Everolimus (Afinitor; Afinitor Disperz)

Medicine at a glance

Everolimus is an oral targeted medicine that blocks a growth-control protein called mTOR. You usually take it once daily. Afinitor is a tablet swallowed whole; Afinitor Disperz is a different formulation made into a liquid suspension before swallowing. They must not be mixed together to make up a daily dose.

This article focuses on cancer treatment. Everolimus also has specialist uses outside ordinary cancer care. Votubia is an everolimus brand associated with tuberous sclerosis complex, a condition that can cause non-cancerous growths. Zortress and Certican are transplant products. Their doses, monitoring and instructions must not be substituted for a cancer prescription.

Important issues include mouth ulcers, infections, lung inflammation, changes in blood sugar and cholesterol, and wound healing. Reporting symptoms early allows the team to treat them and adjust treatment when needed.

What everolimus is and how it works

Cells use mTOR as part of a system that coordinates growth, energy use and protein production. Everolimus attaches to a protein inside cells, forming a complex that inhibits mTOR signalling. This can slow tumour-cell growth and affect signals involved in developing blood vessels that support a tumour. It cannot guarantee that an individual tumour will respond.

Everolimus is a targeted therapy, rather than a conventional chemotherapy medicine. However, mTOR also has important jobs in healthy cells. Blocking it can affect the mouth, immune system, lungs and metabolism. The word “targeted” does not mean that treatment is free from serious effects.

Some prescriptions include a separate partner medicine, such as exemestane, a hormone treatment. Partners have their own purpose and precautions. Keep their schedules separate and ask which medicine to pause if the team changes treatment.

How the team decides whether it is suitable

Your oncologist considers the diagnosis, pathology results, previous treatments, overall health, other medicines and the applicable product information. Hormone-receptor and HER2 results may be relevant when everolimus accompanies hormone therapy. There is no single mandatory “mTOR mutation test” that applies to everyone receiving everolimus.

Liver function matters because it affects how the body clears the medicine. Liver impairment may require a lower dose. Diabetes, high cholesterol, existing lung problems, recurrent infections or a wound that has not healed need a plan before treatment starts. These conditions do not all automatically exclude treatment, but they may change the balance of benefits and risks.

Age and formulation matter. Specialist childhood uses of everolimus have different dosing and monitoring from adult cancer treatment. Afinitor Disperz is not simply a liquid version for every adult cancer prescription. Do not use another person’s tablets or a transplant dose as a substitute.

Before treatment starts

Tell the team about previous hepatitis B, tuberculosis or other significant infections; any current fever or infection; breathing problems; diabetes; kidney or liver disease; high blood fats; recent or planned surgery; and previous or planned radiotherapy. Bring a full medicine list, including mouthwashes, supplements, herbal remedies and cannabidiol products.

Baseline tests usually include a full blood count, kidney and liver tests, blood glucose and blood fats. The team may arrange viral screening, including hepatitis B, and assess respiratory symptoms. Someone who can become pregnant needs a pregnancy assessment before treatment. Mention allergies to everolimus or related medicines such as sirolimus and temsirolimus.

Discuss dental problems, eating difficulties and a mouth-care plan before the first dose. US prescribing information recommends starting an alcohol-free dexamethasone mouthwash with treatment to reduce mouth inflammation. Your team must prescribe the preparation and explain its use; it is not an ordinary shop-bought mouthwash.

Afinitor contains lactose. In the European information, patients with rare hereditary galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take it. These are different from many everyday food intolerances; tell the pharmacist about a diagnosed condition.

How treatment is taken

Daily dosing and food

A common adult cancer dose is 10 mg once daily, but your prescribed dose may be lower because of liver function, side effects or interactions. Take it at approximately the same time each day, consistently with food or consistently without food. Changing the food pattern can change exposure to the medicine.

There is usually no routine weekly break. Continue only according to the treatment plan. A temporary hold or dose reduction is a safety measure and does not by itself mean that treatment has failed.

Swallowing and formulation checks

Swallow ordinary Afinitor tablets whole with water. Do not chew, crush or split them. If swallowing is difficult, contact the oncology pharmacist before the next dose rather than preparing a homemade liquid. The current US and EU Afinitor information does not provide a routine home-dispersion method for these ordinary tablets.

Afinitor Disperz must be prepared as a suspension in water, not swallowed as a whole tablet. The pharmacist should demonstrate the supplied instructions. For the US small-glass method, the prescribed tablets, up to 10 mg per glass, are placed in about 25 mL water in a glass no larger than 100 mL. Allow three minutes, stir gently and drink; add another 25 mL water, stir and drink the rinse. Larger prescribed doses need a separate preparation. Do not crush the tablets or add food. Use immediately and discard if not taken within 60 minutes. A separate oral-syringe method is available.

Caregivers should wear gloves when preparing Disperz. Someone who is pregnant or could become pregnant should avoid preparing it where possible. Feeding-tube administration needs an individual pharmacy plan; do not assume that an oral suspension automatically suits every tube.

