CYP Inhibitory Promiscuity0.9742
Ames testNon AMES toxic0.6617
CarcinogenicityNon-carcinogens0.9546
BiodegradationNot ready biodegradable0.9593
Rat acute toxicity2.8689 LD50, mol/kg Not applicable
hERG inhibition (predictor I)Weak inhibitor0.9831
hERG inhibition (predictor II)Non-inhibitor0.8443
ADMET data is predicted using admetSAR, a free tool for evaluating chemical ADMET properties. (23092397 )
Pharmacoeconomics
Manufacturers
  • Wyeth pharmaceuticals inc
Packagers
Dosage forms
FormRouteStrength
SolutionOral1 mg/ml
TabletOral1.0 mg
TabletOral2 mg
TabletOral5 mg
Tablet, coatedOral0.5 mg
Tablet, coatedOral1 mg
Tablet, coatedOral2 mg
Tablet, sugar coatedOral.5 mg/1
Tablet, sugar coatedOral1 mg/1
Tablet, sugar coatedOral2 mg/1
SolutionOral1.0 mg
TabletOral1 mg/1
TabletOral2 mg/1
Tablet, film coatedOral.5 mg/1
Prices
Unit descriptionCostUnit
Rapamune 2 mg tablet20.59USD tablet
Rapamune 1 mg/ml Solution12.19USD ml
Rapamune 1 mg tablet11.95USD tablet
Rapamune 0.5 mg tablet5.86USD tablet
DrugBank does not sell nor buy drugs. Pricing information is supplied for informational purposes only.
Patents
Patent NumberPediatric ExtensionApprovedExpires (estimated)
CA2103571 No2003-04-292012-02-21Canada
CA2293793 No2006-07-112018-06-11Canada
US5212155 No1993-05-182010-05-18Us
US5989591 Yes1998-09-112018-09-11Us
Properties
StateSolid
Experimental Properties
PropertyValueSource
logP4.3Not Available
Predicted Properties
PropertyValueSource
Water Solubility0.00173 mg/mLALOGPS
logP4.85ALOGPS
logP7.45ChemAxon
logS-5.7ALOGPS
pKa (Strongest Acidic)9.96ChemAxon
pKa (Strongest Basic)-3ChemAxon
Physiological Charge0ChemAxon
Hydrogen Acceptor Count12ChemAxon
Hydrogen Donor Count3ChemAxon
Polar Surface Area195.43 Å2ChemAxon
Rotatable Bond Count6ChemAxon
Refractivity250.66 m3·mol-1ChemAxon
Polarizability100.46 Å3ChemAxon
Number of Rings4ChemAxon
Bioavailability0ChemAxon
Rule of FiveYesChemAxon
Ghose FilterYesChemAxon
Veber's RuleYesChemAxon
MDDR-like RuleYesChemAxon
Spectra
Mass Spec (NIST)Not Available
Spectra
Spectrum TypeDescriptionSplash Key
Predicted LC-MS/MSPredicted LC-MS/MS Spectrum - 10V, PositiveNot Available
Predicted LC-MS/MSPredicted LC-MS/MS Spectrum - 20V, PositiveNot Available
Predicted LC-MS/MSPredicted LC-MS/MS Spectrum - 40V, PositiveNot Available
Predicted LC-MS/MSPredicted LC-MS/MS Spectrum - 10V, NegativeNot Available
Predicted LC-MS/MSPredicted LC-MS/MS Spectrum - 20V, NegativeNot Available
Predicted LC-MS/MSPredicted LC-MS/MS Spectrum - 40V, NegativeNot Available
Taxonomy
DescriptionThis compound belongs to the class of organic compounds known as macrolide lactams. These are cyclic polyketides containing both a cyclic amide and a cyclic ester group.
KingdomOrganic compounds
Super ClassPhenylpropanoids and polyketides
ClassMacrolide lactams
Sub ClassNot Available
Direct ParentMacrolide lactams
Alternative Parents
Substituents
  • Macrolide lactam
  • Macrolide
  • Alpha-amino acid ester
  • Cyclohexanol
  • Piperidine
  • Oxane
  • Tertiary carboxylic acid amide
  • Cyclic alcohol
  • Cyclic ketone
  • Tertiary amine
  • Secondary alcohol
  • Lactone
  • Lactam
  • Ketone
  • Hemiacetal
  • Carboxylic acid ester
  • Carboxamide group
  • Oxacycle
  • Azacycle
  • Organoheterocyclic compound
  • Monocarboxylic acid or derivatives
  • Ether
  • Dialkyl ether
  • Carboxylic acid derivative
  • Hydrocarbon derivative
  • Organooxygen compound
  • Organonitrogen compound
  • Carbonyl group
  • Amine
  • Alcohol
  • Aliphatic heteropolycyclic compound
Molecular FrameworkAliphatic heteropolycyclic compounds
External Descriptors

