Sirolimus tablets, as mTOR inhibitors, are mainly used for organ transplant anti rejection and lymphangioleiomyoma treatment. Strict individualized dosage adjustment and monitoring of blood drug concentration are required. Special populations should pay special attention to the impact on liver and kidney function and infection risk prevention and control.

1. Standard usage and dosage

(1) Initial dose

The loading dose for kidney transplant patients is 6mg, and the maintenance dose is 2mg/day; Liver transplant patients need to take a loading dose of 15mg and a maintenance dose of 5mg/day on an empty stomach.

(2) Concentration monitoring

After taking the medication, the trough concentration was maintained at 4-12ng/mL for 24 hours. Weekly testing was conducted during the initial period after transplantation, and monthly follow-up was conducted after stabilization.

2. Adjustment for special populations

(1) Liver dysfunction

The maintenance dose for Child Pugh A/B grade patients is reduced by 33%, and for C grade patients it is reduced by 50%. Weekly monitoring of liver function is required.

(2) Renal insufficiency

No dose adjustment is needed, but those with GFR<30mL/min should be alert to worsening hyperlipidemia and proteinuria.

3. Special state medication

(1) Pregnancy period

Animal experiments have shown embryotoxicity and are contraindicated during pregnancy. Women of childbearing age should use effective contraception from the time of medication until 12 weeks after discontinuation.

(2) Lactation period

Medications can be secreted into breast milk, and feeding should be suspended during lactation.

4. Medication for the elderly and children

(1) Elderly people

Patients aged 65 and above do not need to adjust their dosage, but infection monitoring should be strengthened, especially for pneumonia and oral ulcers.

(2) Children

The safety and efficacy under the age of 13 have not been established, and for ages 13-18, the dosage is adjusted according to body surface area based on adult dosage.

5. Medication precautions

(1) Drug interactions

CYP3A4/P-gp inhibitors (such as ketoconazole) can increase blood drug concentration by 5 times, while inducers (such as rifampicin) can reduce concentration by 90%.

(2) Adverse reaction management

If interstitial pneumonia occurs, medication should be stopped immediately and glucocorticoid treatment should be used. Medication should be suspended when platelet count is less than 100 × 10 ⁹/L.