Description

Evermil 5 mg (Everolimus) – Fixed Low‑Dose mTOR Inhibitor for Transplant & Oncology

Evermil 5 mg contains 5 mg of the active ingredient everolimus, which is marketed in India by Glenmark Pharmaceuticals. This low-strength tablet is ideal for organ transplant rejection prophylaxis and select cancer therapy protocols. 

🎯 Key Therapeutic Uses

• Kidney (or liver) transplant rejection prophylaxis: Used with reduced-dose calcineurin inhibitors and steroids, especially in low-to-moderate immunological risk patients. Initial dosing often begins at 0.75 mg twice daily (with cyclosporine) or 1.5 mg twice daily (with tacrolimus), tailored to blood-plasma trough levels. 
• Oncology (in selected protocols): While standard doses (10 mg) are common, 5 mg may be used in dose titration regimens for metastatic renal cell carcinoma, hormone receptor–positive breast cancer, pancreatic neuroendocrine tumors, or TSC-related brain/kidney tumors in sensitive populations or during toxicity management.

⚙️ Mechanism of Action

Everolimus binds the intracellular FKBP‑12 protein and inhibits the mTORC1 complex, which slows proliferation of malignant cells, suppresses neovascularization, and modulates lymphocyte activation. This dual immunosuppressive and antiproliferative effect underpins its broad utility. 

🗓️ Low‑Dose Regimens & Administration

• Standard transplant regimen: 5 mg daily (e.g. 2.5 mg × 2) is commonly used post‑transplant to target everolimus trough levels of 3–8 ng/mL, customized based on CNI coadministration.
• Oncology dose tuning: Dose may be reduced to 5 mg daily alone or split (2.5 mg BID) in frail or elderly patients; dosing decisions are made by oncology teams based on tolerability and pharmacokinetics. 
• Always swallow whole with water; do not crush or chew. Can be taken with or without food at the same time every day for consistent absorption. 

⚠️ Side Effects & Monitoring

• Common (>20%): stomatitis, infections, hyperlipidemia, edema, anemia, fatigue, rash. Metabolic disturbances become evident even at low doses. 
• Serious risks: non-infectious pneumonitis, delayed wound healing, impaired vaccination response, BK virus nephropathy (in kidney recipients), TMA, skin malignancies. 
• Baseline labs and periodic monitoring: CBC, LFT, fasting lipids/glucose, renal function, mTOR trough levels, and lung function for early detection of pneumonitis. 

🔐 Precautions & Drug Interactions

• Avoid live vaccines during and up to several months post‑therapy. 
• Use caution with CYP3A4/P-gp modulators (e.g. ketoconazole, rifampin, grapefruit juice) as they significantly alter everolimus levels. Dose-adjust as prescribed.
• In transplant patients: coordinate with nephrology/immunology team to manage dosages of CNIs and steroids and monitor graft‑related blood biomarkers closely. 
• Pregnancy & breastfeeding contraindicated: teratogenic risk is high; contraception advised during treatment and several months after. 

❓ Frequently Asked Questions (FAQs)

1. Why use the 5 mg tablet when 10 mg is standard?

The 5 mg dose offers flexibility for pediatric or low‑clearance patients and allows precise titration when combined with other immunosuppressants or during dose escalation. 

2. What happens if a dose is missed?

If omitted within 6–8 hours, take it as soon as remembered; otherwise skip and return to the usual schedule. Do not double the next dose. 

3. How often should labs be drawn?

Transplant patients: monitor everolimus trough levels (C₀) at 3–5 days post-initiation, then weekly during the first month, followed by monthly to maintain 3–8 ng/mL early, 4–8 ng/mL later. 

4. Can Evermil 5 mg slow healing after surgery?

Yes—mTOR inhibition delays tissue repair. Surgery should ideally be postponed ≥1 week after discontinuation; monitor wound closely if therapy resumed early. 

5. How does long‑term use affect cancer risk?

Chronic immunosuppression may increase the risk of lymphomas or skin malignancies. Regular dermatological surveillance and sun protection are advised.