Targets

Kind
Protein
Organism
Human
Pharmacological action
yes
Actions
inhibitor
General Function:
Tfiiic-class transcription factor binding
Specific Function:
Serine/threonine protein kinase which is a central regulator of cellular metabolism, growth and survival in response to hormones, growth factors, nutrients, energy and stress signals. MTOR directly or indirectly regulates the phosphorylation of at least 800 proteins. Functions as part of 2 structurally and functionally distinct signaling complexes mTORC1 and mTORC2 (mTOR complex 1 and 2). Activ...
Gene Name:
MTOR
Uniprot ID:
P42345
Molecular Weight:
288889.05 Da
References
  1. Dowling RJ, Topisirovic I, Fonseca BD, Sonenberg N: Dissecting the role of mTOR: lessons from mTOR inhibitors. Biochim Biophys Acta. 2010 Mar;1804(3):433-9. doi: 10.1016/j.bbapap.2009.12.001. Epub 2009 Dec 11. [PubMed:20005306 ]
  2. Shuuin T, Karashima H: [Mammalian target of rapamycin, its mode of action and clinical response in metastatic clear cell carcinoma]. Gan To Kagaku Ryoho. 2009 Jul;36(7):1076-9. [PubMed:19620795 ]
  3. Sehgal SN: Sirolimus: its discovery, biological properties, and mechanism of action. Transplant Proc. 2003 May;35(3 Suppl):7S-14S. [PubMed:12742462 ]
  4. Chen X, Ji ZL, Chen YZ: TTD: Therapeutic Target Database. Nucleic Acids Res. 2002 Jan 1;30(1):412-5. [PubMed:11752352 ]
Kind
Protein
Organism
Human
Pharmacological action
yes
Actions
other
General Function:
Type i transforming growth factor beta receptor binding
Specific Function:
Keeps in an inactive conformation TGFBR1, the TGF-beta type I serine/threonine kinase receptor, preventing TGF-beta receptor activation in absence of ligand. Recruites SMAD7 to ACVR1B which prevents the association of SMAD2 and SMAD3 with the activin receptor complex, thereby blocking the activin signal. May modulate the RYR1 calcium channel activity. PPIases accelerate the folding of proteins....
Gene Name:
FKBP1A
Uniprot ID:
P62942
Molecular Weight:
11950.665 Da
References
  1. Chen X, Ji ZL, Chen YZ: TTD: Therapeutic Target Database. Nucleic Acids Res. 2002 Jan 1;30(1):412-5. [PubMed:11752352 ]
  2. Sehgal SN: Sirolimus: its discovery, biological properties, and mechanism of action. Transplant Proc. 2003 May;35(3 Suppl):7S-14S. [PubMed:12742462 ]
Kind
Protein
Organism
Human
Pharmacological action
yes
Actions
other/unknown
General Function:
Ligand-dependent nuclear receptor transcription coactivator activity
Specific Function:
Plays an important role in the regulation of cell survival, cell division, angiogenesis, cell differentiation and cell migration. Functions as potent mitogen in vitro.
Gene Name:
FGF2
Uniprot ID:
P09038
Molecular Weight:
30769.715 Da
References
  1. Sehgal SN: Sirolimus: its discovery, biological properties, and mechanism of action. Transplant Proc. 2003 May;35(3 Suppl):7S-14S. [PubMed:12742462 ]

Enzymes

Kind
Protein
Organism
Human
Pharmacological action
unknown
Actions
substrateinhibitor
General Function:
Vitamin d3 25-hydroxylase activity
Specific Function:
Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It performs a variety of oxidation reactions (e.g. caffeine 8-oxidation, omeprazole sulphoxidation, midazolam 1'-hydroxylation and midazolam 4-hydroxylation) of structurally unrelated compounds, including steroids, fatty acids, and xenobiot...
Gene Name:
CYP3A4
Uniprot ID:
P08684
Molecular Weight:
57342.67 Da
References
  1. Preissner S, Kroll K, Dunkel M, Senger C, Goldsobel G, Kuzman D, Guenther S, Winnenburg R, Schroeder M, Preissner R: SuperCYP: a comprehensive database on Cytochrome P450 enzymes including a tool for analysis of CYP-drug interactions. Nucleic Acids Res. 2010 Jan;38(Database issue):D237-43. doi: 10.1093/nar/gkp970. Epub 2009 Nov 24. [PubMed:19934256 ]
  2. Ekins S, Bravi G, Wikel JH, Wrighton SA: Three-dimensional-quantitative structure activity relationship analysis of cytochrome P-450 3A4 substrates. J Pharmacol Exp Ther. 1999 Oct;291(1):424-33. [PubMed:10490933 ]
  3. Drug Interactions: Cytochrome P450 Drug Interaction Table [Link]
Kind
Protein
Organism
Human
Pharmacological action
unknown
Actions
substrate
General Function:
Oxygen binding
Specific Function:
Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It oxidizes a variety of structurally unrelated compounds, including steroids, fatty acids, and xenobiotics.
Gene Name:
CYP3A5
Uniprot ID:
P20815
Molecular Weight:
57108.065 Da
References
  1. Drug Interactions: Cytochrome P450 Drug Interaction Table [Link]
Kind
Protein
Organism
Human
Pharmacological action
unknown
Actions
substrate
General Function:
Oxygen binding
Specific Function:
Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It oxidizes a variety of structurally unrelated compounds, including steroids, fatty acids, and xenobiotics.
Gene Name:
CYP3A7
Uniprot ID:
P24462
Molecular Weight:
57525.03 Da
References
  1. Drug Interactions: Cytochrome P450 Drug Interaction Table [Link]

