Pharmaceutical grade:
Anticancer
Drug form:
5 and 10 mg tablets
Drug combinations:
Everolimus
Mechanism of action of Neorapa:
Selective mTOR inhibitor
Uses of Neorapa:
Treatment of breast cancers that have hormone receptors (so-called HR positive) and are in the stage of metastasis. This drug is also used in the treatment of rare neuroendocrine tumors of pancreatic, intestinal and lung origin.
Use in pregnancy and breastfeeding Neorapa:
Pregnancy:
• Classification of use in pregnancy: D
• Side effects have been observed in animal fertility studies with lower amounts than those used in humans. Based on the mechanism of action, if everolimus is administered to pregnant women, it may cause harm to the fetus. Women of reproductive age should use very effective contraceptive methods during the use of the drug and up to 8 weeks after the end of the treatment.
• Fertility in men: Absence or reversible reduction of sperm may be observed. Everolimus is an anti-proliferative drug and affects rapidly dividing cells such as sex cells, so it can be effective on male fertility. Therefore, consult your doctor regarding the desire to have a child.
• Women’s fertility: Menstrual irregularity, secondary amenorrhea, increased LH hormone and ovulation stimulating hormone have been seen in women using everolimus. Based on these clinical and animal findings, female fertility may be compromised by everolimus administration. Therefore, consult your doctor regarding the desire to have a child.
Lactation: The secretion of this drug in human milk is not known. Since many drugs are secreted in human milk and due to the possibility of serious side effects in infants caused by everolimus, a decision should be made regarding the cessation of breastfeeding or the discontinuation of the drug taking into account the importance of the drug for the mother. Everolimus may be harmful to a nursing baby. Patients should not breastfeed their babies during the treatment and for two weeks after the last dose of the drug. If you are breastfeeding, consult your doctor before taking the medicine.
Regarding the correct way to use this medicine, pay attention to the following points:
1- Take the medicine once a day, at a certain time, with food or on an empty stomach. Swallow the tablet completely with a full glass of water, avoid chewing and crushing it.
2- In case of liver diseases, the doctor may prescribe to start taking the drug with a lower amount (2.5, 5, 7.5 mg per day).
3- If you experience some side effects while taking the medicine, your doctor may order to reduce the dose or stop the treatment temporarily or permanently.
4- If you accidentally consume more than the amount recommended by the doctor, go to the doctor or hospital immediately. In such cases, prompt treatment may be required.
5- If you forget to take the medicine, take the medicine up to 6 hours after the scheduled time. If the time is more than 6 hours, do not take the missed dose and take the next dose at the scheduled time the next day. Do not double the amount of medicine.
6- If you have more questions about how to take medicine, consult your doctor or pharmacist.
Neorapa drug interactions:
Everolimus may affect the performance of some drugs. If you are taking other medicines at the same time as Aver Velimos, the dosage of Aver Velimos or other medicines may be changed by your doctor. If you have recently used or are taking other drugs, consult your doctor. ACE inhibitors The risk of angioedema may increase with the simultaneous use of Orvelimus and ACE inhibitors. Treatment should be monitored.
Antibacterials:
– The plasma concentration of Urvelimus increases when used simultaneously with clarithromycin, telithromycin (avoid simultaneous use)
– The plasma concentration of Urvelimus increases when used simultaneously with erythromycin (decrease of Urvelimus is recommended)
– The plasma concentration of everolimus decreases when used simultaneously with rifampicin, avoid simultaneous use or increase the duration of everolimus)
Antidepressants: the plasma concentration of Everolimus may decrease when taken simultaneously with St John’s Wort, simultaneous use should be avoided.
Antifungals:
– The plasma concentration of everolimus increases when used simultaneously with ketoconazole, simultaneous use should be avoided)
– Plasma concentration of everolimus in simultaneous use with itraconazole, bosaconazole and voriconazole. Antipsychotics: Avoid the simultaneous use of cytotoxic drugs with clozapine due to the increased risk of agranulocytosis.
Antivirals: the plasma concentration of Orvelimus may increase when used simultaneously with Ataranavir, Darutavir, Indinavir, Ritonavir, Saquitavir, and simultaneous use should be avoided).
Calcium channel blockers: the plasma concentration of both Orvelimus and Verapamil when taken together may increase significantly, it is recommended to reduce the amount of Orvelimus.
Cyclosporine: the plasma concentration of Urvelimus increases when used simultaneously with cyclosporine (reduction of Urvelimus is recommended)
Grapefruit: Do not take the medicine with grapefruit at the same time.
Inactivated vaccines: Immunosuppressants may reduce the therapeutic effects of inactivated vaccines.
Active vaccines: Immunosuppressants may increase the toxic side effects of active vaccines.
Neorapa precautions:
Pulmonary toxicity: non-infectious pneumonia is one of the effects of rapamycin derivatives, including urolimus, interstitial lung disease with non-infectious fibrosis has been seen with everolimus, and even fatal results have been reported. Patients with non-specific respiratory signs and symptoms (such as oxygen deficiency, pleural ctfusion and cough with shortness of breath) with radiological changes and in patients whose infection, cancer and other causes have been ruled out by appropriate examinations should be considered. Non-infectious pneumonia may respond to drug discontinuation with or without glucocorticoid therapy. Although cases of death have occurred, a differential diagnosis of opportunistic infections such as pneumocystis gyrus pneumonia should be made, and patients should promptly report any new or worsening respiratory symptoms to their physician.
