Immunosuppressants
Dental Considerations for Patients Taking Sirolimus / Everolimus
Proceed with precautions (sirolimus/everolimus)
Patient on sirolimus/everolimus. Invasive care can usually proceed with infection vigilance, relevant blood tests, and physician coordination if significantly immunosuppressed.
Emergency vs routine management
If EMERGENCY — what to do
- • Treat infection promptly — immunosuppression masks signs and allows rapid spread.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
- • Avoid clarithromycin/erythromycin and azole antifungals (fluconazole, miconazole) — they sharply raise tacrolimus/ciclosporin/sirolimus levels. Use amoxicillin (or azithromycin with caution) and topical nystatin.Ref: Stockley's Drug Interactions (current edition)
If ROUTINE — what to do
- • Routine non-invasive care can proceed; liaise with the prescriber for surgical procedures.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
Clinical precautions
- • Meticulous infection control; treat oral infection promptly
- • Antibiotic prophylaxis is NOT routinely required for immunosuppression alone — decide case-by-case with the treating physician for invasive/surgical procedures. If indicated: Amoxicillin 2 g orally 1 hour before (adult); if penicillin-allergic, Clindamycin 600 mg or Azithromycin/Clarithromycin 500 mg orally 1 hour before.
- • Coordinate with the treating physician for significant immunosuppression
Information & tests to request
- • Absolute neutrophil count — ANC (x10⁹/L) — sirolimus/everolimus can suppress the bone marrow/immune system. A full blood count checks for neutropenia; we wait for ANC ≥1.0 (ideally ≥2.0) before invasive care.
At a glance by procedure
Initial assessment before lab results or timing details are entered.
| Procedure | Initial assessment |
|---|---|
| Examination / radiographs | ROUTINE Routine non-invasive care (sirolimus/everolimus) |
| Supragingival scaling / polish | MODIFY / CAUTION Proceed with precautions (sirolimus/everolimus) |
| Deep scaling / subgingival RSD (subgingival calculus) | MODIFY / CAUTION Proceed with precautions (sirolimus/everolimus) |
| Root canal treatment | MODIFY / CAUTION Proceed with precautions (sirolimus/everolimus) |
| Simple extraction (1–3 teeth) | MODIFY / CAUTION Proceed with precautions (sirolimus/everolimus) |
| Surgical / bony extraction | MODIFY / CAUTION Proceed with precautions (sirolimus/everolimus) |
| Implant placement | MODIFY / CAUTION Proceed with precautions (sirolimus/everolimus) |
References
- Immunosuppressant drugs — dental considerations
- Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
- Stockley's Drug Interactions (current edition)
Related guides
This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.