Page 24 - RxExam's Naplex Theory Book Part 2

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Dose Special Notes

Everolimus 1. Renal 1). Everolimus (Zortress) inhibits antigenic and interleukin stimulated
(Tablet) Transplant: activation and proliferation of T and B lymphocytes.

0.75 mg PO BID 2). Everolimus (Zortress) is indicated for the prophylaxis of organ
with reduced dose rejection in adult patients at low-moderate immunologic risk receiving
of Cyclosporine. a kidney transplant. It is to be administered in combination with
basiliximab induction and concurrently with reduced doses of
cyclosporine and corticosteroids.

3). Everolimus (Zortress) tablets should be swallowed whole with a
glass of water and not crushed before use. Administer Everolimus
(Zortress) consistently approximately 12 hours apart with or without
food to minimize variability in absorption and at the same time as
cyclosporine.

4). Both cyclosporine doses (standard doses) and the target range for
whole blood trough concentrations should be reduced, when given in
a regimen with Everolimus (Zortress), in order to minimize the risk of
nephrotoxicity.

5). Routine everolimus whole blood therapeutic drug concentration
monitoring is recommended for all patients using appropriate assay
methodology. The recommended everolimus therapeutic range is 3 to
8 ng/ml.

6). Everolimus (Zortress) is mainly metabolized by CYP3A4 in the liver
and to some extent in the intestinal wall and is a substrate for the
multidrug efflux pump, P-glycoprotein. Therefore, absorption and
subsequent elimination of systemically absorbed everolimus may be
influenced by medicinal products that affect CYP3A4 and/or P-
glycoprotein. Concurrent treatment with strong inhibitors (e.g.,
ketoconazole, itraconazole, voriconazole, clarithromycin,
telithromycin, ritonavir) and inducers (e.g., rifampin, rifabutin) of
CYP3A4 is not recommended. Inhibitors of P-glycoprotein (e.g.,
digoxin, cyclosporine) may decrease the efflux of everolimus from
intestinal cells and increase everolimus blood concentrations.

7). Hypersensitivity reactions, serious infections, angioedema,
hyperlipidemia, and nephrotoxicity are reported side effects of
Everolimus (Zortress).

C). TNF Alfa Inhibitors

Infliximab Please Refer To Page 329 (Part 1) of Chapter 36-Rheumatoid Arthritis.

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