{"id":53465,"date":"2023-09-20T09:46:40","date_gmt":"2023-09-20T09:46:40","guid":{"rendered":"https:\/\/medsname.com\/rapacan\/"},"modified":"2026-04-30T10:25:11","modified_gmt":"2026-04-30T10:25:11","slug":"rapacan","status":"publish","type":"product","link":"https:\/\/medsbase.com\/ro\/product\/rapacan\/","title":{"rendered":"Rapacan"},"content":{"rendered":"<p><!-- medsbase-tldr-answer --><\/p>\n<div style=\"background:#fff8e1;border-left:4px solid #f5a623;padding:18px 22px;margin:0 0 24px 0;border-radius:4px;\">\n<h3 class=\"wp-block-heading\" style=\"margin:0 0 8px 0;font-size:16px;font-weight:700;\">\u26a1 R\u0103spuns rapid \u2014 Ce este Rapacan?<\/h3>\n<p style=\"margin:0;\"><strong>Rapacan<\/strong> este un comprimat oral de la Biocon care con\u021bine <strong>sirolimus 1 mg<\/strong> \u2014 un <strong>inhibitor mTOR (\u021binta mamifer\u0103 a rapamicinului)<\/strong> izolat ini\u021bial din <em>Streptomyces hygroscopicus<\/em> pe Insula Pa\u0219telui (rapa nui \u2014 de unde rapamicina). Immunosupresie de \u00eentre\u021binere de prim\u0103 linie la <strong>transplant renal<\/strong> (cu inhibitor calcineurin\u0103 la doz\u0103 mic\u0103 sau ca regim f\u0103r\u0103 calcineurin\u0103). De asemenea, aprobat de FDA pentru <strong>limfangioleiomiomatoz\u0103 (LAM)<\/strong>, \u0219i utilizat off-label \u00een <strong>scleroza tuberoas\u0103 (TSC)<\/strong>-afec\u021biuni asociate inclusiv astrocitom subependimar cu celule gigante (SEGA), angiomiolipom renal \u0219i manifest\u0103ri cutanate. Doz\u0103 standard de \u00eentre\u021binere post-transplant: <strong>2\u20135 mg o dat\u0103 pe zi<\/strong> cu monitorizare terapeutic\u0103 a medicamentului (\u021bint\u0103 valoare minim\u0103 4\u201312 ng\/mL \u00een func\u021bie de regim). <strong>Avertizare FDA (black-box): mortalitate crescut\u0103 \u0219i tromboz\u0103 a arterei hepatice la transplant hepatic; dehiscen\u021b\u0103 anastomotic\u0103 bron\u0219ic\u0103 la transplant pulmonar.<\/strong> Obligatoriu: profil lipidic, hemogram\u0103 complet\u0103, func\u021bie renal\u0103, monitorizare glicemie la stomacul gol; supraveghere pneumonit\u0103. Protec\u021bie solar\u0103 pe via\u021b\u0103 (semnal de risc cancer cutanat).<\/p>\n<\/div>\n<div class=\"medsbase-trust-strip\" style=\"background:#f4f8fb;border:1px solid #d8e3eb;padding:12px 16px;margin:16px 0;border-radius:4px;font-size:14px;\">\n<strong>Ce beneficii ofer\u0103 MedsBase:<\/strong> Produc\u0103tor certificat WHO-GMP \u00b7 Ambalaj discret \u00b7 Livrare la nivel mondial \u00b7 Peste 1.400 de recenzii verificate <a href=\"https:\/\/medsbase.com\/ro\/reviews\/\">ale clien\u021bilor<\/a>\n<\/div>\n<p class=\"medsbase-reship-line\" style=\"font-size:14px;color:#444;margin:8px 0 18px;\">\ud83d\udce6 Fiecare comand\u0103 este acoperit\u0103 de politica noastr\u0103 de <a href=\"https:\/\/medsbase.com\/ro\/medsbase-re-shipment-assurance-policy\/\"><strong>Politica noastr\u0103 de Reexpediere Garantat\u0103<\/strong><\/a> \u2014 dac\u0103 coletul dumneavoastr\u0103 nu sose\u0219te \u00een 20 de zile lucr\u0103toare, \u00eel relivr\u0103m.<\/p>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:14px 18px;margin:0 0 24px 0;border-radius:4px;font-size:14px;\"><strong>\u26a0 Supraveghere specializat\u0103 necesar\u0103.<\/strong> Imunosupresoarele pentru transplant trebuie prescrise \u0219i monitorizate de un specialist \u00een transplant sau reumatolog. Monitorizarea terapeutic\u0103 a medicamentelor, screeningul infec\u021biilor \u0219i prevenirea sarcinii sunt componente obligatorii pentru utilizarea \u00een siguran\u021b\u0103. Nu \u00eencepe\u021bi, nu \u00eentrerupe\u021bi \u0219i nu modifica\u021bi doza f\u0103r\u0103 \u00eendrumare specializat\u0103.