Rapamune is a brand-name prescription medication. It’s FDA-approved to:

  • Help prevent the rejection of kidney transplants. Rejection occurs when your immune system attacks the transplanted kidney. For this purpose, Rapamune is used in combination with cyclosporine (Gengraf, Neoral, Sandimmune) and corticosteroids such as prednisone (Rayos). Rapamune is prescribed for this use in adults and certain children ages 13 years and older.
  • Treat a condition called lymphangioleiomyomatosis. With this condition, abnormal cells grow in the lungs and cause breathing problems that worsen. Lymphangioleiomyomatosis (LAM) can also affect the kidneys and lymphatic system. LAM is rare and mainly develops in females.* For this purpose, the drug is prescribed foruse in adults.

Rapamune has certain limitations of use when used to help prevent the rejection of kidney transplants. To learn more, see the “Rapamune uses” section below.

* Sex and gender exist on spectrums. Use of the term “female” in this article refer to sex assigned at birth.

Drug details

Rapamune contains the active drug sirolimus. Rapamune belongs to a drug class called mammalian target of rapamycin (mTOR) inhibitors.

Rapamune is taken by mouth. It comes in the following forms and strengths:

  • oral tablet, available in three strengths: 0.5 milligrams (mg), 1 mg, and 2 mg
  • oral solution, available in one strength: 1 mg per milliliter (mg/mL)

Effectiveness

For information about the effectiveness of Rapamune, see the “Rapamune uses” section below.

Rapamune is a brand-name drug that contains the active drug sirolimus. This active drug is also available as a generic medication. A generic drug is an exact copy of the active drug in a brand-name medication.

The generic is considered to be as safe and effective as the original drug. Generics tend to cost less than brand-name drugs.

If you’re interested in using the generic form of Rapamune, talk with your doctor. They can tell you if it comes in forms and strengths that can be used for your condition.

Rapamune can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Rapamune. These lists do not include all possible side effects.

Side effects might differ slightly between people who have received a kidney transplant and people with lymphangioleiomyomatosis (LAM).

For more information about the possible side effects of Rapamune, talk with your doctor or pharmacist. They can give you tips on how to manage any side effects that may be concerning or bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Rapamune, you can do so through MedWatch.

Mild side effects

Mild side effects* of Rapamune can include:

Most of these side effects may go away within a few days to a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

* This is a partial list of mild side effects from Rapamune. To learn about other mild side effects, talk with your doctor or pharmacist, or view Rapamune’s prescribing information.

Serious side effects

Serious side effects from Rapamune can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

* Your risk for this side effect is increased when Rapamune is used with cyclosporine.
** This side effect usually doesn’t cause symptoms. Your doctor may monitor certain levels during treatment.
† For more information about this side effect, see “Side effect details” below.
‡ Rapamune has a boxed warning for this side effect. This is the most serious warning from the FDA. A boxed warning alerts doctors and patients about drug effects that may be dangerous.

Side effect details

Here are some details on certain side effects this drug may cause. To find out how often side effects occurred in clinical trials, see the prescribing information for Rapamune.

Swelling

Rapamune can cause various side effects that lead to swelling in different parts of the body. These side effects include:

  • fluid retention that causes peripheral edema (swelling of your ankles, feet, or hands)
  • lymphedema (blockage in lymph vessels that causes a buildup of fluid, often leading to swelling in one arm or leg)
  • pleural or pericardial effusion (buildup of fluid around your heart and lungs that may cause shortness of breath)
  • ascites (buildup of fluid in your abdomen that causes swelling in that area)
  • angioedema (swelling of your face, eyelids, lips, tongue, throat, hands, or feet)

What you can do

If you have swelling in any part of your body, mild shortness of breath, or slight trouble breathing while taking Rapamune, talk with your doctor. They may want to order tests to check what’s causing your symptoms. If needed, your doctor may prescribe medication to treat the swelling.

If you have swelling in your throat, shortness of breath, or trouble breathing that feels life threatening, call 911 or your local emergency number right away.

Risk due to a weakened immune system

Rapamune has a boxed warning about risk due to a weakened immune system (your body’s defense against infection and disease). A boxed warning is the most serious warning from the Food and Drug Administration (FDA). The warning alerts doctors and patients about drug effects that may be dangerous.

Risk of infection

Rapamune weakens your immune system. This can increase your risk of bacterial, fungal, or viral infections. Some of these infections may be serious or life threatening. Symptoms of infections may include fever, cough, and sore throat. They may also include skin rash or sores, muscle aches, and swollen glands. Other possible symptoms include pain or burning sensation when urinating, confusion, or fast heartbeat.

