Evermil 5mg (Everolimus)

DESCRIPTION

Evermil 5mg is a derivative of Rapamycin (sirolimus) and works similarly to Rapamycin as an mTOR (mammalian target of rapamycin) inhibitor.
It is normally used as an immunosuppressant to prevent rejection of organ transplants.
In a similar fashion to other mTOR inhibitors Everolimus' effect is solely on the mTORC1 protein and not on the mTORC2 protein.

INDICATION

Evermil 5mg tablets are mainly indicated for the treatment of Renal carcinoma.

Evermil 5mg tablets are mainly indicated for the treatment of Breast carcinoma.

Evermil 5mg tablets are mainly indicated for the treatment of Brain carcinoma.

Evermil 5mg is also used in various advanced stage cancer in stomach, intestines or pancreas.

MECHANISM OF ACTION

Everolimus is an mTOR prohibitor, joints at high compatibility to FK506 binding protein 12, via producing drug complex whichinhibits the specific of mTOR.

This inhibition decreases the activity of effectors downstream, that may cause blockage of cell progression from G1 into S phase, subsequently causes cell growth arrest and apoptosis

PHARMACOKINETICS

 ABSORPTION

The high plasma concentration time of Everolimus is 1 to 2 hours.
The effect of food with Evermil 5mg that with heavy meal: Reduction of systemic exposure to Evermil 5mg, and the high blood plasma concentration by 54%.

DISTRIBUTION

Evermil 5mg human plasma protein bound with the range of 74%.80 ml/kg

METABOLISM

The metabolism of Everolimus is occurred in liver, which is a substrate of CYP3A4.
The metabolites of Everolimus;
Three monohydroxylated metabolite,
Two hydrolytic rings opened products, &
Phosphatidylcholine conjugate of Everolimus.

EXCRETION

The major route of elimination;
5% in urine; the parent compound has been detected in urine or feces.
The half-life period of Everolimus is relatively 30 hours

DOSAGE MANAGEMENT

In breast cancer, renal cell cancer, pancreatic cancer, Neuro endocrine cancer:
The prescribed dosage is 10mg should be taken as a single dose.
In Brain or intracranial cancer:
The prescribed dosage of Evermil  is 4.5mg/m2 orally as a single dose.
In pediatric:
The usual pediatric dosage of Evermil in brain or intracranial tumor is 4.5mg/m2 should be taken orally as a single dose.
Evermil tablets should be administered with or without food.

PRECAUTIONS

Lymphomas: Increased exposure of skin cancers, patient may protect from UV light
Serious infections: Patients receiving Evermil 5mg have high risk of acquiring various infections related to bacteria, virus, and fungi.
Anti-microbial agents are preferred for the suspected patients.
Hepatic artery thrombosis: In liver transplant patients, Evermil 5mg therapy should not be recommended.
Nephrotoxicity: Renal function should be monitored frequently; caution should be taken while using Evermil 5mg in renal impaired patients.
Angioedema: This may have occurred in the patients receiving concomitantly Evermil 5mg with Angiotensin converting enzyme agents
Hyperlipidemia: Patient getting Evermil 5mg with lipid lowering drugs causes increasing in plasma concentration of these drugs causes hyperlipidemia
Interstitial lung disease: Occurred in Evermil 5mg therapy
Interact with grape juice: Causes increasing blood levels of Everolimus; avoid these concomitants.

SIDE EFFECTS

• Hypersensitivity reactions
  • Lymphomas & other malignancy
  • Serious infections
  • Kidney graft thrombosis
  • Hepatic artery thrombosis
  • Nephrotoxicity
  • Hyperlipemia
  • Angioedema
  • Interstitial lung disease
  • Thrombocytopenia
  • Male infertility
  • Proteinuria
  • New commencement of diabetes.

DRUG INTERACTION

• Evermil 5mg interaction with strong inhibitor of CYP3A4, or P-gp, leads to cause decreasing the efflux of Everolimus and increase the plasma concentration of Everolimus
• Combination of Evermil 5mg with verapamil leads to increasing the plasma concentration of Everolimus.
• Combination of Evermil 5mg with Atorvastatin or pravastatin causes rhabdomyolysis, due to increasing concentration of lipid lowering agents.
• Evermil 5mg combination with strong CYP3A4 inducers, causes increasing the exposure of Everolimus.
• Concomitant use of Evermil 5mg with cyclosporine causes increasing the AUC level of Everolimus frequently.
• Evermil 5mg tablet is interaction with ketoconazole or other CYP3A4 inhibitors causes increasing the plasma concentration and AUC of Everolimus.
• Concomitant use with erythromycin causes increasing in AUC of Everolimus.

 CONTRAINDICATION

Some anaphylactic reaction occurs, if patients are contraindicated to the components present in the Evermil 5mg tablets.

PREGNANCY

Pregnancy category C Evermil 5mg is needed only by the patients after knowing the benefits to the mother outweighs the risk to fetus.

LACTATION

Breast feeding should not be suggested

STORAGE 

Evermil 5mg tablet should be kept at 25°C
Keep the tablet away from moisture, heat and light
Dispense only in original container

OVER DOSAGE

The over dosage of Everolimus is rarely occur, in case of over dosage patient must be provide with supportive measures. The acute toxicity of Everolimus over dosage should be monitored.

MISSED DOSE

If patient failed to take a single dose, patients must consult with medical practitioner and follow the instructions given by them.
Or the missed dose should be avoiding and follow the regular dosing schedule.