Cimetidine: May increase the serum concentration of Carvedilol.Cobicistat: May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).Colchicine: P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of Colchicine. Careful attention should be made to clinical signs/symptoms, tissue biopsy findings, and laboratory parameters.When used in combination with cyclosporine, sirolimus trough concentrations should be maintained within the target-range [The above recommended 24 hour trough concentration ranges for sirolimus are based on chromatographic methods. Data (≥ 12 months post-transplant) presented in the following table show the adverse reactions that occurred in at least one of the sirolimus treatment groups with an incidence of ≥ 20%.The safety profile of the tablet did not differ from that of the oral solution formulation [In general, adverse reactions related to the administration of sirolimus were dependent on dose/concentration. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. All patients in this study received the tablet formulation. The concomitant administration of sirolimus and HMG-CoA reductase inhibitors resulted in adverse reactions such as CPK elevations (3%), myalgia (6.7%) and rhabdomyolysis (<1%). Updated Management: Avoid concurrent use of sirolimus with P-glycoprotein (P-gp) inhibitors when possible and alternative agents with lesser interaction potential with sirolimus should be considered. Sirolimus comes as a tablet and a solution (liquid) to take by mouth. Dronedarone may increase the serum concentration of Beta-Blockers. The safety and efficacy of sirolimus as immunosuppressive therapy have not been established in lung transplant patients; therefore, such use is not recommended.Hypersensitivity reactions, including anaphylactic/anaphylactoid reactions, angioedema, exfoliative dermatitis and hypersensitivity vasculitis, have been associated with the administration of sirolimus [see Sirolimus Tablets and Cyclosporine Combination Therapy It is not necessary to modify the sirolimus tablets loading dose [see This was particularly true among patients with existing abnormal urinary protein excretion prior to conversion.In an open-label, randomized, comparative, multicenter study where kidney transplant patients were either converted from tacrolimus to sirolimus 3 to 5 months post-transplant (sirolimus group) or remained on tacrolimus, there was no significant difference in renal function at 2 years post-transplant. The above information should be taken into account when considering conversion from calcineurin inhibitors to sirolimus in stable renal transplant patients due to the lack of evidence showing that renal function improves following conversion, and the finding of a greater increment in urinary protein excretion, and an increased incidence of treatment-emergent nephrotic range proteinuria following conversion to sirolimus. Carvedilol may increase the serum concentration of Digoxin.Dipyridamole: May enhance the bradycardic effect of Beta-Blockers.Disopyramide: May enhance the bradycardic effect of Beta-Blockers. High blood sugar has happened with this medicine (sirolimus tablets). The study population had a mean age of 46 years (range 15 to 71 years), the distribution was 67% male, and the composition by race was: White (78%), Black (11%), Asian (3%), Hispanic (2%), and Other (5%). In addition, more patients in the sirolimus with cyclosporine group had a pretransplantation history of skin carcinoma.Safety was assessed in 224 patients who received at least one dose of sirolimus with cyclosporine [see Management: Consider cyclosporine dose reductions of 10% to 20% in patients initiating or increasing carvedilol.