title: Drug interactions and the pharmacist: focus on everolimus.
abstract: OBJECTIVE
  To evaluate everolimus drug-drug and drug-food interactions, with an emphasis on patients with cancer.
  
  
  METHODS
  Literature was accessed through PubMed (1990-March 2013) using Boolean combinations of the terms drug interactions, herb-drug interactions, food-drug interactions, everolimus, antineoplastic agents, hormonal, and breast neoplasms. In addition, reference citations from publications and the prescribing information for everolimus were reviewed.
  
  
  METHODS
  All articles published in English, including human, animal, and in vitro studies, identified from the data sources were included.
  
  
  RESULTS
  Patients with cancer are at increased risk for drug interactions because of the multiple medications they are prescribed to treat their disease and comorbid conditions. Everolimus, an oral mammalian target of rapamycin (mTOR) inhibitor, is indicated for the treatment in adults with progressive neuroendocrine tumors of pancreatic origin that are unresectable, locally advanced, or metastatic; adults with advanced renal cell carcinoma after failure of treatment with sunitinib or sorafenib; and, recently, postmenopausal women with advanced hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer in combination with exemestane after failure of treatment with letrozole or anastrozole. As its use increases among patients with cancer, clinicians must be knowledgeable about potential drug and/or food/nutrient interactions and the mechanisms by which these interactions occur, to mitigate and prevent unwanted reactions and ensure patient safety.
  
  
  CONCLUSIONS
  Everolimus is a widely used oral mTOR inhibitor that has the potential for drug interactions that may affect therapeutic outcomes, produce toxicities, or both. This article provides a review of evidence-based literature, along with the prescribing information, to educate clinicians on the significance of these drug interactions and their impact on management with everolimus.
authors.affiliation: Early Phase Investigational Therapeutics, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA. Jennifer.Grabowsky@ucsfmedctr.org
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Grabowsky
mesh_terms: D000818:Animals; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000378:metabolism*; D004347:Drug Interactions / Q000502:physiology*; D000068338:Everolimus; D018565:Food-Drug Interactions / Q000502:physiology*; D041743:Herb-Drug Interactions / Q000502:physiology*; D006801:Humans; D010595:Pharmacists / Q000592:standards; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000378:metabolism
chemical_list: D000970:Antineoplastic Agents; D000068338:Everolimus; D020123:Sirolimus