Examples of serious infections or conditions that have occurred in people taking Rapamune included:

Risk of cancer

A weakened immune system can also increase your risk of developing cancer, especially lymphoma and skin cancer. In clinical trials, cancer occurred rarely in people who took Rapamune.

Symptoms of cancer can include:

  • changes in your skin, such as new or changing moles, patches, or growths
  • skin sores that don’t heal
  • losing weight without meaning to
  • swollen lymph nodes, for example in your neck, armpits, or groin
  • unusual lumps, bumps, or swellings that don’t go away

What you can do

To help prevent infections while taking Rapamune it may help to:

  • wash your hands often with soap, especially before eating
  • stay away from people who are sick
  • avoid crowds
  • avoid sharing personal items such as towels, face cloths, and lipsticks
  • eat a balanced diet, including plenty of fruit and vegetables
  • get plenty of sleep

While taking Rapamune, you can help minimize your risk of cancer by not smoking and maintaining a weight that’s healthy for you. You can also protect your skin from sunlight with clothing or sunscreen with a high SPF. Additionally, you can minimize your risk by not using tanning beds.

If you have symptoms of cancer while taking Rapamune, see your doctor right away.

When to talk with your doctor

Talk with your doctor about any infections you have had or currently have, before you start taking Rapamune. Your doctor may prescribe medication to help prevent infections while you take Rapamune.

Also, before taking Rapamune, be sure to tell your doctor if you or a close family member have or had cancer. (Some cancers run in families.) Your doctor can tell you more about your personal risk of cancer with Rapamune.

If you feel unwell or have any symptoms of infection or cancer while taking Rapamune, see your doctor right away. If you have an infection, your doctor may prescribe medication to treat it. They may also lower your dosage of Rapamune.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Rapamune.

Symptoms of a mild allergic reaction can include:

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing

Call your doctor right away if you have an allergic reaction to Rapamune, as the reaction could become severe. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

As with all medications, the cost of Rapamune can vary. One factor that can affect the cost is the dosage your doctor prescribes. Rapamune tablets come in strengths of 0.5 milligrams (mg), 1 mg, and 2 mg. Higher strength tablets tend to cost more. For example, the 1-mg price will likely be higher in cost than the 0.5-mg price. To find current prices for Rapamune tablets in your area, check out GoodRx.com. You can also find prices for Rapamune oral solution.


The cost you find on GoodRx.com is what you may pay without insurance. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Keep in mind that you may be able to get a 90-day supply of Rapamune. If approved by your insurance company, getting a 90-day supply of the drug could reduce your number of trips to the pharmacy and help lower the cost. If you’re interested in this option, check with your doctor, pharmacist, or insurance company.

Before approving coverage for Rapamune, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide if the drug will be covered.

If you’re not sure whether you’ll need to get prior authorization for Rapamune, contact your insurance company.

Financial and insurance assistance

If you need financial support to pay for Rapamune, or if you need help understanding your insurance coverage, help is available.

Pfizer, the manufacturer of Rapamune, offers a program called RxPathways that provides copayment help and other cost-saving resources. For more information and to find out if you’re eligible for support, call 844-989-7284 or visit the program website.

To learn more about saving money on prescriptions, see this article.

Mail-order pharmacies

Rapamune may be available through a mail-order pharmacy. Using this service may help lower the drug’s cost and allow you to get your medication without leaving home.

If recommended by your doctor, you may be able to receive a 90-day supply of Rapamune, so there’s less concern about running out of the medication. If you’re interested in this option, check with your doctor, pharmacist, or insurance company. Some Medicare plans may help cover the cost of mail-order medications.

If you don’t have insurance, you can ask your doctor or pharmacist about online pharmacy options.

Generic version

Rapamune is available in a generic form called sirolimus. A generic drug is an exact copy of the active drug in a brand-name medication. The generic is considered to be as safe and effective as the original drug. And generics tend to cost less than brand-name drugs. To find out how the cost of sirolimus compares with the cost of Rapamune, visit GoodRx.com.

If your doctor has prescribed Rapamune and you’re interested in using sirolimus instead, talk with your doctor. They may have a preference for one version or the other. You’ll also need to check your insurance plan, as it may only cover one or the other.

