FrancophonIA/ELRC3.0 huggingface dataset:
English: Enrollment in the patient stratum with baseline calculated GFR below 40 mL/min was discontinued due to an imbalance in safety events (see section 4.8).
Danish: Inklusion af patienter i gruppen med en beregnet baseline-GFR på under 40 ml/min blev stoppet på grund af ubalance i hændelser vedrørende sikkerhed (se pkt.
English: What Rapamune looks like and contents of the pack Rapamune oral solution is a pale yellow to yellow solution supplied in a 60 mL bottle.
Danish: Rapamune oral opløsning er en lysegul til gul opløsning, som leveres i en 60 ml flaske.
English: Multiple-dose administration of erythromycin and sirolimus oral solution significantly increased the rate and extent of absorption of both medicinal products.
Danish: Flerdosisadministration af erythromycin og sirolimus oral opløsning påvirker signifikant hastigheden og graden af absorptionen af begge lægemidler.
English: Also contains: ethanol, propylene glycol (E1520), soya fatty acids.
Danish: Indeholder også: ethanol, propylenglycol (E1520), sojafedtsyrer.
English: The clearance of sirolimus may be reduced in patients with impaired hepatic function (see section 5.2).
Danish: Sirolimusclearance kan være nedsat hos patienter med nedsat leverfunktion (se pkt.
English: Keep Rapamune oral solution in its original bottle in order to protect from light.
Danish: Rapamune oral opløsning opbevares i originalflasken for at beskytte mod lys.
English: Once the dosing syringe has been filled with Rapamune oral solution, it should be kept at room temperature, but not above 25C, for maximum 24 hours.
Danish: Når doseringssprøjten er blevet fyldt med Rapamune oral opløsning, skal den opbevares ved stuetemperatur, men ikke over 25
English: Therefore, the sirolimus dose was approximately 4-fold higher to account for both the absence of the pharmacokinetic interaction with ciclosporin (2-fold increase) and the augmented immunosuppressive requirement in the absence of ciclosporin (2-fold increase).
Danish: Sirolimus-dosis er derfor ca. 4 gange så høj for at tage højde for både den manglende farmakokinetiske interaktion med ciclosporin (dobbelt stigning) og det forøgede immunsuppressive behov i mangel af ciclosporin (dobbelt stigning).
English: In mild and moderate hepatically impaired patients (Child-Pugh classification A or B), mean values for sirolimus AUC and t1/2 were increased 61% and 43%, respectively, and CL/F was decreased 33% compared to normal healthy subjects.
Danish: Hos patienter med mild og moderat nedsat leverfunktion (Child-Pugh klassifikation A eller B) steg gennemsnitsværdierne for sirolimus AUC og t½ med hhv. 61% og 43%, og CL/F faldt med 33% sammenlignet med normale raske individer.
English: Based on information from an open-label randomised study, conversion from the calcineurin inhibitor tacrolimus to Rapamune in maintenance renal transplant patients was associated with an unfavourable safety profile without efficacy benefit and can therefore not be recommended (see section 5.1).
Danish: I et åbent, randomiseret forsøg blev skift fra calcineurinhæmmer-tacrolimus til Rapamune som vedligeholdelse hos nyretransplanterede patienter forbundet med en ugunstig sikkerhedsprofil uden effekt fordel og kan derfor ikke anbefales (se pkt.
English: Most patients who received 2 mg of Rapamune 4 hours after ciclosporin had whole blood trough concentrations of sirolimus within the 4 to 12 ng/mL target range (expressed as chromatographic assay values).
Danish: De fleste patienter, som fik 2 mg Rapamune 4 timer efter ciclosporin, havde sirolimus-dalkoncentrationer i fuldblod inden for intervallet 4-12 ng/ml (udtrykt som kromatografisk analyseværdi).
English: Sirolimus pharmacokinetic parameters following daily doses of 2 mg Rapamune tablets administered in combination with ciclosporin microemulsion (4 hours prior to Rapamune tablets) and corticosteroids in 13 renal transplant patients, based on data collected at months 1 and 3 after transplantation, were: Cmin,ss 7.39  2.18 ng/mL; Cmax,ss 15.0  4.9 ng/mL; tmax,ss 3.46  2.40 hours; AUC,ss 230  67 ng.h/mL; CL/F/WT, 139  63 mL/h/kg (parameters calculated from LC-MS/MS assay results).
