Everolimus: what it does and what to watch for
Everolimus is an mTOR inhibitor used two main ways: to prevent organ rejection after transplant (brand: Zortress) and to treat certain cancers (brand: Afinitor). It can be very helpful, but it also changes your immune system and metabolism. That means you need to know the common effects, key drug interactions, and what checks your doctor will order.
How it's used and typical doses
For cancer, common dosing is 10 mg once daily (Afinitor) but some conditions use lower doses — follow the exact plan your oncologist prescribes. For transplant, doctors usually start everolimus at 0.75 mg twice daily or 1 mg twice daily and adjust to reach a target blood level (trough level often kept around 3–8 ng/mL). Never change dose on your own; your team will use blood tests and clinical signs to adjust.
Take everolimus at the same time each day, with or without food, unless your prescriber tells you otherwise. If you miss a dose, take it as soon as you remember unless it’s close to the next dose — don’t double up.
Side effects, monitoring, and safety tips
Common side effects include mouth sores, tiredness, high cholesterol or triglycerides, increased blood sugar, and swelling. Serious risks are infections, poor wound healing, and lung inflammation (pneumonitis) — call your doctor for new cough, shortness of breath, persistent fever, or unexpected wounds that don't heal.
Your medical team will monitor blood counts, kidney and liver tests, lipids, blood sugar, and sometimes everolimus trough levels. If levels are too high, they may lower the dose or stop interacting drugs. If you’re having surgery, tell the surgeon—everolimus can slow wound healing and might need to be paused before elective procedures.
Drug interactions matter a lot. Strong CYP3A4 and P‑glycoprotein inhibitors (for example, ketoconazole, itraconazole, clarithromycin, ritonavir, and grapefruit juice) raise everolimus levels and can increase side effects. Strong inducers (rifampin, carbamazepine, phenytoin, St. John’s wort) lower levels and can reduce effectiveness. Always check with your pharmacist before starting new medicines, herbal products, or supplements.
Live vaccines should be avoided while on everolimus because your immune system is suppressed. Discuss immunizations with your doctor — some vaccines may be given before treatment rather than during it. If you’re pregnant or planning pregnancy, talk with your provider: everolimus can harm a fetus and breastfeeding is not recommended while taking it.
Practical tips: carry a list of your medications, report any signs of infection right away, keep routine blood tests on schedule, and store tablets at room temperature in the original container. If you notice severe breathing problems, high fever, or severe allergic reactions, seek emergency care.
If you want more tailored advice, bring your questions to your transplant or oncology team — they know your exact dose, lab targets, and what to watch for in your situation.