Sirolimus, also known as Rapamycin, is a medication that is from the class of drugs known as Immunosuppressants. It is administered to patients who have had a kidney transplant to prevent their body from rejecting the transplanted kidney. It is used in conjunction with other medications. It is also used in treatment for certain types of tumors, lung disease, and psoriasis. In its compound form, it is used to coat coronary stents.
Sirolimus is sold under the name, Rapamune by Pfizer since 1999.
Sirolimus is a bacterium, that was first isolated by Surendra Nath Sehgal in 1972 while collecting samples of a certain bacteria on the Easter Island and thus the original compound named Rapamycin after the original inhabitants of the island, the Rapa-nui. While initially developed as an anti-fungal agent, it was discovered that it had potent immunosuppressive and antiproliferative properties and later on approved for use in 1999 by the FDA. Then in May 2015, FDA approved Sirolimus for the treatment of a rare lung disorder called Lymphangioleiomyomatosis.
Sirolimus comes as a tablet and a solution to be taken orally. It is usually taken once a day. The dosage is adjusted by the doctor based on the body response once every week or two. This medicine is to be taken exactly as prescribed by the doctor. It is available as an oral solution (1 mg/ml) and tablets (0.5, 1 and 2 mg).
In kidney transplants, to prevent organ rejection, the first dose of 6 mg given soon after the transplant. The doctor will change the dose until the patient’s blood has enough Sirolimus.
In the treatment of S-LAM, a dose of 2 mg is taken daily and after the doctor has tested for effect, the dosage is adjusted in order to achieve the desired levels of Sirolimus in the body.
The cost of Sirolimus
The price of Sirolimus varies vastly by the country and the drugmaker. According to a leading pharmacy, Sirolimus oral solution (1 mg/mL) costs $1,336 for a supply of 60 milliliters in the USA, whereas the price of 1mg tablet varies from 8 USD to 10 USD. In India the prices are significantly lower, starting at 0.7cent to 7 USD per tablet of 1mg.
How does it work?
The body rejects a new organ when the immune system attacks the new organ thinking of it as an invader. Sirolimus works through the weakening of the human immune system, which, in turn, helps the human body, accept the new organ as its own. It does this by attaching itself to a protein inside cells to make a 'complex', which it uses to block a protein called mTOR. mTOR regulates cell growth and proliferation and in the multiplication of white blood cells that attack the newly transplanted organ as an invader. The use of sirolimus reduces the number of white blood cells the body is producing to attack the organ, thus reducing the rejection and increasing chances of acceptance.
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Brands and manufacturers:
Brands: Rapamune, Gd-sirolimus,
Manufacturers: Pfizer, Wyeth, Cardinal health, Genmed A, Amneal, Greenstone LLC and American health packaging
India : Biocon, Zydus, Panacea biotech
Cardinal Health, Hangzhou Zhongmei Huadong Pharmaceutical Co. Ltd., Lake Erie Medical and Surgical Supply,Patheon Inc,., Poli Industria Chimica SPA, Wyeth Pharmaceuticals