Danish: De farmakokinetiske parametre for sirolimus efter daglige doser på 2 mg Rapamune tabletter indgivet i kombination med ciclosporin mikroemulsion (4 timer før Rapamune tabletter) og kortikosteroider hos 13 nyretransplanterede patienter, baseret på data indsamlet 1 og 3 måneder efter transplantation, er: Cmin,ss, 7,39  2,18 ng/ml; Cmax,ss, 15,0  4,9 ng/ml; tmax,ss, 3,46  2,40 timer; AUC,ss, 230  67 ng.time/ml; CL/F/WT, 139  63 ml/time/kg (parametre beregnet ud fra LC-MS/MS testresultater).
English: Co-administration of sirolimus (2 mg single dose) with multiple-dose administration of oral voriconazole (400 mg every 12 hours for 1 day, then 100 mg every 12 hours for 8 days) in healthy subjects has been reported to increase sirolimus Cmax and AUC by an average of 7-fold and 11-fold respectively.
Danish: Samtidig administration af sirolimus (2 mg enkeltdosis) og flerdosisadministration af oral voriconazol (400 mg hver 12. time i 1 dag, og derefter 100 mg hver 12. time i 8 dage) til raske personer er rapporteret at øge sirolimus Cmax med gennemsnitligt 7 gange og AUC med gennemsnitligt 11 gange.
English: The rates of premature study discontinuation, adverse events overall (and infections, specifically), and biopsy-proven acute liver graft rejection at 12 months were all significantly greater in the sirolimus conversion group compared to the CNI continuation group.
Danish: Frekvensen af for tidlig forsøgsafbrydelse, samlede antal bivirkninger (og specielt infektioner) og biopsidokumenteret akut afstødning af levertransplantatet efter 12 måneder var alle signifikant større i gruppen, der skiftede til sirolimus, end i gruppen, der fortsatte med CNIbehandling.
English: More patients converted to sirolimus developed new onset diabetes mellitus defined as 30 days or longer of continuous or at least 25 days non-stop (without gap) use of any diabetic treatment after randomisation, a fasting glucose ≥126 mg/dL or a non-fasting glucose ≥200 mg/dL after randomisation (18.3% vs. 5.6%, p=0.025*).
Danish: Flere patienter, som skiftede til sirolimus, udviklede nyopstået diabetes mellitus, defineret som brug af enhver diabetesbehandling efter randomisering kontinuerligt i 30 dage eller længere eller i mindst 25 dage non-stop (uden afbrydelse), fastende glukose ≥ 126 mg/dl eller ikke-fastende glukose ≥ 200 mg/dl efter randomisering (18,3 % vs 5,6 %, p = 0,025*).
English: The longer half-lives observed in hepatically impaired patients delay reaching steady-state.
Danish: Den længere halveringstid hos patienter med nedsat leverfunktion forsinker opnåelse af steady-state.
English: Also contains: lactose monohydrate, sucrose.
Danish: Indeholder også: lactosemonohydrat, saccharose.
English: In most patients, dose adjustments can be based on simple proportion: new Rapamune dose=current dose x (target concentration/current concentration).
Danish: Hos størstedelen af patienterne kan dosisjusteringer baseres på en simple beregning: ny Rapamunedosis = nuværende dosis x (mål for koncentration/nuværende koncentration).
English: New onset nephrosis (nephrotic syndrome) was also reported in 2% of the patients in the study (see section 4.8).
Danish: Nyt frembrud af nyresygdom (nefrotisk syndrom) blev rapporteret hos 2% af patienterne i forsøget (se pkt.
English: Concomitant immunosuppressive agents included mycophenolate mofetil, azathioprine, and corticosteroids.
Danish: Samtidige immunsuppressiva omfattede mycophenolatmofetil, azathioprin og kortikosteroider.
English: Multiples of 0.5 mg tablets should not be used as a substitute for the 1 mg tablet or for other strengths (see section 5.2).
Danish: Der bør ikke tages flere 0,5 mg tabletter som erstatning for en 1 mg tablet eller andre styrker (se pkt.
English: Inhibitors of CYP3A4 (such as ketoconazole, voriconazole, itraconazole, telithromycin, or clarithromycin) decrease the metabolism of sirolimus and increase sirolimus levels.
