Page 25 - RxExam's Naplex Theory Book Part 2

www.pharmacyexam.com Krisman

Dose Special Notes

Certolizumab Please Refer To Page 328 (Part 1) of Chapter 36-Rheumatoid Arthritis.

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

Etanercept Please Refer To Page 328 (Part 1) of Chapter 36-Rheumatoid Arthritis.

Golimumab Please Refer To Page 330 (Part 1) of Chapter 36-Rheumatoid Arthritis.

D). Miscellaneous

Sirolimus 1. Renal 1). Sirolimus (Rapamune) inhibits T-lymphocyte activation and
(Tablet) Transplant: proliferation that occurs in response to antigenic and cytokine
(Oral solution) (Interleukin IL-2, IL-4, and IL-15) stimulation by a mechanism that is
Dose: Depend on distinct from that of other immunosuppressants. Sirolimus
targeted Sirolimus (Rapamune) also inhibits antibody production.
concentration
requires. 2). Sirolimus is indicated for the prophylaxis of organ rejection in
patients aged 13 years or older receiving renal transplants. It should
Loading Dose: 3 x be used initially in a regimen with cyclosporine and corticosteroids.
Maintenance Dose
3). Sirolimus tablets should NOT be crushed, chewed or split. It is to be
Maintenance Dose: taken orally once daily, consistently with or without food.
Based on Targeted
Concentration 4). Frequent Sirolimus (Rapamune) dose adjustments based on non-
requires. steady-state sirolimus concentrations can lead to overdosing or under

dosing because sirolimus has a long half-life. Once Sirolimus
(Rapamune) maintenance dose is adjusted, patients should continue
on the new maintenance dose for at least 7 to 14 days before further
dosage adjustment with concentration monitoring.
In most patients, dose adjustments can be based on simple
proportion: new Sirolimus (Rapamune) dose = current dose x (target
concentration/current concentration). A loading dose should be
considered in addition to a new maintenance dose when it is necessary
to increase sirolimus trough concentrations: Sirolimus (Rapamune)
loading dose = 3 x (new maintenance dose - current maintenance
dose). The maximum Sirolimus (Rapamune) dose administered on any
day should not exceed 40 mg.

5). When used in combination with cyclosporine, sirolimus trough
concentrations should be maintained within the target-range.
Following cyclosporine withdrawal in transplant patients at low- to
moderate-immunologic risk, the target sirolimus trough concentrations
should be between 16 and 24 ng/mL for the first year following
transplantation. Thereafter, the target sirolimus concentrations should be
between 12 and 20 ng/ml.

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