用雷帕鸣治疗期间需要注意什么？

Rapamin (sirolimus) is a triene macrolide antibiotic extracted from the culture medium of Streptomyces. What should we pay attention to during treatment with rapamin?

Immunosuppression may increase susceptibility to infections and may lead to the development of lymphoma and other malignancies, especially skin cancer. Excessive suppression of the immune system also increases susceptibility to opportunistic infections, sepsis, and fatal infections. Sirolimus should only be used by physicians experienced in immunosuppressive therapy and the treatment of kidney transplant patients. Patients receiving this drug should be treated in an institution with appropriate laboratory and ancillary medical facilities and personnel.

The use of sirolimus in renal transplant patients has been associated with increases in serum cholesterol and triglycerides that may require treatment. The number of patients with newly discovered hypercholesterolemia who required treatment with lipid-lowering drugs was approximately 42-52% in the rapamide group, compared with 16% in the placebo group and 22% in the azathioprine group. All patients taking rapamycin should use laboratory tests to monitor the occurrence of hyperlipidemia. Once hyperlipidemia occurs, appropriate intervention treatments should be taken, such as diet, exercise and lipid-lowering drugs.

Patients receiving Rapamune were more likely to experience increases in serum cholesterol and triglycerides requiring treatment than patients receiving azathioprine or placebo. In a phase III trial, patients who received rapamine plus cyclosporine had an increase in mean serum creatinine and a decrease in mean glomerular filtration rate compared with patients who received cyclosporine plus placebo or cyclosporine plus azathioprine. Renal function should be monitored during maintenance regimens that include immunosuppression combined with cyclosporine and rapamycin; appropriate adjustments to the immunosuppressive regimen should be considered when patients' serum creatinine values ​​rise. Caution should be used when using drugs known to impair renal function.