<\/div>\n<div style=\"background:#f4f8fb;border:1px solid #d6e4ec;padding:12px 18px;margin:14px 0;border-radius:4px;font-size:14px;color:#3a5160;text-align:center;\">\n<strong>\ud83d\udd12 Checkout criptat<\/strong> \u00b7 <strong>\ud83d\udcb3 Procesor verificat<\/strong> \u00b7 <strong>\ud83d\ude9a Livrare worldwide<\/strong> \u00b7 <strong>\u2b50 4,9\/5 de la peste 1.400 de clien\u021bi<\/strong>\n<\/div>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:14px 18px;margin:0 0 24px 0;border-radius:4px;\"><strong>\u26a0 Important \u2014 acesta nu este un medicament oncologic de baz\u0103.<\/strong> Rapacan este \u00een prezent listat \u00een categoria Anti-Cancer dar este \u00een primul r\u00e2nd un <strong>imunosupresor pentru transplant<\/strong>. Calea mTOR este implicat\u0103 \u00een multiple tipuri de cancer \u0219i exist\u0103 cercet\u0103ri \u00een oncologie, dar terapia standard pentru cancer utilizeaz\u0103 agentul \u00eenrudit <strong>everolimus<\/strong> (nu sirolimus). Pentru tratamentul efectiv al cancerului, consulta\u021bi <a href=\"\/ro\/anti-cancer-medication\/\">Medicamente Anti-Cancer<\/a> categoria noastr\u0103 pentru inhibitori de kinaz\u0103, terapii hormonale, agen\u021bi alchilan\u021bi, antimetaboli\u021bi \u0219i imunoterapie.<\/div>\n<h2 class=\"wp-block-heading\">Ce este Rapacan?<\/h2>\n<p>Rapacan este un comprimat oral de la Biocon care con\u021bine <strong>sirolimus 1 mg<\/strong>. Sirolimusul (cunoscut \u0219i sub numele de rapamicin\u0103) este un compus macrolidic care se leag\u0103 de proteina intracelular\u0103 FKBP12 pentru a forma un complex care inhib\u0103 <strong>kinaza serin-treonin\u0103 mTOR (\u021binta mamifer\u0103 a rapamicinei)<\/strong> mTOR este un regulator principal al cre\u0219terii, prolifer\u0103rii \u0219i supravie\u021buirii celulare \u00een avalul semnaliz\u0103rii factorilor de cre\u0219tere \u0219i nutrien\u021bilor. Sirolimusul a fost dezvoltat ini\u021bial de Wyeth \u0219i aprobat de FDA \u00een 1999 (sub numele de marc\u0103 Rapamune). Este compusul p\u0103rinte al everolimusului \u0219i temsirolimusului, structural similare.<\/p>\n<h2 class=\"wp-block-heading\">Cum func\u021bioneaz\u0103 Rapacan?<\/h2>\n<ul>\n<li><strong>Sirolimusul se leag\u0103 de FKBP12<\/strong> \u2014 acela\u0219i receptor intracelular ca tacrolimusul (FK506). Cu toate acestea, complexul sirolimus-FKBP12 inhib\u0103 o \u021bint\u0103 diferit\u0103 \u00een aval (mTOR) fa\u021b\u0103 de complexul tacrolimus-FKBP12 care inhib\u0103 calcineurina.<\/li>\n<li><strong>Inhibi\u021bia mTOR<\/strong> blocheaz\u0103 progresia condus\u0103 de IL-2 de la faza G1 la faza S a ciclului celular al limfocitelor \u2014 suprinz\u00e2nd proliferarea celulelor T \u0219i B f\u0103r\u0103 a le epuiza.<\/li>\n<li><strong>Efecte antifibrotice \u0219i antiangiogene<\/strong> \u2014 Inhibi\u021bia mTOR reduce semnalizarea VEGF \u0219i explic\u0103 eficacitatea \u00een leziunile asociate LAM \u0219i TSC.<\/li>\n<li><strong>Mecanism distinct fa\u021b\u0103 de inhibitorii calcineurinei<\/strong> \u2014 permite minimizarea sau eliminarea inhibitorilor calcineurinei \u00een unele protocoale de transplant, reduc\u00e2nd nefrotoxicitatea \u00een faza de \u00eentre\u021binere post-transplant.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Utiliz\u0103ri \u0219i indica\u021bii<\/h2>\n<ul>\n<li><strong>\u00centre\u021binere dup\u0103 transplant renal<\/strong> \u2014 de la 2\u20134 luni post-transplant \u00eencolo, cu minimizare a inhibitorilor calcineurinei sau \u00een regimuri f\u0103r\u0103 calcineurin\u0103. Util\u0103 \u00een special la pacien\u021bii cu nefrotoxicitate indus\u0103 de inhibitorii calcineurinei.