Transporters

Kind
Protein
Organism
Human
Pharmacological action
unknown
Actions
inhibitorinducer
General Function:
Xenobiotic-transporting atpase activity
Specific Function:
Energy-dependent efflux pump responsible for decreased drug accumulation in multidrug-resistant cells.
Gene Name:
ABCB1
Uniprot ID:
P08183
Molecular Weight:
141477.255 Da
References
  1. Schuetz EG, Beck WT, Schuetz JD: Modulators and substrates of P-glycoprotein and cytochrome P4503A coordinately up-regulate these proteins in human colon carcinoma cells. Mol Pharmacol. 1996 Feb;49(2):311-8. [PubMed:8632764 ]
  2. Wacher VJ, Silverman JA, Wong S, Tran-Tau P, Chan AO, Chai A, Yu XQ, O'Mahony D, Ramtoola Z: Sirolimus oral absorption in rats is increased by ketoconazole but is not affected by D-alpha-tocopheryl poly(ethylene glycol 1000) succinate. J Pharmacol Exp Ther. 2002 Oct;303(1):308-13. [PubMed:12235265 ]
  3. Arceci RJ, Stieglitz K, Bierer BE: Immunosuppressants FK506 and rapamycin function as reversal agents of the multidrug resistance phenotype. Blood. 1992 Sep 15;80(6):1528-36. [PubMed:1381629 ]
  4. Nagy H, Goda K, Fenyvesi F, Bacso Z, Szilasi M, Kappelmayer J, Lustyik G, Cianfriglia M, Szabo G Jr: Distinct groups of multidrug resistance modulating agents are distinguished by competition of P-glycoprotein-specific antibodies. Biochem Biophys Res Commun. 2004 Mar 19;315(4):942-9. [PubMed:14985103 ]
Kind
Protein
Organism
Human
Pharmacological action
unknown
Actions
inhibitor
General Function:
Sodium-independent organic anion transmembrane transporter activity
Specific Function:
Mediates the Na(+)-independent uptake of organic anions such as pravastatin, taurocholate, methotrexate, dehydroepiandrosterone sulfate, 17-beta-glucuronosyl estradiol, estrone sulfate, prostaglandin E2, thromboxane B2, leukotriene C3, leukotriene E4, thyroxine and triiodothyronine. Involved in the clearance of bile acids and organic anions from the liver.
Gene Name:
SLCO1B1
Uniprot ID:
Q9Y6L6
Molecular Weight:
76447.99 Da
References
  1. Fehrenbach T, Cui Y, Faulstich H, Keppler D: Characterization of the transport of the bicyclic peptide phalloidin by human hepatic transport proteins. Naunyn Schmiedebergs Arch Pharmacol. 2003 Nov;368(5):415-20. Epub 2003 Oct 3. [PubMed:14530907 ]
Kind
Protein
Organism
Human
Pharmacological action
unknown
General Function:
Monovalent cation:proton antiporter activity
Specific Function:
Solute transporter for tetraethylammonium (TEA), 1-methyl-4-phenylpyridinium (MPP), cimetidine, N-methylnicotinamide (NMN), metformin, creatinine, guanidine, procainamide, topotecan, estrone sulfate, acyclovir, ganciclovir and also the zwitterionic cephalosporin, cephalexin and cephradin. Seems to also play a role in the uptake of oxaliplatin (a new platinum anticancer agent). Able to transport...
Gene Name:
SLC47A1
Uniprot ID:
Q96FL8
Molecular Weight:
61921.585 Da
References
  1. Meyer zu Schwabedissen HE, Verstuyft C, Kroemer HK, Becquemont L, Kim RB: Human multidrug and toxin extrusion 1 (MATE1/SLC47A1) transporter: functional characterization, interaction with OCT2 (SLC22A2), and single nucleotide polymorphisms. Am J Physiol Renal Physiol. 2010 Apr;298(4):F997-F1005. doi: 10.1152/ajprenal.00431.2009. Epub 2010 Jan 6. [PubMed:20053795 ]
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Drug created on June 13, 2005 07:24 / Updated on December 09, 2016 03:54