"The US Food and Drug Administration (FDA) has approved soluble ferric pyrophosphate (Triferic, Rockwell Medical) to replace iron and maintain hemoglobin in adults with chronic kidney disease who are undergoing dialysis.
Zortress Side Effects Center
Medical Editor: John P. Cunha, DO, FACOEP
Zortress (everolimus) is a macrolide immunosuppressant used to prevent organ rejection after a kidney or liver transplant. Zortress is used together with cyclosporine (Gengraf, Neoral, Sandimmune), steroids, and other medications. Afinitor is another brand of everolimus used to treat kidney cancer. Common side effects of Zortress include constipation, diarrhea, headache, nausea, vomiting, sores in the mouth/throat, swelling in your legs/ankles/feet, tiredness, pain in your arms or legs, or sleep problems (insomnia).
An initial Zortress dose of 0.75 mg orally twice daily (1.5 mg per day) is recommended for adult kidney transplant patients in combination with reduced dose cyclosporine, administered as soon as possible after transplantation. An initial dose of 1.0 mg orally twice daily (2.0 mg per day) is recommended for adult liver transplant patients in combination with reduced dose tacrolimus. Zortress may interact with aprepitant, dexamethasone, isoniazid, rifabutin, rifampin, rifapentine, St. John's wort, antidepressants, other drugs that weaken your immune system, antibiotics, antifungals, barbiturates, cholesterol-lowering medicines, heart or blood pressure medications, HIV medications, seizure medications, or "live" vaccines. Tell your doctor all medications and supplements you use and all vaccines you recently received. Zortress is not recommended for use during pregnancy. It may harm a fetus. Consult your doctor to discuss using at least 2 forms of birth control while taking this medication and for 8 weeks after stopping treatment. If you become pregnant or think you may be pregnant, tell your doctor. It is unknown if this medication passes into breast milk. Because of the possible risk to the infant, breastfeeding while using this drug is not recommended.
Our Zortress (everolimus) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What is Patient Information in Detail?
Easy-to-read and understand detailed drug information and pill images for the patient or caregiver from Cerner Multum.
Zortress in Detail - Patient Information: Side Effects
Serious and sometimes fatal infections may occur during treatment with Zortress. Stop taking this medicine and call your doctor right away if you have signs of infection such as fever, chills, body aches, or flu symptoms.
Get emergency medical help if you have any of these signs of an allergic reaction: hives; chest pain, difficult breathing; swelling of your face, lips, tongue, or throat.
Call your doctor right away if you have any other serious side effects such as:
- pain in your stomach, groin, lower back or side;
- urinating less than usual or not at all;
- pain or burning when you urinate;
- blood in your urine, dark colored urine, fever with nausea or vomiting;
- redness, warmth, swelling, oozing, or slow healing of a wound or surgical incision;
- new or worsening cough, feeling short of breath;
- wheezing, trouble breathing;
- stabbing chest pain, cough with yellow or green mucus;
- pale skin, feeling light-headed, rapid heart rate, trouble concentrating;
- white patches or sores inside your mouth or on your lips;
- easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;
- high potassium (slow heart rate, weak pulse, muscle weakness, tingly feeling);
- high blood sugar (increased thirst, increased urination, hunger, dry mouth, fruity breath odor, drowsiness, dry skin, blurred vision, weight loss); or
- dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).
Less serious side effects may include:
- swelling in your legs, ankles, or feet;
- tired feeling;
- nausea, constipation, diarrhea;
- pain in your arms and legs; or
- sleep problems (insomnia).
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Read the entire detailed patient monograph for Zortress (Everolimus)
What is Patient Information Overview?
A concise overview of the drug for the patient or caregiver from First DataBank.
Zortress Overview - Patient Information: Side Effects
Constipation, headache, nausea, and sores in the mouth/throat may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.
Many people using this medication have serious side effects. However, your doctor has prescribed this drug because he or she has judged that the benefit to you is greater than the risk of side effects. Careful monitoring by your doctor may decrease your risk.
