Drug General Information (ID: DDI0T87HE9)
Drug Name			Sirolimus		Drug Info		Metoclopramide		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Immunosuppressive Agents				Antiemetics
Structure

Mechanism of Sirolimus-Metoclopramide Interaction (Severity Level: Moderate)
Altered gastrointestinal dynamics Click to Show/Hide Mechanism Graph
Drug Name		Sirolimus				Metoclopramide
Mechanism		Absorption is influenced by gastrointestinal motility				Increase gastrointestinal motility
Key Mechanism Factor 1
		Factor Name		Gastrointestinal Motility
		Factor Description		Gastrointestinal motility is an important factor in determining the absorption of orally administered drugs, and it controls the residence time of the drug in the digestive tract.
Mechanism Description		Altered absorption of Sirolimus due to GI dynamics variation caused by Metoclopramide

Recommended Action
Management		Pharmacologic response, renal function, and macrolide immunosuppressant blood levels should be monitored more closely whenever a gastrointestinal prokinetic agent is added to or discontinue from therapy, and the immunosuppressant dosage adjusted as necessary. Patients should be advised to contact their physician if they experience potential signs and symptoms of macrolide immunosuppressant toxicity such as fever, infection, diarrhea, tremor, headache, fatigue, or lethargy.

References
1	Prescott WA Jr, Callahan BL, Park JM "Tacrolimus toxicity associated with concomitant metoclopramide therapy." Pharmacotherapy 24 (2004): 532-7. [PMID: 15098810]
2	Product Information. Prograf (tacrolimus). Fujisawa, Deerfield, IL.
3	Product Information. Rapamune (sirolimus) Wyeth-Ayerst Laboratories, Philadelphia, PA.