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

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.