The Rapamune dosage your doctor prescribes will depend on several factors. These include:

  • the type and severity of the condition you’re taking Rapamune to treat
  • your age and body weight
  • your liver function
  • the form of Rapamune you take
  • other medical conditions you may have
  • other medications you take

While you take Rapamune, your doctor will usually order blood tests to check the level of Rapamune in your blood. Based on the results, they’ll adjust your dosage over time to reach the level that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Rapamune is taken by mouth. It comes in the following forms and strengths:

  • oral tablet, available in three strengths: 0.5 milligrams (mg), 1 mg, and 2 mg
  • oral solution, available in one strength: 1 mg per milliliter (mg/mL)

Dosage for helping prevent kidney transplant rejection

When you start taking Rapamune to help prevent kidney transplant rejection, you’ll first be prescribed a loading dose. A loading dose is a high dose of medication that’s given at the beginning of your treatment. This allows the drug to start working quickly.

After this, you’ll be prescribed a maintenance dose. This is a lower dose that helps maintain a consistent level of a medication in your body over time.

The typical Rapamune dosage for adults is described below. The dosage your doctor prescribes depends on your risk of transplant rejection.*

If you have a low to moderate risk of rejection: The typical loading dose is one dose of 6 mg. After this, the typical maintenance dosage is 2 mg once per day.

If you have a high risk of rejection: The typical loading dose is one dose of up to 15 mg. After this, the typical maintenance dosage is 5 mg once per day.

* Black people and people who have high levels of certain antibodies (proteins in the immune system) may have a high risk of transplant rejection. You may also be at high risk if your body has rejected a donor kidney in the past.

Dosage for treating lymphangioleiomyomatosis (LAM)

The typical starting dosage of Rapamune for treating lymphangioleiomyomatosis (LAM) is 2 mg once per day.

To make sure your body maintains a certain level of Rapamune, your doctor will monitor the level of the drug in your blood. They’ll make dose adjustments as needed until your appropriate maintenance dose is reached. This is a lower dose that helps maintain a consistent level of a medication in your body over time.

Once you reach your maintenance dose, your doctor will continue to monitor the level of Rapamune in your blood. This helps make sure the drug works as intended.

Children’s dosage

Rapamune is used to help prevent kidney transplant rejection in children ages 13 years and older with a low to moderate risk of rejection.

When your child starts to take Rapamune for this purpose, they’ll first be prescribed a loading dose. A loading dose is a high dose of medication that’s given at the beginning of treatment. This allows the drug to start working quickly.After this they’ll be prescribed a maintenance dose. This is a lower dose that helps maintain a consistent level of a medication in your body over time.

The typical Rapamune dosage for children ages 13 years and older depends on their body weight. (Kilograms and pounds are abbreviated as kg and lb below. One kg equals about 2.2 lb.)

For children weighing less than 40 kg (about 88 lb): The dosage is calculated using your child’s body surface area (BSA)*. The typical loading dose is one dose of 3 mg/m2. After this, the typical maintenance dosage is 1 mg/m2 once per day. Your child’s doctor will adjust the dosage as your child grows.

For children weighing 40 kg (about 88 lb) or more: The typical loading dose is one dose of up to 6 mg. After this, the typical maintenance dosage is 2 mg once per day.

* Your child’s doctor will calculate their BSA using a formula that includes your child’s height in centimeters and weight in kilograms. BSA is measured in meters squared (m2).

What if I miss a dose?

If you miss a dose of Rapamune, take it as soon as possible. However, if it’s nearly time for your next dose, skip the missed dose and take your next dose as scheduled. You should not take two doses of Rapamune together to make up for a missed dose. And you should not take extra doses throughout the day to make up for missed doses.

Keep in mind that if you also take cyclosporine (Gengraf, Neoral, Sandimmune), you should not take Rapamune at the same time. You also should not take a missed dose of Rapamune within 4 hours of your next dose of cyclosporine. To learn more, see the “Rapamune interactions” section below.

If you’re unsure whether or when you should take a missed dose, talk with your doctor or pharmacist.

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm or using a timer. You could also download a reminder app on your phone.

Will I need to use this drug long term?

Rapamune is meant to be used as a long-term treatment. If you and your doctor determine that Rapamune is safe and effective for you, you’ll likely take it long term.

The Food and Drug Administration (FDA) approves prescription drugs such as Rapamune to treat certain conditions. Rapamune may also be used off-label for other conditions. Off-label drug use is when an FDA-approved drug is prescribed for a purpose other than what it’s approved for.

Rapamune for preventing kidney transplant rejection

Rapamune is FDA-approved to help prevent kidney transplant rejection in adults and certain children ages 13 years and older. (With rejection, your immune system attacks the transplanted kidney.)

