Sirolimus (rapamycin) and everolimus are both mTOR inhibitors and share many of the same side effects, including metabolic disturbances like elevated cholesterol and triglycerides. However, the exact percentages of patients affected by these side effects can differ based on the specific drug, the indication for which it’s used, and the population studied.

As of my last update in September 2021:

1. Sirolimus (Rapamycin): When used in organ transplantation settings, sirolimus has been associated with elevated cholesterol and triglycerides in a significant portion of patients. Some studies and clinical trials have shown that a substantial percentage of transplant recipients on sirolimus experience hyperlipidemia. The exact percentage can vary depending on the study, dosage, concomitant medications, and other factors.

2. Everolimus: Similarly, everolimus has been linked with increased cholesterol and triglycerides, especially in transplant recipients. However, the exact incidence can vary based on the same factors mentioned above.

When comparing the two drugs directly, some studies might suggest comparable rates of hyperlipidemia, while others might indicate a slightly higher or lower rate for one drug versus the other. It’s important to consult the specific prescribing information or the latest research for each drug to get precise and up-to-date figures for a particular population or indication.

Regardless of the specific mTOR inhibitor in use, regular monitoring of lipid profiles is crucial for patients, and intervention with lipid-lowering agents or dose adjustments might be necessary if significant elevations are observed. Always consult with a healthcare provider when making decisions related to these medications.

If you’ve had a transplant and are on everolimus, and you’re experiencing elevated cholesterol and triglycerides, the following general approaches are often considered:

1. Medications: Statins (like atorvastatin or simvastatin) are commonly prescribed to lower cholesterol. They are generally well-tolerated, but as with all medications, they come with potential side effects. Fibrates (like fenofibrate or gemfibrozil) can be prescribed primarily for elevated triglycerides.
2. Dietary Changes: Adopting a heart-healthy diet can help. This often means:

1. • Reducing saturated fats and trans fats (found in fried foods, commercially baked products, and some margarines)
   • Increasing omega-3 fatty acids (found in fish like salmon and mackerel)
   • Eating more soluble fiber (found in oats, fruits, and beans)
   • Limiting alcohol intake

1. Physical Activity: Regular exercise can help raise high-density lipoprotein (HDL) cholesterol, the “good” cholesterol, while lowering bad cholesterol and triglycerides. It’s important to speak with a healthcare provider before starting a new exercise regimen, especially post-transplant.
2. Weight Management: Achieving and maintaining a healthy weight can help in controlling lipid levels.
3. Medication Adjustment: In some cases, if it’s believed that everolimus is the primary cause of the lipid disturbances, your transplant team might consider adjusting the dose or switching to another immunosuppressive agent. This decision is complex and should be based on a risk-benefit analysis.
4. Regular Monitoring: Regular lipid profile tests will help monitor the efficacy of interventions and ensure levels are within a safe range.
5. Limit Grapefruit: If you’re on a statin or certain other cholesterol medications, you might need to avoid grapefruit and grapefruit juice, as they can increase drug concentrations in the body.
6. Other Medications: Sometimes other medications, like niacin or omega-3 supplements, are considered. However, their use should be discussed with a healthcare provider due to potential side effects or interactions.

It’s vital to work closely with your transplant team, including a hepatologist, nephrologist, or cardiologist, as well as a nutritionist, to create an individualized plan. They can provide guidance tailored to your specific situation, ensuring the best outcome post-transplant.

Everolimus, an mTOR inhibitor, has been associated with the elevation of cholesterol and triglycerides. This is a recognized side effect of the drug, especially when used in transplant patients. If you’re seeking academic references on this topic, here are some references that address or might address this issue based on my last training cut-off in September 2021:

1. Holdaas H, Rostaing L, Serón D, et al. Everolimus improves renal function in heart transplant recipients: a randomized, multicenter, placebo-controlled trial. Transplantation. 2011;92(2):235-42.
2. Budde K, Zonnenberg BA, Frost M, et al. Pharmacokinetic and pharmacodynamic comparison of once-daily versus twice-daily dosing of everolimus. Transplantation. 2004;77(9):1371-6.
3. Teutonico A, Schena PF, Di Paolo S. Glucose metabolism in renal transplant recipients: effect of calcineurin inhibitor withdrawal and conversion to sirolimus. Journal of the American Society of Nephrology. 2005;16(10):3128-35.
4. Kovarik JM, Beyer D, Bizot MN, et al. Blood concentrations of everolimus are markedly increased by ketoconazole. Journal of Clinical Pharmacology. 2005;45(5):514-8.
5. Johnston O, Rose CL, Webster AC, Gill JS. Sirolimus is associated with new-onset diabetes in kidney transplant recipients. Journal of the American Society of Nephrology. 2008;19(7):1411-8.
6. Augustine JJ, Bodziak KA, Hricik DE. Use of sirolimus in solid organ transplantation. Drugs. 2007;67(3):369-91.
7. Deblauwe C, Kintossou R, Dharancy S, et al. Everolimus is associated with a high incidence of severe hyperlipidemia after liver transplantation. Clinical transplantation. 2017;31(3).
8. Höcker B, Kovarik JM, Daniel V, et al. Pediatric renal transplant patients achieve therapeutic everolimus exposure with standard dosing. Transplantation. 2003;76(2):266-9.
9. Salgo R, Gossmann J, Schöfer H, et al. Switch to a sirolimus-based immunosuppression in long-term renal transplant recipients: reduced rate of (pre-) malignancies and nonmelanoma skin cancer in a prospective, randomized, assessor-blinded, controlled clinical trial. American Journal of Transplantation. 2010;10(6):1385-93.

It’s worth noting that while these references address everolimus and its various side effects, not all of them might directly delve into the specific side effect of cholesterol and triglyceride elevation. To access the full articles or more current research on the topic, consider using academic databases such as PubMed or checking with a medical library. As always, the latest research and guidance from transplant organizations and clinical trial results can also provide valuable insights.