Tell your doctor right away if you have any serious side effects, including: swelling hands/ankles/feet, wound problems (such as infection, slow wound healing, opening of wound), decreased sexual ability (in men), chest pain/pressure, shortness of breath, unusual bruising/bleeding.
This medication may increase your risk of getting a rare but very serious (sometimes fatal) brain infection (progressive multifocal leukoencephalopathy-PML). Get medical help right away if any of these rare but very serious side effects occur: clumsiness, loss of coordination, weakness, sudden change in your thinking (such as confusion, difficulty concentrating), difficulty moving your muscles, problems with speech, seizure, vision changes.
This medication has caused very serious (rarely fatal) lung problems. Tell your doctor right away if you have symptoms of lung problems, such as shortness of breath, chest pain.
Everolimus may cause your cholesterol/triglycerides or blood sugar to increase. You may be required to have your cholesterol/triglycerides or blood sugar checked periodically. You may need medication to control your cholesterol/triglycerides or blood sugar. Tell your doctor or pharmacist if you experience symptoms of high blood sugar, including increased thirst/hunger, frequent urination.
This medication can decrease sperm production, an effect that may lower male fertility. Consult your doctor for more details.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
In the US -
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Read the entire patient information overview for Zortress (Everolimus)
What is Prescribing information?
The FDA package insert formatted in easy-to-find categories for health professionals and clinicians.
Zortress FDA Prescribing Information: Side Effects
Serious And Otherwise Important Adverse Reactions
The following adverse reactions are discussed in greater detail in other sections of the label.
- Hypersensitivity Reactions [See CONTRAINDICATIONS]
- Lymphomas and Other Malignancies [See BOXED WARNING, WARNINGS AND PRECAUTIONS]
- Serious Infections [See WARNINGS AND PRECAUTIONS]
- Kidney Graft Thrombosis [See WARNINGS AND PRECAUTIONS]
- Hepatic Artery Thrombosis [See WARNINGS AND PRECAUTIONS]
- Zortress and Calcineurin Inhibitor-Induced Nephrotoxicity [See WARNINGS AND PRECAUTIONS]
- Heart Transplantation [See WARNINGS AND PRECAUTIONS]
- Angioedema [See WARNINGS AND PRECAUTIONS]
- Wound Healing and Fluid Accumulation [See WARNINGS AND PRECAUTIONS]
- Interstitial Lung Disease/Non-Infectious Pneumonitis [See WARNINGS AND PRECAUTIONS]
- Hyperlipidemia [See WARNINGS AND PRECAUTIONS]
- Proteinuria [See WARNINGS AND PRECAUTIONS]
- Polyoma Virus Infections [See WARNINGS AND PRECAUTIONS]
- Thrombotic Microangiopathy/Thrombotic Thrombocytopenic Purpura/Hemolytic Uremic Syndrome (TMA/TTP/HUS) [See WARNINGS AND PRECAUTIONS]
- New Onset Diabetes After Transplant [See WARNINGS AND PRECAUTIONS]
- Male Infertility [See WARNINGS AND PRECAUTIONS]
Clinical Studies Experience
Because clinical trials are conducted under widely varying conditions, the adverse reaction rates observed cannot be directly compared to rates in other trials and may not reflect the rates observed in clinical practice.