Infections: Everolimus has immunosuppressive properties and may make patients susceptible to bacterial, fungal, and protozoan viral infections, including infections with opportunistic pathogens. Local and systemic infections including pneumonia, mycobacterial infections, other bacterial infections, viral infections (including hepatitis B virus reactivation) and invasive fungal infections including aspergillosis or candidiasis with Pneumocystis jirovsi (Carini) pneumonia in patients taking everolimus has happened. Some of these infections are severe (such as systemic infection, respiratory failure with media, or fatal). Invasive fungal infections of elephants should be treated before starting treatment with everolimus. Inform the symptoms of infections. If an infection is detected, the appropriate treatment should be interrupted and the medication should be stopped immediately. If invasive fungal infections are detected, the medication should be stopped and appropriate antifungal treatments should be started. Due to the risk of weakening An overactive immune system that can increase the chance of infection.The use of combination drugs that weaken the immune system should be done with caution.
Oral ulcers: Oral ulcers, inflammation of the oral mucosa occurred in patients treated with O Rolimus with a prevalence rate of 44 to 86 percent. In such cases, topical treatments are suggested, but mouthwashes containing alcohol, hydrogen peroxide, bad, or thyme should be avoided because of the aggravation of the condition. Antifungal medications should be avoided unless a fungal infection has been diagnosed.
Renal effects: Increased serum creatinine levels have been reported. Cases of renal failure (including acute renal failure), which in some cases have been fatal, have been observed. In case of simultaneous use of Urvelimus with cyclosporine, monitor kidney function. It is necessary to check kidney function, especially in patients with risk factors that impair kidney function.Vaccination Avoid vaccination with live vaccines and close contact with people who have received these vaccines.
Lymphoma and other malignancies: Due to suppression of the immune system, the risk of developing lymphoma and other malignancies, especially skin cancer, increases. Therefore, avoid contact with sunlight and ultraviolet rays by wearing protective clothing and using strong sunscreen creams.
Thrombosis of kidney transplant with everolimus, there is a possibility of venous and arterial thrombosis of the kidney, which leads to the loss of the transplant. This effect mostly occurs during the first 30 days after transplantation.
Thrombosis of Kiddie’s artery: Most of the reported cases occur during the first 30 days after transplantation, which in most cases lead to the loss of the graft and death, so everolimus should not be used earlier than the first 30 days of transplantation.
Heart transplantation in heart transplant patients who are under immunosuppressive regimens with or without induction therapy. Increased mortality, often associated with serious infection, has been observed during the first 3 months after heart transplantation. Therefore, everolimus is not recommended for heart transplantation.
Angioedema Everolimus use is associated with angioedema. Concomitant use with other drugs that cause angioedema (such as ACE inhibitors) may increase the risk of angioedema.
Wound healing and fluid accumulation: There is a possibility of impaired wound healing and fluid accumulation in patients treated with O Rolimus. General fluid accumulation including peripheral edema (such as lymphedema) and other types of fluid accumulation locally in the pericardium, lung, and ascites have also been reported, and hyperlipidemia: an increase in the serum level of cholesterol and triglycerides, which requires medical treatment. Rolimus has been observed after starting treatment with him. The risk of hyperlipidemia increases with increasing blood concentrations of Orovelimus. The use of anti-lipid treatment in patients receiving Orvelimus may normalize the lipid level.
Diabetes: Elevated third glucose level is common; The amount of insulin used may be changed with blood sugar-lowering treatments in patients with diabetes. Everolimus increases the risk of new onset diabetes in transplant recipients.
Blood effects: In clinical studies, a decrease in hemoglobin, lymphocytes, neutrophils and platelets has been reported. A complete blood cell count should be done before starting treatment and then at certain intervals after treatment with everolimus. Concomitant use of Orvelimus with cyclosporine may increase the risk of thrombotic thrombotic microangiopathy, thrombocytopenia, purpura, and hemolytic Ormick syndrome.
Galactose intolerance: Avoid using the drug in patients with rare genetic disease of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption, because it may cause diarrhea and malabsorption.
Liver failure: In case of liver disease or any disease that affects the liver, the amount of medicine may need to be changed by the doctor.
Patient monitoring: monitoring of renal function, including measurement of serum creatinine, serum urea nitrogen, protein in urine, fasting blood sugar, complete blood cell count and lipids, is recommended before starting treatment and then periodically, monitoring of renal function, especially in When patients have risk factors that may later cause renal dysfunction, monitoring of fasting blood glucose and lipid profile is recommended before starting treatment and periodically thereafter, in patients receiving everolimus with other are taking drugs that increase blood sugar, frequent monitoring of blood sugar is recommended, examination of patients in terms of proteinuria and signs and symptoms of infection is recommended, monitor the blood concentrations of everolimus and cyclosporine, in the simultaneous use of everolimus and cyclosporine, If HMF-CoA reductase inhibitors or fibrates are prescribed, patients should be monitored for gross rhabdomyolysis and other side effects. The volume of subintimal Raynaud’s cell astrocytoma should be checked three months after the start of treatment and then periodically.
Driving and operating machinery: If you feel unusually tired (fatigue is a very common side effect. Be careful when driving and operating machinery.
Neopara is lactose free; If you do not tolerate some Kandahar, contact your doctor before taking the medicine.
Neorapa contraindications:
Hypersensitivity to everolimus, sirolimus, other rapamycin derivatives or any of the components of this medicine
Allergic reactions to everolimus include anaphylaxis, shortness of breath, flushing, chest pain, and angioedema (such as swelling of the airways or tongue with or without respiratory failure).
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