Rapamycin dose differs between different treatments

[Krister_Kauppi]

“The dose makes the poison” is a common expression which means that different doses lead to different results. Here is a summary when it comes to rapamycin and how doses differs between different treatments. Have I missed to include some treatment or some dose that needs adjustment? All feedback is welcome

[RapAdmin]

The variance in dosing for cancer is much larger than you’ve identified. Here is one where they used 90mg/week:

Cancer patients and rapamycin doses?

In this study they were taking rapamycin at a level as high as 90mg/week for cancer. “The most common toxicities attributed to sirolimus observed throughout all three studies were hyperglycemia, hyperlipidemia, lymphopenia, anemia, and diarrhea. In the sirolimus alone study, the single weekly dose of 60 mg was associated with significant diarrhea and gastrointestinal upset so subsequent cohorts were administered split doses” Gastrointestinal toxicity on the split dose level consisted of diarrhea, nausea, and emesis. These were managed conservatively with antidiarrheals (loperamide or diphenoxylate/atropine as needed) and antiemetics. All subjects were able to continue therapy although one required dose interruption due to diarrhea. A single cycle of treatment was defined as 4 conse…

[LaraPo]

For organ transplant the maintenance dose is usually 1 mg/day. The initial dose (right after transplant surgery) may be higher. So probably the range then is 1 - 5 mg/day.

[Krister_Kauppi]

Interesting, because I based the dose on different claims on pubmed. For example this study.

“The usual maintenance dose of Sirolimus in these patients is 2 to 5 mg/d and its optimal maintenance trough level is 5 to 10 ng/mL.
Source:Sirolimus Dose Requirement in Kidney Transplant Recipients in Iran - PubMed

I think you have better knowledge in this are then me so I’m humble here But do you have any study or page where they point out that the maintenance dose is usually 1 mg/day?

[Krister_Kauppi]

Thanks for reminding me about that post I wonder if that dose regime is more a specific study dose than a dose that is used in real life cases. Do you know if there exists any guide page for doctors regarding this dose regime?

[LaraPo]

There are so many protocols and unique situations based on donor/recipient match. I was prescribed 1mg/day Rapamune from the very beginning (12 years ago) and I’m still on 1mg.

[LaraPo]

No, I don’t have any reference. I just share what I was prescribed after kidney transplant. May be the dose in my case was low because it was a perfect match (my donor was my son).

[LaraPo]

Found this link. Sirolimus Dose Requirement in Kidney Transplant Recipients in Iran - PubMed

Contrary to the recommended dose of Sirolimus in the references (2 to 5 mg/d) Iranian kidney transplant recipients needed lower daily doses of Sirolimus (1.2 mg/d) to achieve the desired whole blood level.

[Krister_Kauppi]

Great that you found that, Lara! I will update the image with the new data 1 - 5mg / daily

If you find anything more just let me know.