Missed or vomited doses

Check your written product-specific instructions. European Afinitor advice is to skip the forgotten dose and take the next scheduled dose normally. US prescribing information permits a dose up to six hours after its usual time and says to skip it if more than six hours late; the US patient leaflet uses “less than six hours”. If you are at that boundary or unsure which instructions apply, contact the pharmacist rather than guessing. Never double a dose.

If you take more than prescribed, contact the team immediately and bring the medicine packaging. Do not wait for symptoms.

If you vomit after a dose, do not take another tablet to replace it. Take the next dose at the usual time. Report repeated vomiting or difficulty keeping fluids down promptly.

Storage and handling

Keep tablets in their original packaging, protected from light and moisture, away from children. Follow the pack temperature limit: European Afinitor says not above 25°C (77°F); the US label specifies 25°C (77°F) with permitted short excursions. Do not leave it in a hot car. Wash your hands after handling and return unused medicine through the pharmacy’s recommended route.

Monitoring and checking whether treatment is working

Blood tests look for changes in blood cells, kidneys, liver, glucose and blood fats. Urine testing may check for protein leakage from the kidneys. Blood pressure, weight, swelling, appetite, mouth symptoms and breathing also help the team assess safety.

Testing frequency depends on your health and treatment combination. The US label gives baseline and ongoing schedules, including more frequent kidney checks when risk factors exist and additional glucose monitoring in diabetes. Your oncology clinic may test much more often, especially early in treatment or after abnormal results. Do not postpone scheduled tests because a general leaflet describes a longer interval.

Blood levels of everolimus are routinely used for some specialist tuberous-sclerosis regimens, and for transplant treatment. This is different from routine adult cancer monitoring. A blood-level target from another patient’s treatment is not a dose target for you.

Scans and clinical assessment show whether treatment is helping. Stable disease can be a worthwhile result even without substantial shrinkage. Side effects, laboratory changes or a planned procedure may require a pause, reduction or permanent stop. Do not restart a held dose until the team confirms the plan.

Common side effects and practical management

Mouth ulcers and soreness

Stomatitis means inflammation of the mouth. Small painful ulcers often appear early, particularly during the first eight weeks. Use a soft toothbrush and gentle mouth care. Soft, cool foods may be easier than spicy, acidic or rough foods. Report ulcers early, before pain prevents drinking or eating.

Use prescribed steroid mouthwash exactly as directed, swishing and spitting rather than swallowing. Avoid mouth products containing alcohol, peroxide, iodine or thyme unless the team specifically approves them. White patches or persistent burning may indicate fungal infection and need assessment. Do not start an antifungal treatment yourself; some interact with everolimus. Inability to drink needs urgent advice.

Diarrhoea, nausea and reduced appetite

Take prescribed anti-sickness or diarrhoea treatment as instructed. Try smaller meals and frequent sips of fluid, within any kidney or heart-related fluid limit. Keep a record of stools, vomiting and your ability to drink. Ongoing diarrhoea, blood in stools, dizziness, reduced urine or increasing abdominal pain needs prompt assessment.

Changes in taste or mouth discomfort may reduce appetite. Ask for dietary support if you are losing weight or meals become a struggle. Restrictive diets and unverified “anti-cancer” supplements can make it harder to meet nutritional needs.

Skin and nail changes

A rash, dryness, itching or fragile nails can occur. Gentle fragrance-free moisturisers and protection from sunlight may help. Use clothing, shade and sunscreen. Tell the team about painful, spreading or infected-looking areas, or a sore swollen nail fold. Severe blistering or peeling needs urgent assessment. Avoid choosing strong acne products without advice.

Tiredness and swelling

Pace activity and allow rest, while keeping gentle movement when possible. Tiredness may reflect treatment, anaemia, poor sleep or another treatable problem. Report worsening fatigue rather than assuming it is unavoidable. Ankle swelling or weight gain may reflect fluid retention and should be discussed, particularly if accompanied by reduced urine or breathlessness.

Less common but important side effects

Infection and hepatitis reactivation

Everolimus suppresses parts of the immune response. Serious bacterial, viral and fungal infections can develop, including infections that mainly affect people with weakened immunity. Hepatitis B can become active again. Tell the team about past infection even if it was many years ago or caused no symptoms. Screening, prevention and follow-up depend on your results and clinical situation.

Fever, chills, sore throat, burning urine or sudden deterioration need immediate advice. Serious infection can occur without a high temperature. If corticosteroids or another immune-suppressing treatment are needed, ask about prevention against a particular pneumonia called PJP. The US label requires this preventive treatment in that situation; European information says it should be considered. This is not a reason to start antibiotics yourself.