For this purpose, Rapamune is used with corticosteroids such as prednisone (Rayos) and an immunosuppressant medication called cyclosporine (Gengraf, Neoral, Sandimmune).

If you have a low to moderate risk of rejection, your doctor will likely recommend that you stop taking cyclosporine 2 to 4 months after your transplant. If you have a high risk of rejection,* your doctor will likely recommend that you continue to take cyclosporine for the first year after your transplant.

* Black people and people who have high levels of certain antibodies (proteins in the immune system) may have a high risk of transplant rejection. You may also be at high risk if your body has rejected a donor kidney in the past.

Limitations of use

Rapamune has some limitations of use. For certain people taking Rapamune, it’s not known if it’s safe for them to stop taking cyclosporine. These groups include:

  • Black people
  • those who have certain forms of kidney rejection (Banff Grade 3 acute rejection or vascular rejection)
  • people dependent on dialysis (a treatment that removes waste and excess water, and sometimes drugs, from your blood)
  • people with a blood creatinine level higher than 4.5 milligrams per deciliter (mg/dL), which could be a sign of kidney problems
  • people who have received multiorgan transplants (more than one organ transplanted at a time) or secondary transplants (a type of stem cell transplant)
  • those with high levels of panel-reactive antibodies (certain disease-fighting proteins)

If you’re in one of these groups, your doctor will determine whether it’s safe for you to stop taking cyclosporine during your Rapamune treatment.

It’s not known if Rapamune is safe or effective for helping prevent kidney transplant rejection in the following people and situations:

  • in children younger than age 13 years
  • in children younger than age 18 years who have a high risk of rejection
  • in people who have previously been taking a type of medication called a calcineurin inhibitor, such as tacrolimus (Prograf, Astagraf XL) to help prevent kidney transplant rejection
  • if cyclosporine wasn’t used initially after the transplant
  • if used with corticosteroids and cyclosporine for more than 1 year in people with a high risk of rejection

Kidney transplant explained

When you receive a kidney transplant, your doctor will make sure that the donor kidney you receive is as close a match for you as possible. This usually involves matching your blood type, body size, and tissue type with the donor.

However, even if the donor kidney is a close match for you, your immune system may still recognize the transplanted kidney as foreign tissue. This can lead to your immune system attacking the transplanted kidney, causing rejection. As a result, the transplant can sometimes fail.

Rejection of a kidney transplant may cause symptoms such as:

  • fever
  • flu-like symptoms, such as aches, headache and chills
  • severe fatigue
  • producing less urine than usual
  • swelling of your ankles
  • sudden weight gain
  • pain or tenderness in the area around the transplanted kidney

Rapamune helps prevent rejection by weakening your immune system. If your immune system is not as strong as usual, it’s less likely to attack the transplanted kidney.*

* Rapamune has a boxed warning for risk due to a weakened immune system. This is the most serious warning from the FDA. A boxed warning alerts doctors and patients about drug effects that may be dangerous. To learn more, see “Side effect details” in the “Rapamune side effects” section above.

Effectiveness for preventing kidney transplant rejection

Rapamune has been found effective for helping prevent the rejection of kidney transplants. For information about how this medication performed in clinical trials, see Rapamune’s prescribing information.

Rapamune for treating lymphangioleiomyomatosis

Rapamune is FDA-approved to treat lymphangioleiomyomatosis (LAM) in adults.

LAM is a rare condition that mainly affects females.* With this condition, abnormal cells called LAM cells grow and spread throughout your lungs. The LAM cells cause cysts and blockages in your lungs that lead to breathing difficulties.

The LAM cells may also grow in your kidneys and lymphatic system, causing cysts and tumors that aren’t cancerous. The LAM cells’ growth can also cause pneumothorax (collapsed lung) and fluid buildup around your lungs or in your abdomen.

LAM is a progressive condition, which means it typically worsens over time.

Symptoms of LAM can include:

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

Effectiveness for treating lymphangioleiomyomatosis

Rapamune is an effective treatment for LAM. The drug slows down the progression of the disease and can delay worsening of the lung function. Rapamune can also reduce fluid buildup around your lungs and shrink noncancerous growths in your kidneys and lymphatic system. The medication has also been found to improve quality of life in people with LAM.

For information about how this medication performed in clinical trials, see Rapamune’s prescribing information.

Rapamune is recommended as a treatment for LAM in guidelines from the American Thoracic Society.