Danish: CYP3A4hæmmere (som f.eks. ketoconazol, voriconazol, itraconazol, telithromycin eller clarithromycin) nedsætter metaboliseringen af sirolimus og øger sirolimusniveauet.
English: Your doctor will perform tests to monitor the levels of Rapamune in your blood.
Danish: Deres læge vil tage prøver for at måle niveauet af Rapamune i Deres blod.
English: Carcinogenicity studies conducted in mouse and rat showed increased incidences of lymphomas (male and female mouse), hepatocellular adenoma and carcinoma (male mouse) and granulocytic leukaemia (female mouse).
Danish: Carcinogenicitetsforsøg udført på mus og rotter viser øget hyppighed af lymfomer (han- og hunmus), hepatocellulært adenom og carcinom (hanmus) og granulocytisk leukæmi (hunmus).
English: Empty the correct amount of Rapamune from the syringe into only a glass or plastic container with at least 60 mL of water or orange juice.
Danish: Den korrekte mængde Rapamune tømmes fra sprøjten over i enten en glas- eller plastikbeholder med mindst 60 ml vand eller appelsinjuice.
English: Very common: may affect more than 1 in 10 people
Danish: Meget almindelige (forekommer hos flere end 1 ud af 10 patienter):
English: The concomitant use of sirolimus with a calcineurin inhibitor may increase the risk of calcineurin inhibitor-induced HUS/TTP/TMA.
Danish: Samtidig brug af sirolimus og en calcineurinhæmmer kan øge risikoen for calcineurinhæmmerinduceret HUS/TTP/TMA.
English: It is not recommended that Rapamune be taken with rifampicin, ketoconazole or voriconazole.
Danish: Det frarådes at tage Rapamune samtidig med rifampicin, ketoconazol og voriconazol.
English: Prophylaxis of organ rejection
Danish: Forebyggelse af organafstødning
English: The risk/benefit should be considered in patients with established hyperlipidaemia before initiating an immunosuppressive regimen, including Rapamune.
Danish: Fordele og ulemper ved behandling af patienter med fastslået hyperlipidæmi bør overvejes, før immunsupprimerende behandling herunder Rapamune påbegyndes.
English: Multiples of 0.5 mg tablets should not be used as a substitute for 1 mg and 2 mg tablets, as the different strengths are not directly interchangeable.
Danish: De må ikke tage flere 0,5 mg tabletter i stedet for 1 mg og 2 mg tabletterne, da de forskellige tabletstyrker ikke direkte kan erstatte hinanden.
English: Nephrotic syndrome (see section 4.4); Focal segmental glomerulosclerosis*
Danish: 4.4), fokal segmental glomerulosklerose*
English: Kidney damage with low blood cell counts (thrombocytopaenic purpura/haemolytic uraemic syndrome)
Danish: Nyreskade med lavt antal blodceller (trombocytopenisk purpura/hæmolytisk uræmisk syndrom)
English: Pyelonephritis; Cytomegalovirus infection; Herpes zoster caused by the varicella zoster virus
Danish: Sepsis, pyelonephritis, cytomegalovirus-infektion, herpes zosterforårsaget af varicella zoster-virus
English: Sirolimus inhibits the activated mTOR pathway and thus the proliferation of LAM cells.
Danish: Sirolimus hæmmer den aktiverede mTOR-signalvej og dermed proliferationen af LAM-celler.
English: In a study evaluating conversion from calcineurin inhibitors to Rapamune in maintenance renal transplant patients, increased urinary protein excretion was commonly observed at 6 to 24 months after conversion to Rapamune (see section 5.1).
Danish: I et forsøg, hvor skift fra calcineurinhæmmere til Rapamune blev undersøgt hos nyretransplanterede patienter i vedligeholdelsesbehandling, blev øget udskillelse af urinprotein almindeligvis set 6-24 måneder efter skiftet til Rapamune (se pkt.
English: CARTONS - PACK SIZES 30 AND 100 TABLETS
Danish: ÆSKER - PAKNINGSSTØRRELSE 30 og 100 TABLETTER
English: In some cases, the angioedema has resolved upon discontinuation or dose reduction of Rapamune.
Danish: I nogle tilfælde er angioødemet forsvundet igen efter seponering eller dosisnedsættelse af Rapamune.