<\/li>\n<li><strong>Limbangioleiomiomatoz\u0103 (LAM)<\/strong> \u2014 Aprobat de FDA \u00een 2015 (studiu MILES) \u2014 stabilizeaz\u0103 func\u021bia pulmonar\u0103 \u00een aceast\u0103 boal\u0103 pulmonar\u0103 chistic\u0103 rar\u0103, care afecteaz\u0103 aproape exclusiv femeile.<\/li>\n<li><strong>Leziuni asociate complexului tuberos sclerotic (TSC)<\/strong> (off-label \u00een unele jurisdic\u021bii; everolimus este agentul aprobat): astrocitom subependimal cu celule gigante (SEGA), angiomiolipom renal, angiofibroame faciale (topical), epilepsie refractar\u0103.<\/li>\n<li><strong>Hipertensiune arterial\u0103 pulmonar\u0103 (off-label):<\/strong> unele utiliz\u0103ri de specialitate.<\/li>\n<li><strong>Stenturi coronare eluitoare de medicament:<\/strong> sirolimus \u0219i analogii acestuia acoper\u0103 stenturi expandabile cu balon pentru a preveni restenoza (indica\u021bie separat\u0103 pentru dispozitiv medical).<\/li>\n<\/ul>\n<p>Rapacan este <strong>prime\u0219te,<\/strong> indicat pentru tratamentul primar al cancerului. Everolimusul, str\u00e2ns \u00eenrudit, are multiple indica\u021bii \u00een oncologie (cancer de s\u00e2n HR+ HER2- cu exemestan, carcinom renal avansat, tumori neuroendocrine, SEGA, angiomiolipom TSC), dar sirolimusul \u00een sine este axat \u00een principal pe transplanturi.<\/p>\n<h2 class=\"wp-block-heading\">Doza Rapacan \u0219i cum s\u0103 o lua\u021bi<\/h2>\n<p>Doza standard de \u00eentre\u021binere: <strong>2\u20135 mg o dat\u0103 pe zi<\/strong> dup\u0103 o doz\u0103 de \u00eenc\u0103rcare. Monitorizarea terapeutic\u0103 a medicamentului este obligatorie \u2014 concentra\u021bia \u021bint\u0103 \u00een s\u00e2nge \u00eentre doze depinde de indica\u021bie \u0219i de regimul de combina\u021bie.<\/p>\n<table style=\"border-collapse:collapse;width:100%;margin:12px 0;\">\n<thead>\n<tr style=\"background:#2c7cb0;color:#fff;\">\n<th style=\"padding:10px;border:1px solid #ddd;\">Indica\u021bie<\/th>\n<th style=\"padding:10px;border:1px solid #ddd;\">Abordarea doz\u0103rii<\/th>\n<th style=\"padding:10px;border:1px solid #ddd;\">Concentra\u021bie \u021bint\u0103 \u00eentre doze (ng\/mL)<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Transplant renal + ciclosporin\u0103<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">6 mg doz\u0103 de \u00eenc\u0103rcare, apoi 2 mg\/zi<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">4\u201312<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Transplant renal f\u0103r\u0103 inhibitori de calcineurin\u0103<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">15 mg doz\u0103 de \u00eenc\u0103rcare, apoi 5 mg\/zi<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">12\u201320 primul an<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">LAM<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">2 mg\/zi, titrare dup\u0103 nivelul minim<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">5\u201315<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">angiomiolipom TSC \/ SEGA<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Titrare specializat\u0103<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">5\u201315 (preferat everolimus)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3 class=\"wp-block-heading\">Cum s\u0103 lua\u021bi corect Rapacan<\/h3>\n<ol>\n<li><strong>O dat\u0103 pe zi, la aceea\u0219i or\u0103 \u00een fiecare zi.<\/strong> Consisten\u021ba este mai important\u0103 dec\u00e2t diminea\u021ba vs seara.<\/li>\n<li><strong>Lua\u021bi constant cu sau f\u0103r\u0103 m\u00e2ncare.<\/strong> O mas\u0103 bogat\u0103 \u00een gr\u0103simi cre\u0219te AUC cu ~35% \u0219i Cmax cu ~65% \u2014 alege\u021bi una \u0219i respecta\u021bi-o; nu alterna\u021bi \u00eentre administrare la stomac plin \u0219i gol, deoarece modific\u0103 nivelurile minime.