Rapamune and children

Rapamune is FDA-approved to help prevent kidney transplant rejection in children ages 13 years and older with low to moderate risk of rejection. It’s not approved for any other uses in children. See “Rapamune for preventing kidney transplant rejection” section above for details.

Here are answers to some frequently asked questions about Rapamune.

Does Rapamune cause long-term side effects?

It can. Many of Rapamune’s mild side effects improve or go away after a few days or weeks. However, some side effects may take longer to ease, even with treatment. Others, such as a weakened immune system* or reduced fertility,† can last as long as you continue taking the drug. They can even continue for a while after you stop treatment.

In addition, you can develop kidney problems or high cholesterol or triglyceride levels with Rapamune. These side effects could last a long time or, in some cases, be permanent. Your doctor can work with you to help manage these side effects.

If you’re concerned about long-term side effects with Rapamune, talk with your doctor.

* Rapamune has a boxed warning for risk due to a weakened immune system. This is the most serious warning from the FDA. A boxed warning alerts doctors and patients about drug effects that may be dangerous. To learn more, see “Side effect details” in the “Rapamune side effects” section above.
† Fertility refers to the ability to become pregnant or make someone become pregnant.

What is rapamycin, and how does it relate to Rapamune?

Rapamycin is another name for sirolimus, which is the active drug in Rapamune.

Can I take Rapamune to prevent other organ transplant rejections?

No, that’s not usually recommended. Rapamune is approved to help prevent the rejection of only kidney transplants.

Rapamune is specifically not recommended to help prevent the rejection of lung or liver transplants. Clinical trials show that Rapamune may increase the risk of complications and, in some cases, death when used in people who have had a lung or liver transplant. In fact, the drug has a boxed warning about these risks. A boxed warning is the most serious warning from the Food and Drug Administration (FDA).

Rapamune may sometimes be used to help prevent the rejection of heart transplants, but this is an off-label use of the drug. Off-label use refers to prescribing a drug for a use that the FDA hasn’t approved.

If you’re interested in taking Rapamune to help prevent the rejection of other organ transplants, talk with your doctor.

If you’ve been prescribed Rapamune to help prevent a kidney transplant rejection, you’ll typically take it in combination with other drugs. This includes a corticosteroid such as prednisone (Rayos). You’ll also likely take Rapamune with an immunosuppressant medication called cyclosporine (Gengraf, Neoral, Sandimmune).

If you have a low to moderate risk of rejection, your doctor will likely recommend stopping cyclosporine treatment 2 to 4 months after your transplant. If you have a high risk of rejection,* your doctor will likely recommend continuing cyclosporine treatment for the first year after your transplant.

If you’ve been prescribed Rapamune for the treatment of lymphangioleiomyomatosis (LAM), it is typically not used in combination with other medications.

* Black people and people who have high levels of certain antibodies (proteins in the immune system) may have a high risk of transplant rejection. You may also be at high risk if your body has rejected a donor kidney in the past.

Rapamune isn’t known to interact with alcohol. However, if you have certain side effects with Rapamune, drinking alcohol may make them worse. These side effects include diarrhea, nausea, and headache.

In addition, regularly consuming large amounts of alcohol can cause liver problems. It can also weaken the immune system. Both these factors may increase the risk of side effects with Rapamune.

If you drink alcohol, talk with your doctor about how much, if any, is safe to drink while you take Rapamune.

Rapamune can interact with several other medications. It can also interact with certain supplements and foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Rapamune and other medications

Below is a list of medications that can interact with Rapamune. This list does not contain all drugs that may interact with Rapamune.

Before taking Rapamune, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

Examples of types of drugs that can interact with Rapamune include:

  • ACE inhibitors. Angiotensin-converting enzyme (ACE) inhibitors are used to treat high blood pressure and heart failure. Taking Rapamune with an ACE inhibitor can increase your risk of angioedema (swelling of your face, eyelids, lips, tongue, throat, hands, or feet). Examples of these drugs include:
    • captopril
    • ramipril (Altace)
  • Calcineurin inhibitors. Calcineurin inhibitors are immunosuppressant medications used to help prevent transplant rejection. Taking Rapamune with one of these drugs can increase the risk of certain blood clotting problems that are side effects of these drugs. Examples of calcineurin inhibitors include:
    • tacrolimus (Prograf)
  • Certain antibiotics that can increase the risk of side effects. Antibiotics are used to help prevent and treat bacterial infections. Taking certain antibiotics with Rapamune can increase your risk of side effects from Rapamune. Examples of these drugs include:
    • amikacin
    • gentamicin
    • tobramycin (Bethkis)
    • clarithromycin
    • erythromycin (Eryc, Ery-Tab, EryPed, Erythrocin)
  • Certain antibiotics that can make Rapamune less effective than usual. Taking certain other antibiotics with Rapamune can make Rapamune less effective than usual. Examples of these drugs include:
    • rifampin (Rifadin, Rimactane)
    • rifabutin (Mycobutin)
    • rifapentine (Priftin)
  • Certain antifungals. Antifungals are used to help prevent and treat fungal infections. Taking certain antifungals with Rapamune can increase your risk of side effects from Rapamune. Examples of these drugs include:
    • amphotericin B (Abelcet, AmBisome)
    • itraconazole (Sporanox, Tolsura)
    • voriconazole (Vfend)
  • Certain seizure medications. Taking certain seizure medications with Rapamune can make Rapamune less effective than usual. Examples of these drugs include:
  • Certain calcium-channel blockers. Calcium-channel blockers are medications used to treat high blood pressure and angina. Taking certain calcium-channel blockers with Rapamune could increase your risk of side effects from Rapamune. Examples of these drugs include:
    • diltiazem (Cartia XT, Cardizem, Tiazac, Taztia XT)
    • nicardipine
  • Certain HIV drugs. Taking certain HIV drugs with Rapamune could increase your risk of side effects from Rapamune. Examples of these drugs include:
    • ritonavir (Norvir)
    • cobicistat (Tybost)
  • Statins and fibrates. Statins and fibrates are medications used to lower cholesterol or triglyceride levels. Taking a statin or fibrate with Rapamune may increase your risk of muscle damage that’s related to statins or fibrates. Examples of these drugs include:
    • fluvastatin (Lescol XL)
  • Other medications. Taking certain other drugs with Rapamune could increase your risk of side effects from Rapamune. Examples of these drugs include:
    • bromocriptine (Parlodel, Cycloset)
    • cimetidine (Tagamet HB)
    • danazol

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

* Cyclosporine is used in combination with Rapamune to help prevent kidney transplant rejection. Due to the possible interaction between the drugs, it’s recommended that you take your Rapamune dose 4 hours after your cyclosporine dose. For more information, see the “How to take Rapamune” section below.

Rapamune and herbs and supplements

Taking the herbal remedy St. John’s wort with Rapamune can make Rapamune less effective than usual. Due to this interaction, your doctor will likely recommend that you do not take St. John’s wort with Rapamune.

There aren’t any other herbs or supplements that have been specifically reported to interact with Rapamune. However, you should still check with your doctor or pharmacist before using any of these products while taking Rapamune.

Rapamune and foods

You should not eat grapefruit or drink grapefruit juice while taking Rapamune. Grapefruit can raise the level of Rapamune in your blood, which can increase the risk of side effects from the drug.

There aren’t any other foods that have been specifically reported to interact with Rapamune.

If you have any questions about eating certain foods with Rapamune, talk with your doctor.

Rapamune and vaccines

Rapamune weakens your immune system (your body’s defense against infection). The drug can affect the way your body responds to vaccines. Before you start taking Rapamune, it is recommended that you get up to date with any recommended vaccines. Talk with your doctor about this.

Keep in mind that you should not get live vaccines while you take Rapamune. Live vaccines contain a live but weakened version of the bacteria or virus they’re meant to protect you from. If your immune system is healthy, live vaccines shouldn’t cause infection. But if your immune system isn’t as strong as usual, there’s a risk that a live vaccine could cause an infection. (Rapamune works by weakening your immune system.)

Examples of live vaccines include the:

Non-live (inactivated) vaccines do not contain a live version of the infection they’re meant to protect you from. If you get non-live vaccines while you take Rapamune, your immune system might not respond to them as well as usual. So these vaccines might be less effective at protecting you from infection.

Examples of inactivated vaccines include:

Be sure to take Rapamune according to the instructions your doctor gives you.

If your doctor prescribes Rapamune tablets, you should swallow them whole.

If your doctor prescribes Rapamune oral solution, you’ll dilute the drug in water or orange juice before drinking the mixture. For details, see Rapamune’s instructions for use.

When to take

You’ll usually take Rapamune once per day. You can take your dose at any time of day that works for you. However, try to take it at the same time each day.

If you take Rapamune with cyclosporine (Gengraf, Neoral, Sandimmune), it’s recommended that you take Rapamune at least 4 hours after you take cyclosporine. When Rapamune and cyclosporine are taken at the same time, there’s a risk of a drug interaction involving blood clotting problems. Taking Rapamune at least 4 hours after you take cyclosporine helps prevent this interaction. To learn more, see the “Rapamune interactions” section above.