English: Each mL contains up to 25 mg of ethanol, approximately 350 mg of propylene glycol (E1520), and 20 mg of soya oil.
Danish: Hjælpestoffer, som behandleren skal være opmærksom på Hver ml indeholder op til 25 mg ethanol, ca. 350 mg propylenglycol (E1520) og 20 mg sojaolie.
English: With concentration-control (target concentrations 5 to 15 ng/mL), the median sirolimus concentration at the end of 12 months of treatment was 6.8 ng/mL (interquartile range 5.9 to 8.9 ng/mL; n=37).
Danish: Med koncentration-kontrol (målkoncentrationer 5 til 15 ng/ml) var den mediane sirolimus-koncentration 6,8 ng/ml efter 12 måneders behandling (interkvartilområde 5,9 til 8,9 ng/ml; n=37).
English: If this occurs, simply bring your Rapamune oral solution to room temperature and shake gently.
Danish: Hvis dette sker, skal Rapamune oral opløsning blot have stuetemperatur igen og rystes forsigtigt.
English: Inducers of CYP3A4 may increase the metabolism of sirolimus and decrease sirolimus blood levels (e.g. St. John's Wort (Hypericum perforatum), anticonvulsants: carbamazepine, phenobarbital, phenytoin).
Danish: CYP3A4-induktorer kan øge metaboliseringen af sirolimus og nedsætte sirolimusniveauet i blodet (f.eks. perikon (Hyperikum perforatum), antiepileptika: carbamazepin, phenobarbital, phenytoin).
English: Rapamune may be continued as maintenance therapy with corticosteroids only if ciclosporin microemulsion can be progressively discontinued (see sections 4.2 and 5.1).
Danish: Vedligeholdelsesbehandling med Rapamune og kortikosteroider må kun fortsætte, hvis ciclosporin-mikroemulsion kan seponeres gradvist (se pkt.
English: Stomach pain, diarrhoea, constipation, nausea
Danish: Abdominalsmerter, diarré, obstipation, kvalme
English: What Rapamune contains
Danish: Rapamune indeholder:
English: Inhibitors of P-gp may decrease the efflux of sirolimus from intestinal cells and increase sirolimus levels.
Danish: P-gp-hæmmere kan nedsætte udstrømningen af sirolimus fra tarmcellerne og øge sirolimusniveauet.
English: Rare reports of fatal hepatic necrosis have been reported with elevated trough sirolimus levels.
Danish: Sjældne tilfælde af dødelig hepatisk nekrose er rapporteret, når dalkoncentrationen af sirolimus stiger.
English: Data from controlled studies for treatment of S-LAM longer than one year are currently not available, therefore the benefit of treatment should be reassessed when used long-term.
Danish: Data fra kontrollerede forsøg i forbindelse med behandling af S-LAM, der varer udover et år, er endnu ikke tilgængelige.
English: Tablet core: lactose monohydrate, macrogol, magnesium stearate, talc Tablet coating: macrogol, glycerol monooleate, pharmaceutical glaze, calcium sulfate, microcrystalline cellulose, sucrose, titanium dioxide, poloxamer 188, -tocopherol, povidone, carnauba wax, Printing ink (Shellac, Iron Oxide Red, Propylene Glycol [E1520], Concentrated Ammonia Solution, Simethicone).
Danish: Tabletovertræk: macrogol, glycerolmono-oleat, shellac, calciumsulfat; mikrokrystallinsk cellulose, saccharose, titandioxid, poloxamer 188, -tocopherol, povidon, carnaubavoks og prægeblæk (shellac, rød jernoxid, propylenglycol [E1520], koncentreret ammoniakopløsning, simeticon).
English: Brown iron oxide (E172)
Danish: Brun jernoxid (E172)
English: Sirolimus was not mutagenic in the in vitro bacterial reverse mutation assays, the Chinese Hamster Ovary cell chromosomal aberration assay, the mouse lymphoma cell forward mutation assay, or the in vivo mouse micronucleus assay.
Danish: Sirolimus er ikke mutagent i in vitro bakteriel omvendt mutationsbestemmelse, kromosomafvigelsesbestemmelse i en kinesisk hamsters ovariecelle, fremadrettet mutationsbestemmelse i muselymfecelle eller in vivo mikronuklear bestemmelse i mus.