<\/li>\n<li><strong>\u00cenghi\u021bi\u021bi comprimatele \u00eentregi cu ap\u0103.<\/strong> Nu zdrobi\u021bi, nu mesteca\u021bi \u0219i nu desp\u0103r\u021bi\u021bi.<\/li>\n<li><strong>Monitorizare obligatorie:<\/strong> nivelul minim de sirolimus \u00een s\u00e2nge integral (recoltat la 24 de ore dup\u0103 doz\u0103, imediat \u00eenainte de urm\u0103toarea doz\u0103). Nivel ini\u021bial la s\u0103pt\u0103m\u00e2na 1, s\u0103pt\u0103m\u00e2nal p\u00e2n\u0103 la stabilizare, apoi la 3\u20136 luni. Profil lipidic la baz\u0103 + lunar ini\u021bial. Hemogram\u0103, teste hepatice, func\u021bie renal\u0103, glicemie la stomacul gol lunar ini\u021bial.<\/li>\n<li><strong>Protec\u021bie cutanat\u0103:<\/strong> SPF 50+ zilnic, p\u0103l\u0103rie cu bor larg, m\u00e2neci lungi. Examinare dermatologic\u0103 anual\u0103 a \u00eentregului corp \u2014 inhibarea pe termen lung a mTOR cre\u0219te riscul de cancer de piele.<\/li>\n<li><strong>Vaccin\u0103ri:<\/strong> vaccinurile cu virus viu (ROR, varicel\u0103, febr\u0103 galben\u0103, BCG) sunt <strong>contraindica\u021biat<\/strong>. Vaccinuri inactivate (grip\u0103 anual\u0103, COVID, pneumococ) recomandate.<\/li>\n<li><strong>\u00cengrijirea r\u0103nilor:<\/strong> sirolimus afecteaz\u0103 cicatrizarea. \u00centrerupe\u021bi temporar \u00eenainte de interven\u021bii chirurgicale programate (de obicei 2\u20134 s\u0103pt\u0103m\u00e2ni preoperator) \u0219i relua\u021bi dup\u0103 vindecarea complet\u0103 a r\u0103nii.<\/li>\n<li><strong>Nu \u00eentrerupe\u021bi f\u0103r\u0103 instruc\u021biuni specializate.<\/strong><\/li>\n<\/ol>\n<h2 class=\"wp-block-heading\">Efecte Secundare Rapacan<\/h2>\n<p><strong>Frecvente (adesea dependente de doz\u0103):<\/strong><\/p>\n<ul>\n<li>Hiperlipidemie (cre\u0219teri ale colesterolului \u0219i trigliceridelor) \u2014 efectul metabolic dominant; trata\u021bi cu statine<\/li>\n<li>Afte (ulcer\u0103ri orale) \/ mucozit\u0103 \u2014 mai ales la \u00eenceputul tratamentului<\/li>\n<li>Acnee \u0219i erup\u021bii cutanate<\/li>\n<li>Edem periferic<\/li>\n<li>Hipertensiune arterial\u0103<\/li>\n<li>Anemie, trombocitopenie, leucopenie<\/li>\n<li>Diaree, grea\u021b\u0103<\/li>\n<li>Dureri de cap<\/li>\n<li>Durere articular\u0103<\/li>\n<\/ul>\n<p><strong>Important \u2014 declan\u0219eaz\u0103 investiga\u021bii sau suspendarea tratamentului:<\/strong><\/p>\n<ul>\n<li><strong>Pneumonit\u0103 (boal\u0103 pulmonar\u0103 intersti\u021bial\u0103)<\/strong> \u2014 efect de clas\u0103 al inhibitorilor mTOR. Tuse de nou-apari\u021bie, dispnee, hipoxie: oprire, CT toracic, bronhoscopie, evaluare specializat\u0103<\/li>\n<li><strong>Complica\u021bii severe ale cicatriz\u0103rii<\/strong> \u2014 dehiscen\u021b\u0103, limfocel, infec\u021bie. Suspendare \u00een jurul interven\u021biei chirurgicale<\/li>\n<li><strong>Infec\u021bii grave<\/strong> \u2014 CMV, virusul BK, Pneumocystis, infec\u021bii fungice oportuniste<\/li>\n<li><strong>Proteinurie<\/strong> (\u00een special \u00een regimurile f\u0103r\u0103 calcineurin\u0103) \u2014 necesit\u0103 ajustarea dozei sau evaluare specializat\u0103<\/li>\n<li><strong>Diabet de nou-apari\u021bie dup\u0103 transplant<\/strong> \u2014 profilul metabolic al sirolimusului contribuie<\/li>\n<li><strong>Limfoame \u0219i cancer de piele<\/strong> \u2014 risc pe termen lung al imunosupresiei; examinare anual\u0103 a pielii<\/li>\n<\/ul>\n<p><strong>Rare dar grave:<\/strong> tromboz\u0103 a arterei hepatice (avertizare FDA; sirolimus evitat \u00een transplantul hepatic), dehiscen\u021b\u0103 a anastomozei bron\u0219ice (avertizare FDA; sirolimus evitat \u00een transplantul pulmonar), microangiopatie trombotic\u0103.