The data described below reflect exposure to Zortress in an open-label, randomized trial of de novo kidney transplant patients of concentration-controlled everolimus at an initial Zortress starting dose of 1.5 mg per day [target trough concentrations 3 to 8 ng/mL with reduced exposure cyclosporine (N=274) compared to mycophenolic acid (N=273) with standard exposure cyclosporine]. All patients received basiliximab induction therapy and corticosteroids. The population was between 18 and 70 years, more than 43% were 50 years of age or older (mean age was 46 years in the Zortress group, 47 years control group); a majority of recipients were male (64% in the Zortress group, 69% control group); and a majority of patients were Caucasian (70% in the Zortress group, 69% control group). Demographic characteristics were comparable between treatment groups. The most frequent diseases leading to transplantation were balanced between groups and included hypertension/nephrosclerosis, glomerulonephritis/glomerular disease and diabetes mellitus. Significantly more patients discontinued Zortress 1.5 mg per day treatment (83/277, 30%) than discontinued the control regimen (60/277, 22%). Of those patients who prematurely discontinued treatment, most discontinuations were due to adverse reactions: 18% in the Zortress group compared to 9% in the control group (p-value = 0.004). This difference was more prominent between treatment groups among female patients. In those patients discontinuing study medication, adverse reactions were collected up to 7 days after study medication discontinuation and serious adverse reactions up to 30 days after study medication discontinuation.
Discontinuation of Zortress at a higher dose (3 mg per day) was 95/279, 34%, including 20% due to adverse reactions, and this regimen is not recommended (see below).
The overall incidences of serious adverse reactions were 57% (159/278) in the Zortress group and 52% (141/273) in the mycophenolic acid group. Infections and infestations reported as serious adverse reactions had the highest incidence in both groups [20% (54/274) in the Zortress group and 25% (69/273) in the control group]. The difference was mainly due to the higher incidence of viral infections in the mycophenolic acid group, mainly CMV and BK virus infections. Injury, poisoning and procedural complications reported as serious adverse reactions had the second highest incidence in both groups [14% (39/274) in the Zortress group and 12% (32/273) in the control group] followed by renal and urinary disorders [10% (28/274) in the Zortress group and 13% (36/273) in the control group] and vascular disorders [10% (26/274) in the Zortress group and 7% (20/273) in the control group].
A total of 13 patients died during the first 12 months of study; 7 (3%) in the Zortress group and 6 (2%) in the control group. The most common causes of death across the study groups were related to cardiac conditions and infections.
There were 12 (4%) graft losses in the Zortress group and 8 (3%) in the control group over the 12 month study period. Of the graft losses, 4 were due to renal artery and two due to renal vein thrombosis in the Zortress group (2%) compared to two renal artery thromboses in the control group (1%). [See BOXED WARNING and WARNINGS AND PRECAUTIONS]
The overall incidence of bacterial, fungal and viral infections reported as adverse reactions was higher in the control group (68%) compared to the Zortress group (64%) and was primarily due to an increased number of viral infections (21% in the control group and 10% in the Zortress group). The incidence of cytomegalovirus (CMV) infections reported as adverse reactions was 8% in the control group compared to 1% in the Zortress group; and 3% of the serious CMV infections in the control group versus 0% in the Zortress group were considered serious. [See WARNINGS AND PRECAUTIONS]
BK virus infections were lower in incidence in the Zortress group (2 patients, 1%) compared to the control group (11 patients, 4%). One of the two BK virus infections in the Zortress group and two of the 11 BK virus infections in the control group were also reported as serious adverse reactions. BK virus infections did not result in graft loss in any of the groups in the clinical trial.
Wound Healing and Fluid Collections
Wound healing-related reactions were identified through a retrospective search and request for additional data. The overall incidence of wound-related reactions, including lymphocele, seroma, hematoma, dehiscence, incisional hernia, and infections was 35% in the Zortress group compared to 26% in the control group. More patients required intraoperative repair debridement or drainage of incisional wound complications and more required drainage of lymphoceles and seromas in the Zortress group compared to control.
Adverse reactions due to major fluid collections such as edema and other types of fluid collections was 45% in the Zortress group and 40% in the control group. [See WARNINGS AND PRECAUTIONS]
Adverse reactions due to malignant and benign neoplasms were reported in 3% of patients in the Zortress group and 6% in the control group. The most frequently reported neoplasms in the control group were basal cell carcinoma, squamous cell carcinoma, skin papilloma and seborrheic keratosis. One patient in the Zortress group who underwent a melanoma excision prior to transplantation died due to metastatic melanoma. [See BOXED WARNING and WARNINGS AND PRECAUTIONS]
New Onset Diabetes Mellitus (NODM)
NODM reported based on adverse reactions and random serum glucose values, was 9% in the Zortress group compared to 7% in the control group.
