Patient Comments

This suggestion comes from CS posted on 6/21/23

Sirolimus is metabolized by the cytochrome P450 3A enzyme system. Strong inhibitors like Grapefruit juice of P450 slow metabolism and result in prolonged high levels of Sirolimus.

Strong Inducers of cytochrome P450 speed metabolism and quickly result in low levels. CS suggests combining these two. For the first few days after taking a regular dose of sirolimus, drink 8 oz grapefruit juice a day. On day 4 switch to St John's wort and speed up metabolism.

This requires monitoring of Sirolimus blood levels. CS reported these numbers from Ultra Lab tests.

2/17/23 sirolimus 45.7

2/23/23 sirolimus 2.5 

Why is this helpful? The benefits are related to high blood levels. The absence of side effects related to LOW blood levels before the new dose.

In some conditions, such as using Sirolimus as an adjuvant treatment to metastatic cancer; you might desire a very high dose for a few days and then quickly reduce the blood level.

Almost nobody has explored this technique of combining strong inhibitors with strong inducers. 

Thanks to CS for his suggestion.