<\/p>\n<h2 class=\"wp-block-heading\">Avertismente \u0219i precau\u021bii<\/h2>\n<ul>\n<li><strong>Transplant hepatic:<\/strong> FDA black-box \u2014 mortalitate crescut\u0103 \u0219i tromboz\u0103 a arterei hepatice. <strong>Evita\u021bi la pacien\u021bii cu transplant hepatic.<\/strong><\/li>\n<li><strong>Transplant pulmonar:<\/strong> FDA black-box \u2014 dehiscen\u021b\u0103 a anastomozei bron\u0219ice. <strong>Evita\u021bi la pacien\u021bii cu transplant pulmonar \u00een perioada postoperatorie timpurie.<\/strong><\/li>\n<li><strong>Sarcina:<\/strong> contraindica\u021bie \u2014 teratogen \u00een modele animale. Contraceptie eficient\u0103 pe toat\u0103 durata tratamentului + 12 s\u0103pt\u0103m\u00e2ni dup\u0103 \u00eencetare. Afecteaz\u0103 fertilitatea at\u00e2t la b\u0103rba\u021bi, c\u00e2t \u0219i la femei.<\/li>\n<li><strong>Al\u0103ptarea:<\/strong> contraindicated.<\/li>\n<li><strong>Vaccinuri cu virus viu:<\/strong> contraindicated.<\/li>\n<li><strong>Cicatrizare:<\/strong> \u00eentrerupe\u021bi tratamentul cu 2\u20134 s\u0103pt\u0103m\u00e2ni \u00eenainte de interven\u021bii chirurgicale elective; relua\u021bi dup\u0103 cicatrizare complet\u0103.<\/li>\n<li><strong>Infec\u021bie grav\u0103 activ\u0103:<\/strong> suspendare tratament.<\/li>\n<li><strong>Insuficien\u021b\u0103 hepatic\u0103 sever\u0103:<\/strong> reducere a dozei cu aproximativ o treime; supraveghere specializat\u0103.<\/li>\n<li><strong>Hiperlipidemie:<\/strong> panel lipidic ini\u021bial + lunar. Tratament cu statin\u0103 dac\u0103 persisten\u021b\u0103 \u2014 preferat pravastatin\u0103 sau fluvastatin\u0103 (interac\u021biune CYP3A4 minim\u0103).<\/li>\n<li><strong>Monitorizare cancer de piele:<\/strong> examen dermatologic anual complet. Protec\u021bie zilnic\u0103 strict\u0103 cu SPF 50+.<\/li>\n<li><strong>Transplant cardiac:<\/strong> Risc de pneumonit\u0103 cu inhibitori mTOR \u2014 teste de func\u021bie pulmonar\u0103 de baz\u0103 + imagistic\u0103 toracic\u0103 dac\u0103 apar simptome.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Interac\u021biuni medicamentoase<\/h2>\n<p>Sirolimusul este substrat pentru CYP3A4 \u0219i P-gp \u2014 numeroase interac\u021biuni clinic relevante.<\/p>\n<table style=\"border-collapse:collapse;width:100%;margin:12px 0;\">\n<thead>\n<tr style=\"background:#2c7cb0;color:#fff;\">\n<th style=\"padding:10px;border:1px solid #ddd;\">Combina\u021bi cu<\/th>\n<th style=\"padding:10px;border:1px solid #ddd;\">Efect<\/th>\n<th style=\"padding:10px;border:1px solid #ddd;\">Ce s\u0103 face\u021bi<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Inhibitori puternici ai CYP3A4 (ketoconazol, itraconazol, voriconazol, ritonavir, claritromicin\u0103, suc de grapefruit)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Nivelurile de sirolimus cresc dramatic \u2014 risc de toxicitate<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Evita\u021bi asocierea. Dac\u0103 este inevitabil\u0103, reduce\u021bi doza de sirolimus cu 50\u201375% cu monitorizare intensiv\u0103 a concentra\u021biei minime.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Inductori puternici ai CYP3A4 (rifampicin\u0103, carbamazepin\u0103, fenitoin\u0103, fenobarbital, Hypericum perforatum)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Nivelurile de sirolimus scad brusc \u2014 risc de respingere<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Evita\u021bi asocierea. Dac\u0103 este inevitabil\u0103, cre\u0219te\u021bi doza de sirolimus cu monitorizare intensiv\u0103.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Ciclosporin<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Ciclosporina cre\u0219te AUC-ul sirolimusului \u2014 combina\u021bie standard dar dependent\u0103 de momentul administr\u0103rii.