Lung inflammation

Non-infectious pneumonitis is inflammation in the lungs that is not caused by germs. It can resemble pneumonia or cancer-related breathing problems and can be serious. Report a new or worsening cough, shortness of breath or chest discomfort immediately. It can happen even after a dose reduction.

The team may arrange oxygen measurements, scans and infection tests. Treatment may involve holding everolimus, corticosteroids or permanent discontinuation, depending on severity. Do not use leftover steroids or assume a cough is merely a cold. Severe breathing difficulty needs emergency care.

Kidney, blood-count and metabolic effects

Kidney injury can sometimes be severe. Reduced urine, blood in urine or increasing swelling requires prompt assessment. Low platelets may cause bruising or bleeding; low red cells may cause unusual tiredness or breathlessness. Heavy or uncontrolled bleeding is an emergency.

High glucose may cause marked thirst, frequent urination or increasing tiredness. Report these symptoms, especially if you already have diabetes. Vomiting, confusion or unusual drowsiness with high glucose needs urgent assessment. Cholesterol and triglyceride increases often cause no symptoms, which is why blood testing matters. The team can adjust diabetes or lipid treatment.

Allergy, wound healing and radiotherapy

Swelling of the lips, tongue or throat, wheezing or collapse may indicate a serious allergic reaction. Stop taking everolimus and get emergency help. Clinically significant allergy or angioedema requires permanent discontinuation under the prescribing information. ACE-inhibitor blood-pressure medicines can increase angioedema risk.

Everolimus can delay wound healing. The US label specifies holding it at least one week before elective surgery and not restarting for at least two weeks after major surgery and until adequate healing. European information advises particular caution around operations without the same fixed timetable. Your surgeon and oncologist must coordinate the actual dates. Dental surgery also needs advance discussion.

Radiation reactions can be worse during or around treatment, and inflammation can reappear in a previously irradiated area. Report new redness or pain in that area, painful swallowing, cough or breathing changes. Tell both oncology teams about all radiotherapy.

Other medicines, supplements and vaccinations

Everolimus is affected by the CYP3A enzyme and P-glycoprotein transport system. Some antibiotics, antifungals, antiviral treatments, epilepsy medicines and heart medicines can raise or lower its levels. Strong inhibitors of these systems should be avoided; some other interacting medicines require a specialist dose change. A pharmacist must check every new prescription, including a short course. Avoid grapefruit and grapefruit juice, and do not take St John’s wort.

Cannabidiol oral solution can substantially increase exposure. The June 2026 US label contains specific dose-reduction instructions; these are for the prescriber. Other cannabidiol products have not been adequately studied, so disclose CBD oils and other preparations as well. Do not stop a prescribed seizure medicine abruptly.

Live vaccines should be avoided during treatment. Ask the team about household contacts receiving live vaccines because some require contact precautions. Inactivated vaccines may be possible, although protection may be reduced. Arrange travel-vaccine advice early, and let the oncology team plan timing.

Everyday life during treatment

Some people continue working with adjustments; others need time away. Flexible hours, rest breaks and access to a bathroom can help. Do not drive or operate machinery if tired, dizzy or otherwise unable to concentrate safely.

Maintain hand hygiene and avoid close contact with people who are unwell. Check before dental procedures, operations or new treatments. For travel, carry medicine in original packaging, your prescription and the treating hospital’s contact details. Plan how you will obtain urgent medical care and attend required tests.

Sex and intimacy may change because of fatigue, mouth soreness, hormone treatment or worries about illness. Discuss contraception and any discomfort with the team. A counsellor, specialist nurse or support group can also help with the demands of taking daily treatment over a long period.

Fertility, contraception, pregnancy and breastfeeding

Everolimus can harm a developing baby. Patients who can become pregnant should use effective contraception during treatment and for eight weeks after the last dose; European information specifies a highly effective method. The method should suit the cancer diagnosis and accompanying medicines; an oestrogen-containing method may be unsuitable in some situations. Contact the team promptly if pregnancy is suspected.

The US label advises male patients with partners who could become pregnant to use effective contraception during treatment and for four weeks afterwards. European Afinitor information does not impose that male restriction. Agree the precaution period with your team rather than choosing between different leaflets yourself. A partner treatment may require longer precautions.

Do not breastfeed during treatment or for two weeks after the final dose. Fertility may be affected in patients of any sex; periods may become irregular or stop, and sperm production can be reduced. This does not guarantee infertility or prevent pregnancy. Discuss preservation options before treatment if future parenthood matters to you.

After treatment finishes

Keep follow-up appointments and report continuing or new symptoms, especially infection, breathing problems, unhealed wounds or symptoms in a previously irradiated area. Mouth, skin and energy levels may recover gradually. Some abnormal blood results need continued monitoring or treatment.

Keep contraception and breastfeeding precautions for the prescribed period. Do not resume live vaccines, restart interacting supplements or use leftover everolimus without advice. Ask for a written plan explaining why treatment stopped, which medicines continue and when the next assessment is due.

Frequently asked questions