Endocrine Effects in Males
In the Zortress group, serum testosterone levels significantly decreased while the FSH levels significantly increased without significant changes being observed in the control group. In both the Zortress and the control groups mean testosterone and FSH levels remained within the normal range with the mean FSH level in the Zortress group being at the upper limit of the normal range (11.1 U/L). More patients were reported with erectile dysfunction in the Zortress treatment group compared to the control group (5% compared to 2%, respectively).
Table 2 compares the incidence of treatment-emergent adverse reactions reported with an incidence of ≥ 10% for patients receiving Zortress with reduced dose cyclosporine or mycophenolic acid with standard dose cyclosporine. Within each MedDRA system organ class, the adverse reactions are presented in order of decreasing frequency.
Table 2: Incidence Rates of
Frequent ( ≥ 10% in Any Treatment Group) Adverse Reactions by Primary
System Organ Class and Preferred Term
|Primary System Organ Class Preferred Term||Zortress (everolimus) 1.5 mg With reduced exposure cyclosporine
|Mycophenolic acid 1.44 g With standard exposure cyclosporine
|Any Adverse Reactions*||271 (99)||270 (99)|
|Blood lymphatic system disorders||93 (34)||111 (41)|
|Anemia||70 (26)||68 (25)|
|Leukopenia||8 (3)||33 (12)|
|Gastrointestinal disorders||196(72)||207 (76)|
|Constipation||105 (38)||117 (43)|
|Nausea||79 (29)||85 (31)|
|Diarrhea||51 (19)||54 (20)|
|Abdominal pain||36 (13)||42 (15)|
|Dyspepsia||12 (4)||31 (11)|
|Abdominal pain upper||9 (3)||30 (11)|
|General disorders and administrative site conditions||181(66)||160 (59)|
|Edema peripheral||123 (45)||108 (40)|
|Pyrexia||51 (19)||40 (15)|
|Fatigue||25 (9)||28 (10)|
|Infections and infestations||169(62)||185 (68)|
|Urinary tract infection||60 (22)||63 (23)|
|Upper respiratory tract infection||44 (16)||49(18)|
|Injury, poisoning and procedural complications||163 (60)||163 (60)|
|Incision site pain||45 (16)||47 (17)|
|Procedural pain||40 (15)||37 (14)|
|Investigations||137 (50)||133 (49)|
|Blood creatinine increased||48 (18)||59 (22)|
|Metabolism and nutrition disorders||222 (81)||199 (73)|
|Hyperlipidemia||57 (21)||43 (16)|
|Hyperkalemia||49 (18)||48 (18)|
|Hypercholesterolemia||47 (17)||34 (13)|
|Hypomagnesemia||37 (14)||40 (15)|
|Hypophosphatemia||35 (13)||35 (13)|
|Hypokalemia||32 (12)||32 (12)|
|Musculoskeletal and connective tissue disorders||112 (41)||105 (39)|
|Pain in extremity||32 (12)||29 (11)|
|Back pain||30 (11)||28(10)|
|Nervous system disorders||92 (34)||109 (40)|
|Headache||49 (18)||40 (15)|
|Tremor||23 (8)||38 (14)|
|Psychiatric disorders||90 (33)||72 (26)|
|Insomnia||47 (17)||43 (16)|
|Renal and urinary disorders||112 (41)||124 (45)|
|Respiratory, thoracic and mediastinal disorders||86 (31)||93 (34)|
|Cough||20 (7)||30 (11)|
|Vascular disorders||122 (45)||124 (45)|
|Hypertension||81 (30)||82 (30)|
|* As reported in the safety analysis population defined as all randomized patients who received at least one dose of treatment and had at least one post-baseline safety assessment.|
Adverse reaction that occurred with at least a 5% higher frequency in the Zortress 1.5 mg group compared to the control group were: peripheral edema (45% compared to 40%), hyperlipidemia (21% compared to 16%), dyslipidemia (15% compared to 9%), and stomatitis/mouth ulceration (8% compared to 3%).
