Home Drug Guide Temsirolimus

Drug Guide

Generic Name

Temsirolimus

Brand Names Torisel

Classification

Therapeutic: Antineoplastic Agent

Pharmacological: mTOR Inhibitor

FDA Approved Indications

Treatment of advanced renal cell carcinoma (RCC)

Mechanism of Action

Temsirolimus inhibits the mammalian target of rapamycin (mTOR) pathway, which is involved in cell growth, proliferation, and angiogenesis, thereby inhibiting tumor cell growth and angiogenesis.

Dosage and Administration

Adult: 25 mg IV weekly over 30–60 minutes

Pediatric: Not approved for pediatric use

Geriatric: No specific dosage adjustments recommended based on age alone, but consider renal and hepatic function

Renal Impairment: Use with caution; no specific dose adjustment, monitor renal function

Hepatic Impairment: Use with caution; reduce dose in severe hepatic impairment; no specific dose adjustment for mild to moderate impairment

Pharmacokinetics

Absorption: Administered intravenously, bypassing absorption issues

Distribution: Extensively bound to plasma proteins

Metabolism: Metabolized primarily via CYP3A4/5 enzymes

Excretion: Excreted mainly in feces, minimal urinary excretion

Half Life: Approximately 14–18 hours

Contraindications

Known hypersensitivity to temsirolimus or its components

Precautions

Use in patients with pre-existing lymphopenia, active infection, bleeding disorders, hepatic impairment, or renal impairment; monitor blood counts and hepatic function regularly

Adverse Reactions - Common

Mucositis/stomatitis (Common)
Fatigue (Common)
Nausea and vomiting (Common)
Hyperglycemia (Common)
Hyperlipidemia (Common)
Thrombocytopenia (Common)

Adverse Reactions - Serious

Interstitial lung disease/pneumonitis (Serious but rare)
Severe infection (Rare)
Anaphylaxis (Rare)
Hepatotoxicity (Rare)

Drug-Drug Interactions

CYP3A4 inducers (e.g., rifampin), CYP3A4 inhibitors (e.g., ketoconazole)

Drug-Food Interactions

Grapefruit and grapefruit juice (may inhibit CYP3A4)

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood counts, liver and renal function, lipid profile, signs of infection, and pulmonary symptoms before and during therapy

Diagnoses:

Risk for infection
Impaired skin integrity
Risk for bleeding

Implementation: Administer IV as scheduled, monitor for adverse effects, educate patient on signs of toxicity and infection, manage mucositis with appropriate care

Evaluation: Assess response to therapy through imaging, monitor lab values and side effects, ensure patient adheres to scheduled assessments

Patient/Family Teaching

Report signs of infection, bleeding, or lung problems promptly
Maintain good skin and oral hygiene
Follow dietary and activity recommendations
Understand the importance of regular lab monitoring

Special Considerations

Black Box Warnings:

Risk of infection and pulmonary toxicity (pneumonitis/Interstitial lung disease)

Genetic Factors: No specific genetic testing recommended, but pharmacogenomic data may influence metabolism

Lab Test Interference: May cause elevated lipid levels, hyperglycemia, and abnormal liver function tests

Overdose Management

Signs/Symptoms: Severe mucositis, infection, pulmonary symptoms, thrombocytopenia

Treatment: Supportive care, monitor vital signs and labs, consider hospitalization for severe reactions, no specific antidote

Storage and Handling

Storage: Store at room temperature (20°C to 25°C), protected from light

Stability: Stable for the duration of the labeled expiration date when stored properly