<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Administra\u021bi sirolimus la 4 ore dup\u0103 ciclosporin\u0103. Regim standard de transplant cu minimizare a inhibitorilor de calcineurin\u0103.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Tacrolimus<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Nefrotoxicitate combinat\u0103<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Combina\u021bie specializat\u0103 doar cu monitorizare intensiv\u0103.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Inhibitori ACE<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Risc de angioedem (efect aditiv cu inhibarea mTOR)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Precau\u021bie \u2014 trece\u021bi la ARB dac\u0103 apare angioedem.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Statine (simvastatin\u0103, lovastatin\u0103)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Niveluri crescute de statin\u0103 \u2014 risc de miopatie<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Trece\u021bi la pravastatin\u0103, fluvastatin\u0103 sau rosuvastatin\u0103 (dependen\u021b\u0103 mai mic\u0103 de CYP3A4).<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Vaccinuri cu virus viu<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Risc de infec\u021bie diseminat\u0103 cu tulpina vaccinului<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Contraindicated.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Suc de grapefruit<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Inhibi\u021bie CYP3A4 \u2014 nivelurile de sirolimus cresc imprevizibil<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Evita\u021bi pe tot parcursul tratamentului.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2 class=\"wp-block-heading\">Instruc\u021biuni de Depozitare<\/h2>\n<ul>\n<li>Depozita\u021bi la <strong>2\u20138\u00b0C<\/strong> (la frigider). Unele formul\u0103ri sunt stabile la temperatura camerei pentru perioade limitate \u2014 verifica\u021bi eticheta ambalajului.<\/li>\n<li>Proteja\u021bi de lumin\u0103. P\u0103stra\u021bi \u00een blisterul original.<\/li>\n<li>P\u0103stra\u021bi departe de copii \u0219i animale de companie.<\/li>\n<li>Returna\u021bi comprimatele nefolosite la o farmacie pentru eliminare.<\/li>\n<\/ul>\n<p><!-- medsbase-why-order --><\/p>\n<h3>De ce s\u0103 comanzi de la MedsBase<\/h3>\n<p>Fiecare lot este procurat de la un <strong>produc\u0103tor certificat WHO-GMP<\/strong>. Comenzile sunt expediate \u00een ambalaje simple, f\u0103r\u0103 marc\u0103, de la partenerii no\u0219tri de onorare \u0219i acoperite de <a href=\"\/ro\/medsbase-re-shipment-assurance-policy\/\">Politica noastr\u0103 de Reexpediere Garantat\u0103<\/a>: dac\u0103 un colet nu ajunge \u00een 20 de zile lucr\u0103toare, trimitem gratuit o nou\u0103 comand\u0103, f\u0103r\u0103 \u00eentreb\u0103ri.<\/p>\n<p><!-- medsbase-related-alts-v1 --><\/p>\n<h3 class=\"wp-block-heading\">Medicamente \u00eenrudite<\/h3>\n<p>Alte medicamente stocate al\u0103turi de acest produs:<\/p>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/ro\/siromus\/\">Siromus (sirolimus 1 mg)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/cellcept\/\">Cellcept (micofenolat mofetil 500 mg)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/imutrex\/\">Imutrex (metotrexat 2,5\/7,5\/10 mg)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/folitrax\/\">Folitrax (metotrexat 2,5\/7,5\/10 mg)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/endoxan\/\">Endoxan (ciclosfosfamid\u0103 50 mg)<\/a><\/li>\n<\/ul>\n<h2 id=\"faqs\">\u00centreb\u0103ri frecvente<\/h2>\n<h3 class=\"wp-block-heading\">De ce este Rapacan listat sub Anti-Cancer?