To help make sure you don’t miss a dose, try using a medication reminder. This can include setting an alarm or using a timer. You could also download a reminder app on your phone.

Accessible labels and containers

If your prescription label is hard to read, talk with your doctor or pharmacist. Some pharmacies offer labels that have large print, braille, or a code you scan with a smartphone to convert text to speech. If your local pharmacy doesn’t have these options, your doctor or pharmacist may be able to direct you to one that does.

If you have trouble opening medication bottles, ask your pharmacist if they can put Rapamune in an easy-open container. They may also be able to recommend tools that can make it simpler to open lids.

Taking Rapamune with food

You can take Rapamune either with or without food. However, you should always take it the same way, either with food or without food. This will help keep the level of Rapamune in your blood stable. Changing the way you take Rapamune can change the level of medication that reaches your blood.

You should not take Rapamune with grapefruit or grapefruit juice. Grapefruit can increase the level of Rapamune in your blood, which can increase the risk of side effects from the drug.

Can Rapamune be crushed, split, or chewed?

You should not crush, split, or chew Rapamune tablets. If you have trouble swallowing the tablets whole, talk with your doctor. They may prescribe Rapamune oral solution instead.

The Food and Drug Administration (FDA) has approved Rapamune to help prevent the rejection of kidney transplants. The drug is also approved to treat a rare disease called lymphangioleiomyomatosis (LAM).

What happens with a kidney transplant

When you have a kidney transplant, it’s possible that your body will reject the transplanted kidney. Rejection occurs when your immune system recognizes the transplanted kidney as foreign tissue and attacks it.

Your immune system is your body’s defense against infection and disease. It’s made up of several parts, including organs, tissues, cells, and proteins. White blood cells are a key part of your immune system.

When your immune system recognizes foreign tissue in your body, it sends various messages. These messages cause your white blood cells to multiply and attack the foreign tissue. Normally this is a good thing, as it helps your body fight off an infection. However, this can also lead to the rejection of a kidney transplant.

What happens with LAM

With LAM, you have abnormal cells that grow and spread in certain parts of your body. These cells are called LAM cells.

LAM cells have a genetic mutation (abnormal change in a gene). This mutation makes the LAM cells grow, multiply, and spread in an uncontrolled way.

LAM cells mainly grow and spread in your lungs, causing breathing problems that get worse over time. The cells can also grow and spread in your kidneys and lymphatic system. This can cause symptoms such as bleeding in your abdomen, swelling in your lymphatic system, or blood in your urine.

What Rapamune does

Rapamune is a type of drug called a mammalian target of rapamycin (mTOR) inhibitor. mTOR is an enzyme (a type of protein) that helps cells grow, multiply, and spread. Rapamune works by blocking the action of mTOR.

When you receive a kidney transplant, your immune system sends messages that activate (switch on) mTOR in white blood cells. mTOR helps these cells multiply and attack the transplanted kidney. Rapamune blocks (switches off) the action of mTOR in white blood cells. This stops the cells from attacking the transplanted kidney and helps prevent your body from rejecting the kidney.

If you have LAM, the genetic mutation activates mTOR in LAM cells. mTOR helps the LAM cells grow and multiply in your lungs, kidneys, and lymph vessels. Rapamune blocks the action of mTOR in the LAM cells. This stops LAM cells from growing and spreading.

How long does it take to work?

Rapamune begins working soon after you start taking it, although you may not notice it working.

If you’ve had a kidney transplant, Rapamune helps stop your body from rejecting the transplanted kidney. If you have LAM, the drug helps stop your condition from getting worse. In some cases, Rapamune may also ease breathing problems.

Your doctor may order various tests to make sure Rapamune is working for you.

Rapamune is not safe to take during pregnancy. The drug has not been studied in pregnancy. However, animal trials and the way the drug works suggest that Rapamune is likely to harm a developing fetus.

If you could become pregnant, your doctor will want you to have a pregnancy test before you start taking Rapamune. This is to confirm that you’re not pregnant.

If you’re pregnant or plan to become pregnant, talk with your doctor about other treatment options.

Rapamune and fertility

Rapamune may reduce fertility in males* and females* taking the drug. Fertility refers to the ability to become pregnant or make someone become pregnant. Fertility problems usually end when you stop taking Rapamune. If you’re concerned about Rapamune and its potential impact on your fertility, talk with your doctor.