A third treatment group of Zortress 3.0 mg per day (1.5 mg twice daily; target trough concentrations 6 to 12 ng/mL) with reduced exposure cyclosporine was included in the study described above. Although as effective as the lower dose Zortress group, the overall safety was worse and consequently higher doses of Zortress cannot be recommended. Out of 279 patients, 95 (34%) discontinued the study medication with 57 (20%) doing so because of adverse reactions. The most frequent adverse reactions leading to discontinuation of Zortress when used at this higher dose were injury, poisoning and procedural complications (Zortress 1.5 mg: 5%, Zortress 3.0 mg: 7%, and control: 2%), infections (2%, 6%, and 3%, respectively), renal and urinary disorders (4%, 7%, and 4%, respectively) and gastrointestinal disorders (1%, 3%, and 2%).
The combination of fixed dose Zortress and standard doses of cyclosporine in previous kidney clinical trials resulted in frequent elevations of serum creatinine with higher mean and median serum creatinine values observed than in the current study with reduced exposure cyclosporine. These results indicate that Zortress increases the cyclosporine-induced nephrotoxicity; and therefore should only be used in a concentration-controlled regimen with reduced exposure cyclosporine. [See BOXED WARNINGS, INDICATIONS AND USAGE, WARNINGS AND PRECAUTIONS]
The data described below reflect exposure to Zortress starting 30 days after transplantation in an open-label, randomized trial of liver transplant patients. Seven hundred and nineteen (719) patients who fulfilled the inclusion/exclusion criteria [See Clinical Studies section] were randomized into one of the three treatment groups of the study. During the first 30 days prior to randomization patients received tacrolimus and corticosteroids, with or without mycophenolate mofetil (about 70 to 80% received MMF). No induction antibody was administered. At randomization, MMF was discontinued and patients were randomized to Zortress initial dose of 1.0 mg twice per day (2.0 mg daily) and adjusted to protocol specified target trough concentrations of 3 to 8 ng/mL with reduced exposure tacrolimus [protocol specified target troughs 3 to 5 ng/mL] (N=245) or to a control group of standard exposure tacrolimus [protocol specified target troughs 8 to 12 ng/mL up to Month 4 post-transplant, then 6 to 10 ng/mL Month 4 through Month 12 post-transplant] (N=241). A third randomized group was discontinued prematurely [See Clinical Studies] and is not described in this section.
The population was between 18 and 70 years, more than 50% were 50 years of age (mean age was 54 years in the Zortress group, 55 years in the tacrolimus control group); 74% were male in both Zortress and control groups, respectively, and a majority were Caucasian (86% Zortress group, 80% control group). Demographic characteristics were comparable between treatment groups. The most frequent diseases leading to transplantation were balanced between groups. The most frequent causes of end-stage liver disease (ESLD) were alcoholic cirrhosis, hepatitis C, and hepatocellular carcinoma and were balanced between groups.
Twenty-seven percent discontinued study drug in the Zortress group compared with 22% for the tacrolimus control group. The most common reason for discontinuation of study medication was due to adverse reactions (19% and 11%, respectively), including proteinuria, recurrent hepatitis C, and pancytopenia in the Zortress group.
The overall incidences of serious adverse reactions were 50% (122/245) in the Zortress group and 43% (104/241) in the control group. Infections and infestations were reported as serious adverse reactions with the highest incidence followed by Gastrointestinal disorders and Hepatobiliary disorders.