<\/h3>\n<p>Sirolimusul este \u00een primul r\u00e2nd un imunosupresor pentru transplant. Calea mTOR este implicat\u0103 \u00een multiple tipuri de cancer, iar everolimusul, structural \u00eenrudit, are aprobarea FDA pentru mai multe indica\u021bii oncologice, dar sirolimusul \u00een sine nu este un medicament standard pentru cancer. Plasarea actual\u0103 \u00een categorie pare a fi o problem\u0103 de taxonomie istoric\u0103.<\/p>\n<h3 class=\"wp-block-heading\">Rapacan versus tacrolimus \u2014 care este mai bun?<\/h3>\n<p>Acestea au mecanisme diferite (mTOR vs calcineurin\u0103), profile diferite de efecte adverse \u0219i roluri diferite. Tacrolimusul este standardul de baz\u0103 pentru induc\u021bia \u0219i men\u021binerea post-transplant timpurie. Sirolimusul este introdus \u00een mod tipic de la 2\u20134 luni post-transplant, adesea \u00eenlocuind sau reduc\u00e2nd tacrolimusul, \u00een special la pacien\u021bii cu nefrotoxicitate indus\u0103 de inhibitorii calcineurinei. Nu sunt interschimbabile.<\/p>\n<h3 class=\"wp-block-heading\">Rapacan versus everolimus?<\/h3>\n<p>Everolimusul este un analog al sirolimusului cu o modificare hidroxietil care confer\u0103 o semivie mai scurt\u0103 (28 vs 60 de ore), permi\u021b\u00e2nd administrarea de dou\u0103 ori pe zi \u0219i ajustarea mai rapid\u0103 a dozei. Everolimusul are mai multe indica\u021bii aprobate (cancer de s\u00e2n HR+ HER2- cu exemestan, carcinom renal avansat, tumori neuroendocrine, SEGA, TSC-AML, stenturi eluitoare de medicament). Sirolimusul este compusul p\u0103rinte \u0219i r\u0103m\u00e2ne utilizat pe scar\u0103 larg\u0103 \u00een men\u021binerea transplantului \u0219i LAM.<\/p>\n<h3 class=\"wp-block-heading\">Va cre\u0219te Rapacan riscul meu de cancer?<\/h3>\n<p>Imunosupresia pe termen lung cu orice agent (sirolimus, tacrolimus, ciclosporin\u0103, micofenolat) cre\u0219te riscul pe via\u021b\u0103 de cancer de piele, tulbur\u0103ri limfoproliferative post-transplant \u0219i alte maligne. Clasa inhibitorilor mTOR poate avea un <em>un risc mai sc\u0103zut<\/em> risc de cancer de piele mai mic dec\u00e2t inhibitorii calcineurinei conform datelor din cohortele de transplant \u2014 unele centre schimb\u0103 pacien\u021bii cu multiple cancere de piele pe sirolimus. Examinarea anual\u0103 a \u00eentregului corp + SPF 50+ zilnic este standard indiferent de regim.<\/p>\n<h3 class=\"wp-block-heading\">De ce am nevoie de un test sanguin pentru sirolimus?<\/h3>\n<p>Sirolimusul are o fereastr\u0103 terapeutic\u0103 \u00eengust\u0103. Sub nivelul \u021bint\u0103 al concentra\u021biei minime risca\u021bi respingerea transplantului; peste nivelul \u021bint\u0103 risca\u021bi pneumonit\u0103, hiperlipidemie sever\u0103, infec\u021bie \u0219i alte toxicit\u0103\u021bi. Concentra\u021bia minim\u0103 din s\u00e2nge \u00eenainte de doz\u0103 la 24 de ore este proba standard de monitorizare. \u021aintele variaz\u0103 \u00een func\u021bie de indica\u021bie \u0219i regim \u2014 echipa dumneavoastr\u0103 de transplant v\u0103 va stabili nivelul.<\/p>\n<h3 class=\"wp-block-heading\">Pot avea o opera\u021bie \u00een timp ce iau Rapacan?<\/h3>\n<p>Sirolimusul afecteaz\u0103 vindecarea prin inhibarea mTOR a prolifer\u0103rii fibroblastelor \u0219i a celulelor endoteliale. Pentru opera\u021biile elective, sirolimusul este de obicei \u00eentrerupt 2\u20134 s\u0103pt\u0103m\u00e2ni \u00eenainte de opera\u021bie \u0219i reluat dup\u0103 ce rana este bine vindecat\u0103 (de obicei 2\u20134 s\u0103pt\u0103m\u00e2ni post-op). Pentru opera\u021biile de urgen\u021b\u0103, sirolimusul este \u00eentrerupt imediat \u0219i se substituie un regim bazat pe inhibitori de calcineurin\u0103 sub \u00eendrumarea echipei de transplant.<\/p>\n<h3 class=\"wp-block-heading\">De ce trebuie s\u0103 iau Rapacan \u00een mod constant, cu sau f\u0103r\u0103 m\u00e2ncare?