English: The concomitant administration of Rapamune and angiotensin-converting enzyme (ACE) inhibitors has resulted in angioneurotic oedema-type reactions.
Danish: Samtidig administration af Rapamune og ACE-hæmmere har medført angioødemlignende reaktioner.
English: In another study enrolling renal transplant patients 20 years of age and below that was intended to assess the safety of progressive corticosteroid withdrawal (beginning at six months post-transplantation) from an immunosuppressive regimen initiated at transplantation that included full-dose immunosuppression with both Rapamune and a calcineurin inhibitor in combination with basiliximab induction, of the 274 patients enrolled, 19 (6.9%) were reported to have developed post-transplant lymphoproliferative disorder (PTLD).
Danish: I et andet forsøg, der inkluderede nyretransplanterede patienter i alderen 20 år og derunder, hvor hensigten var at vurdere sikkerheden ved en gradvis seponering af kortikosteroider (begyndende 6 måneder efter transplantationen) fra et immunsuppressivt regime, som blev initieret ved transplantationen og indeholdt fuld dosis immunosuppression med både Rapamune og en calcineurinhæmmer i kombination med basiliximab-induktion, blev det observeret, at 19 (6,9%) af de 274 inkluderede patienter udviklede lymfoproliferativ sygdom efter transplantationen (PTLD).
English: During Rapamune therapy with or without CsA, patients should be monitored for elevated lipids, and patients administered an HMG-CoA reductase inhibitor and/or fibrate should be monitored for the possible development of rhabdomyolysis and other adverse reactions, as described in the respective Summary of Product Characteristics of these agents.
Danish: Under behandling med Rapamune med eller uden ciclosporin (CsA) bør patienter kontrolleres for forhøjede nivauer af lipider, og patienter, der får HMG-CoA-reduktasehæmmer og/eller fibrat, bør kontrolleres for mulig udvikling af rabdomyolyse eller andre bivirkninger, som er beskrevet i de respektive produktresuméer for disse stoffer.
English: Elevated sirolimus levels, for example due to interaction with strong CYP3A4 inhibitors, (with/without concomitant ACE inhibitors) may also potentiate angioedema (see section 4.5).
Danish: Forhøjet sirolimusniveau, fx på grund af interaktion med potente CYP3A4-hæmmere (med/uden samtidige ACE-hæmmer) kan også potensere angioødem (se pkt.
English: Each pack contains: one bottle (amber glass) containing 60 mL of Rapamune solution, one syringe adapter, 30 dosing syringes (amber plastic) and one syringe carry case.
Danish: Hver pakning indeholder: 1 flaske (ravfarvet glas) indeholdende 60 ml Rapamune opløsning, 1 sprøjteadapter, 30 doseringssprøjter (ravfarvet plastik) og 1 transportæske til sprøjte.
English: The most commonly reported adverse reactions (occurring in 10% of patients) are thrombocytopaenia, anaemia, pyrexia, hypertension, hypokalaemia, hypophosphataemia, urinary tract infection, hypercholesterolaemia, hyperglycaemia, hypertriglyceridaemia, abdominal pain, lymphocoele, peripheral oedema, arthralgia, acne, diarrhoea, pain, constipation, nausea, headache, increased blood creatinine, and increased blood lactate dehydrogenase (LDH).
Danish: De hyppigst rapporterede bivirkninger (forekommer hos > 10% af patienterne) er trombocytopeni, anæmi, pyreksi, hypertension, hypokaliæmi, hypofosfatæmi, urinvejsinfektion, hyperkolesterolæmi, hyperglykæmi, hypertriglyceridæmi, abdominalsmerter, lymfocele, perifert ødem, artralgi, akne, diarré, smerte, forstoppelse, kvalme, hovedpine, øget kreatinin i blodet og øget laktatdehydrogenase (LDH).
English: Rapamune was assessed in a 36-month controlled clinical study enrolling renal transplant patients below 18 years of age considered at high-immunologic risk, defined as having a history of one or more acute allograft rejection episodes and/or the presence of chronic allograft nephropathy on a renal biopsy.
Danish: Rapamune blev vurderet i et kontrolleret klinisk forsøg af 36 måneders varighed, hvor der er inkluderet nyretransplanterede patienter i alderen under 18 år, som anses for at have en høj immunologisk risiko, defineret som havende én eller flere akutte episoder med afstødning af homologt transplantat i anamnesen og/eller med tilstedeværelse af kronisk afstødning af nyretransplantat bekræftet ved nyrebiopsi.