* Sex and gender exist on spectrums. Use of the terms “male” and “female” in this article refer to sex assigned at birth.

Rapamune is not safe to take during pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re using Rapamune.

For more information about taking Rapamune during pregnancy, see the “Rapamune and pregnancy” section above.

For females using Rapamune

If you’re female,* you should start using birth control before you start taking Rapamune. You should continue to use birth control while taking Rapamune and for 12 weeks after your last dose.

For males using Rapamune

The manufacturer of Rapamune has not given birth control recommendations for males* who take the drug. If you’re sexually active and your partner can become pregnant, talk with your doctor about your birth control needs while taking this drug.

* Sex and gender exist on spectrums. Use of the terms “male” and “female” in this article refer to sex assigned at birth.

It’s not known if Rapamune passes into breast milk. However, if the drug does pass into breast milk, it could cause serious side effects in a child who’s breastfed.

If you’re breastfeeding or plan to breastfeed, talk with your doctor about the best way to feed your child while you take Rapamune.

This drug comes with several warnings and precautions.

FDA warnings

This drug has boxed warnings. These are the most serious warnings from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

  • Risk due to a weakened immune system. Rapamune weakens your immune system (your body’s defense against infection and disease). By doing this, the drug can increase your risk of infections, including those that may be serious or life threatening. Your risk of developing cancer, especially lymphoma and skin cancer, may also increase. To learn more about these risks, see “Side effect details” in the “Rapamune side effects” section above.
  • Risk following a lung or liver transplant. Rapamune is not recommended to help prevent the rejection of lung or liver transplants. (Rejection occurs when your immune system attacks a transplanted organ.) Clinical trials show that in people who have received a lung or liver transplant, Rapamune may increase the risk of complications and, in some cases, death. To learn more about this boxed warning, see the “Common questions about Rapamune” section above.

Other precautions

Before taking Rapamune, talk with your doctor about your health history. Rapamune may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

  • Allergic reaction. If you’ve had an allergic reaction to Rapamune or any of its ingredients, your doctor will likely not prescribe Rapamune. Ask your doctor what other medications may be better options for you.
  • Liver problems. If you have liver problems, such as hepatitis, Rapamune can build up in your blood. This can increase the risk of side effects from Rapamune. Your doctor will likely prescribe a dosage of Rapamune that’s lower than usual.
  • High cholesterol or triglyceride levels. If you have high levels of cholesterol or other fats called triglycerides in your blood, Rapamune may increase these levels further. Your doctor will monitor your levels during your treatment. If they become too high, your doctor may adjust your existing cholesterol or triglyceride treatment or prescribe new medication to help lower them. However, your cholesterol or triglyceride levels may remain high even with treatment.
  • Pregnancy. Rapamune is not safe to use during pregnancy. For more information, see the “Rapamune and pregnancy” section above.
  • Breastfeeding. It’s not known if it’s safe to breastfeed while taking Rapamune. For more information, see the “Rapamune and breastfeeding” section above.

Note: For more information about the potential negative effects of Rapamune, see the “Rapamune side effects” section above.

Do not use more Rapamune than your doctor recommends. For some drugs, doing so may lead to unwanted side effects or overdose.

What to do in case you take too much Rapamune

If you think you’ve taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use its online tool. But if your symptoms are severe, call 911 or your local emergency number, or go to the nearest emergency room right away.

When you get Rapamune from the pharmacy, the pharmacist will add an expiration date to the label on the packaging. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee that the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk with your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good to use can depend on many factors, including how and where you store the medication.

You should store Rapamune tablets at room temperature from 68°F to 77°F (20°C to 25°C) in a tightly sealed container away from light. Avoid storing this medication in areas where it could get damp or wet, such as bathrooms.

You should store bottles of Rapamune oral solution in a refrigerator from 36°F to 46°F (2°C to 8°C). Once opened, the oral solution is good for 1 month. If any medication remains in the bottle 1 month after opening, you should dispose of this safely. If needed, you can store the bottle at room temperature for up to 15 days.

Rapamune oral solution comes with a disposable oral syringe that’s used to measure the prescribed dose. The measured dose can be kept in the oral syringe with the cap on for up to 24 hours, either in a refrigerator or at room temperature. However, after the dose has been diluted, you should use it right away. (To learn more, see the “How to take Rapamune” section above.)

Disposal

If you no longer need to take Rapamune and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

This article provides several useful tips on medication disposal. You can also ask your pharmacist for information about how to dispose of your medication.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.