<\/h3>\n<p>O mas\u0103 bogat\u0103 \u00een gr\u0103simi cre\u0219te AUC-ul sirolimusului cu ~35% \u0219i concentra\u021bia maxim\u0103 cu ~65%. Dac\u0103 alterna\u021bi \u00eentre administrarea cu \u0219i f\u0103r\u0103 m\u00e2ncare, nivelurile minime devin impredictibile. Alege\u021bi o rutin\u0103 (majoritatea oamenilor prefer\u0103 administrarea constant\u0103 \u00een stare de post deoarece este mai u\u0219or de reprodus) \u0219i respecta\u021bi-o.<\/p>\n<h3 class=\"wp-block-heading\">Rapacan \u0219i Siromus sunt acela\u0219i lucru cu Rapamune?<\/h3>\n<p>Da \u2014 Rapacan, Siromus \u0219i Rapamune con\u021bin toate sirolimus 1 mg. Rapamune este marca original\u0103 Wyeth\/Pfizer. Rapacan \u0219i Siromus sunt versiuni generice bioechivalente de la diferi\u021bi produc\u0103tori.<\/p>\n<h3 class=\"wp-block-heading\">Ce este LAM?<\/h3>\n<p>Limbangioleiomiomatoza este o boal\u0103 pulmonar\u0103 chistic\u0103 rar\u0103 \u0219i progresiv\u0103 care afecteaz\u0103 aproape exclusiv femeile, fiind adesea asociat\u0103 cu scleroza tuberoas\u0103. Inhibi\u021bia mTOR cu sirolimus stabilizeaz\u0103 func\u021bia pulmonar\u0103 (FEV1) \u00een LAM \u2014 studiul MILES a condus la aprobarea FDA \u00een 2015. LAM este diagnosticat\u0103 \u0219i gestionat\u0103 \u00een centre specializate.<\/p>\n<h3 class=\"wp-block-heading\">Pot consuma alcool \u00een timp ce iau Rapacan?<\/h3>\n<p>Nu exist\u0103 o interac\u021biune specific\u0103 cu alcoolul. Consumul moderat este \u00een general acceptabil, dar alcoolul agraveaz\u0103 hiperlipidemia (un efect secundar comun al sirolimusului) \u0219i poate interac\u021biona cu metabolismul hepatic. Dac\u0103 ave\u021bi o transplantare de ficat sau alt\u0103 afec\u021biune hepatic\u0103, alcoolul este contraindicat.<\/p>\n<p style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:12px 16px;margin:24px 0;border-radius:4px;font-size:13px;\"><strong>Avertizare medical\u0103:<\/strong> Aceast\u0103 pagin\u0103 de produs are scop informativ \u0219i nu \u00eenlocuie\u0219te sfatul medical. Imunosupresoarele pot provoca infec\u021bii poten\u021bial letale, neoplasme \u0219i malforma\u021bii congenitale. Utiliza\u021bi numai sub supraveghere specializat\u0103, cu monitorizare adecvat\u0103.<\/p>","protected":false},"excerpt":{"rendered":"<p>\u2705 Medicament Immunosupresor<br \/>\n\u2705 Previne Respingerea Organelor<br \/>\n\u2705 Trateaz\u0103 Limfangioleiomioza<br \/>\n\u2705 Reduce deteriorarea rinichilor<br \/>\n\u2705 Controleaz\u0103 boli pulmonare rare<\/p>","protected":false},"featured_media":53466,"comment_status":"open","ping_status":"open","template":"","meta":[],"product_brand":[],"product_cat":[3595,3141,3223],"product_tag":[],"class_list":{"0":"post-53465","1":"product","2":"type-product","3":"status-publish","4":"has-post-thumbnail","6":"product_cat-anti-cancer-medication","7":"product_cat-category-overview","8":"product_cat-chronic-conditions","10":"first","11":"instock","12":"shipping-taxable","13":"purchasable","14":"product-type-variable","15":"has-default-attributes"},"acf":[],"_links":{"self":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product\/53465","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/comments?post=53465"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/media\/53466"}],"wp:attachment":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/media?parent=53465"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product_brand?post=53465"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product_cat?post=53465"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product_tag?post=53465"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}