English: The use of Rapamune in combination with calcineurin inhibitors and corticosteroids was associated with an increased risk of deterioration of renal function, serum lipid abnormalities (including, but not limited to, increased serum triglycerides and cholesterol), and urinary tract infections.
Danish: Brugen af Rapamune i kombination med calcineurinhæmmere og kortikosteroider blev forbundet med en øget risiko for svækkelse af nyrefunktionen, abnorme niveauer af serum-lipider (herunder, men ikke begrænset til, forhøjede niveauer af serum-triglycerider og serum-kolesterol) samt urinvejsinfektioner.
English: Side effect frequencies
Danish: Hyppigheden af bivirkninger
English: When taken with medicines called calcineurin inhibitors (ciclosporin or tacrolimus), Rapamune may increase the risk of kidney damage with low blood platelets and low red blood cell counts, with or without rash (thrombocytopaenic purpura/haemolytic uraemic syndrome).
Danish: Hvis Rapamune tages sammen med medicin, som kaldes calcineurinhæmmere (ciclosporin eller tacrolimus), kan det muligvis øge risikoen for nyreskade med et lavt antal blodplader og røde blodlegemer, med eller uden udslæt (trombocytopenisk purpura/hæmolytisk uræmisk syndrom).
English: A clinical study in liver transplant patients randomised to conversion from a calcineurin inhibitor (CNI)-based regimen to a sirolimus-based regimen versus continuation of a CNI-based regimen 6-144 months post-liver transplantation failed to demonstrate superiority in baseline-adjusted GFR at 12 months (-4.45 mL/min and -3.07 mL/min, respectively).
Danish: Et klinisk forsøg med levertransplanterede patienter randomiseret til skift fra en calcineurinhæmmer (CNI)-baseret behandling til en sirolimusbaseret behandling versus fortsat CNI-baseret behandling 6144 måneder efter levertransplantationen kunne ikke dokumentere en forbedring i baseline-justeret GFR efter 12 måneder (henholdsvis -4,45 ml/min.
English: Each pack contains: one bottle (amber glass) containing 60 mL of Rapamune solution, one syringe adapter, 30 dosing syringes (amber polypropylene) and one syringe carry case.
Danish: Hver pakning indeholder: 1 flaske (ravfarvet glas) indeholdende 60 ml Rapamune opløsning, 1 sprøjteadapter, 30 doseringssprøjter (ravfarvet polypropylen) og 1 transportæske til sprøjte.
English: In severe hepatically impaired patients (Child-Pugh classification C), mean values for sirolimus AUC and t1/2 were increased 210% and 170% respectively, and CL/F was decreased by 67% compared to normal healthy subjects.
Danish: Hos patienter med svært nedsat leverfunktion (Child-Pugh klassifikation C) var gennemsnitsværdierne for sirolimus AUC og t½ øget med henholdsvis 210% og 170%, og CL/F var nedsat med 67% sammenlignet med normale raske frivillige personer.
English: In patients with severe hepatic impairment, reduction in maintenance dose by one half is recommended based on decreased clearance (see sections 4.2 and 5.2).
Danish: Hos patienter med svært nedsat leverfunktion anbefales reduktion af vedligeholdelsesdosis til halv dosis på grund af den nedsatte clearance (se pkt.
English: In reproduction toxicity studies decreased fertility in male rats was observed.
Danish: I reproduktionstoksicitsforsøg er der set nedsat fertilitet hos hanrotter.
English: Rapamune should be taken consistently, either with or without food.
Danish: Rapamune bør tages konsekvent enten med eller uden mad.
English: Hepatoxicity has been reported.
Danish: Levertoksicitet er rapporteret.
English: Hypersensitivity reactions, including anaphylactic/anaphylactoid reactions, angioedema, exfoliative dermatitis, and hypersensitivity vasculitis, have been associated with the administration of sirolimus (see section 4.8).
Danish: Overfølsomhedsreaktioner, herunder anafylaktiske/anafylaktoide reaktioner, angioødem, eksfoliativ dermatitis og overfølsomhedsvaskulitis, er set i forbindelse med indgivelse af sirolimus (se pkt.