During the first 12 months of study, 13 deaths were reported in the Zortress group (one patient never took Zortress). In the same 12 month period, 7 deaths were reported in the tacrolimus control group. Deaths occurred in both groups for a variety of reasons and were mostly associated with liver-related issues, infections and sepsis.
The most common adverse reactions (reported for ≥ 10% patients in any group) in the Zortress group were: diarrhea, headache, peripheral edema, hypertension, nausea, pyrexia, abdominal pain, and leukopenia (see Table 3).
The overall incidence of infections reported as adverse reactions was 50% for Zortress and 44% in the control group. The types of infections were reported as follows: bacterial 16% vs 12%, viral 17% vs 13%; and fungal infections 2% vs 5% for Zortress and control, respectively. [See WARNINGS AND PRECAUTIONS]
Wound Healing and Fluid Collections
Wound healing complications were reported as adverse reactions for 11% of patients in the Zortress group compared to 8% of patients in the control group. Pleural effusions were reported in 5% in both groups, and ascites in 4% of patients in the Zortress group and 3% in the control arm.
Malignant and benign neoplasms were reported as adverse reactions in 4% of patients in the Zortress group and 7% in the control group. In the Zortress group 3 malignant tumors were reported compared to 9 cases in the control group. For the Zortress group this included lymphoma, lymphoproliferative disorder and a hepatocellular carcinoma, and for the control group included Kaposi's sarcoma (2), metastatic colorectal cancer, glioblastoma, malignant hepatic neoplasm, pancreatic neuroendocrine tumor, hemophagocytic histiocytosis, and squamous cell carcinomas. [See BOXED WARNING and WARNINGS AND PRECAUTIONS]
Hyperlipidemia adverse reactions (including the preferred terms: hyperlipidemia, hypercholesterolemia, blood cholesterol increased, blood triglycerides increased, hypertriglyceridemia lipids increased, total cholesterol/HDL ratio increased, and dyslipidemia) were reported for 24% Zortress patients, and 10% control patients.
New Onset of Diabetes After Transplant (NODAT)
Of the patients without diabetes mellitus at randomization, NODAT was reported in 32% in the Zortress group compared to 29% in the control group.
Table 3 compares the incidence of treatment-emergent adverse reactions reported with an incidence of ≥ 10% for patients receiving Zortress with reduced exposure tacrolimus or standard dose tacrolimus. Within each MedDRA system organ class, the adverse reactions are presented in order of decreasing frequency.
Table 3: Incidence Rates of
most Frequent ( ≥ 10% in Any Treatment Group) Adverse Reactions by Primary
System Organ Class and Preferred Term and Treatment (Safety population - 12
|Primary System Organ Class Preferred Term||Zortress (everolimus) with reduced exposure Tacrolimus
|Tacrolimus (standard exposure)
|Any Adverse Reaction/Infection||232 (95)||229 (95)|
|Blood & lymphatic system disorders||66 (27)||47 (20)|
|Leukopenia||29 (12)||12 (5)|
|Gastrointestinal disorders||136 (56)||121 (50)|
|Diarrhea||47 (19)||50 (21)|
|Nausea||33 (14)||28 (12)|
|Abdominal pain||32 (13)||22 (9)|
|General disorders and administration site conditions||94 (38)||85 (35)|
|Peripheral edema||43 (18)||26 (11)|
|Pyrexia||32 (13)||25 (10)|
|Fatigue||22 (9)||26 (11)|
|Infections and infestations||123 (50)||105 (44)|
|Hepatitis C*||28 (11)||19 (8)|
|Investigations||81 (33)||78 (32)|
|Liver function test abnormal||16 (7)||24 (10)|
|Nervous system disorders||89 (36)||85 (35)|
|Headache||47 (19)||46 (19)|
|Tremor||23 (9)||29 (12)|
|Vascular disorders||56 (23)||57 (24)|
|Hypertension||42 (17)||38 (16)|
|Primary system organ classes
are presented alphabetically.
* No de novo hepatitis C cases were reported
Less common adverse reactions, occurring overall in ≥ 1% to < 10% of either kidney or liver transplant patients treated with Zortress include:
Cardiac and Vascular Disorders: angina pectoris, atrial fibrillation, cardiac failure congestive, palpitations, tachycardia, hypertension including hypertensive crisis, hypotension, deep vein thrombosis
Gastrointestinal Disorders: abdominal distention, dyspepsia, dysphagia, epigastric discomfort, flatulence, gastroesophageal reflux disease, gingival hypertrophy, hematemesis, hemorrhoids, ileus, mouth ulceration, peritonitis, stomatitis
General Disorders and Administrative Site Conditions: chest discomfort, chest pain, chills, fatigue, incisional hernia, malaise, edema including generalized edema, pain
Hepatobiliary Disorders: hepatic enzyme increased, bilirubin increased, hepatitis (non-infectious)
Infections and Infestations: BK virus infection [See WARNINGS AND PRECAUTIONS], bacteremia, bronchitis, candidiasis, cellulitis, folliculitis, gastroenteritis, herpes infections, influenza, lower respiratory tract, nasopharyngitis, onychomycosis, oral candidiasis, oral herpes, osteomyelitis, pneumonia, pyelonephritis, sepsis, sinusitis, tinea pedis, upper respiratory tract infection, urethritis, urinary tract infection, wound infection [See BOXED WARNING and WARNINGS AND PRECAUTIONS]
Injury Poisoning and Procedural Complications: incision site complications including infections, perinephric collection, seroma, wound dehiscence, incisional hernia, perinephric hematoma, localized intraabdominal fluid collection, impaired healing, lymophocele, lymphorrhea
Investigations:blood alkaline phosphatase increased, white blood cell count decreased, transaminases increased
Metabolism and Nutrition Disorders: blood urea increased, acidosis, anorexia, dehydration, diabetes mellitus [See WARNINGS AND PRECAUTIONS], decreased appetite, fluid retention, gout, hypercalcemia, hypertriglyceridemia, hyperuricemia, hypocalcemia, hypoglycemia, hyponatremia, iron deficiency, new onset diabetes mellitus, vitamin B12 deficiency
Psychiatric Disorders: agitation, anxiety, depression, hallucination
Renal and Urinary Disorders: bladder spasm, hydronephrosis, micturation urgency, nephritis interstitial, pollakiuria, polyuria, proteinuria [See WARNINGS AND PRECAUTIONS], pyuria, renal artery thrombosis [See BOXED WARNING and WARNINGS AND PRECAUTIONS], acute renal failure, renal impairment [See WARNINGS AND PRECAUTIONS], renal tubular necrosis, urinary retention
Vascular Disorders: venous thromboembolism (including deep vein thrombosis), pulmonary embolism
Less common, serious adverse reactions occurring overall in < 1% of either kidney or liver transplant patients treated with Zortress include:
- Angioedema [See WARNINGS AND PRECAUTIONS]
- Interstitial Lung Disease/Non-Infectious Pneumonitis [See WARNINGS AND PRECAUTIONS and Serious and Otherwise Important Adverse Reactions]
- Pericardial effusions [See WARNINGS AND PRECAUTIONS]
- Thrombotic Microangiopathy (TMA), Thrombotic Thrombocytopenic Purpura (TTP), and Hemolytic Uremic Syndrome (HUS) [See WARNINGS AND PRECAUTIONS]
Adverse reactions identified from the postmarketing use of the combination regimen of Zortress and cyclosporine that are not specific to any one transplant indication include angioedema [See WARNINGS AND PRECAUTIONS], erythroderma, leukocytoclastic vasculitis, pancreatitis, pulmonary alveolar proteinosis, and pulmonary embolism. There have also been reports of male infertility with mTOR inhibitors including Zortress. [See WARNINGS AND PRECAUTIONS]
Read the entire FDA prescribing information for Zortress (Everolimus)
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