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everolimus

Generic Zortress
Used for Organ Transplant, Breast Cancer, Pancreatic Cancer, Renal Cancer, Tuberous Sclerosis Complex
Used for Organ Transplant, Breast Cancer, Pancreatic Cancer, Renal Cancer, Tuberous Sclerosis Complex

Everolimus, also known by the brand name Zortress, is an FDA approved immunosuppressant used in adults to prevent rejection after a kidney or liver transplant. The tablet is typically taken by mouth twice a day along with other anti-rejection medications. Your transplant provider will adjust your dose based on the levels of the medication in your body. Common side effects include swelling in the arms and legs, nausea, and high blood pressure.

Last reviewed on February 28, 2025
basics-icon

What is Everolimus (Zortress)?

What is Everolimus (Zortress) used for?

How Everolimus (Zortress) works

Everolimus (Zortress) is an immunosuppressant. It works by weakening your immune system to help prevent organ rejection after a transplant. This makes it easier for your body to accept the new organ and lowers the risk of rejection.

Are you looking for information on everolimus (Afinitor) for cancer instead?

Drug Facts

Common BrandsZortress
Drug ClassImmunosuppressant
Controlled Substance ClassificationNot a controlled medication
Generic StatusLower-cost generic available
AvailabilityPrescription only
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What are the side effects of Everolimus (Zortress)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

Kidney transplant:
  • Swelling in the arms and legs (45%)
  • Constipation (38%)
  • High blood pressure (30%)
  • Nausea (29%)
  • Low red blood count, anemia (26%)
  • Urinary tract infection (UTI) (22%)
  • High cholesterol (21%)
Note: These side effects were reported in people taking everolimus (Zortress) and cyclosporine.

Liver transplant:
  • Diarrhea (19-24%)
  • Headache (19-22%)
  • High blood pressure (17-21%)
  • Swelling in the arms and legs (18-20%)
Note: These side effects were reported in people taking everolimus (Zortress) and tacrolimus.

Other Side Effects

Kidney transplant:
  • Diarrhea
  • Vomiting
  • Stomach pain
  • Fever
  • Fatigue
  • Upper respiratory tract infection
  • Muscle pain
  • Back pain
  • Headache
  • Trouble sleeping
Liver transplant:
  • Nausea
  • Stomach pain
  • Fever
  • Fatigue
  • Tremor
  • Trouble sleeping

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Serious infection: fever, chills, fatigue, muscle aches, cough, sore throat, runny or stuffy nose
  • Cancers:
  • Severe allergic reaction: trouble breathing, swelling of the face, tightening of the throat, rash, hives, welts, itchy or painful skin
  • Serious lung problems: cough, shortness of breath, trouble breathing, wheezing
  • Kidney damage (for kidney transplant): feeling sick or weak, dehydrated, urinating less than usual, confusion, blood in urine, swelling in the legs, ankles, or feet

Source: DailyMed

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

Bloating or swelling of the face, arms, hands, lower legs, or feet

bloody nose

chest pain or tightness

chills

cough

decreased weight

diarrhea

difficult or labored breathing

difficulty with swallowing

fever

general feeling of discomfort or illness

hoarseness

lower back or side pain

painful or difficult urination

rapid weight gain

sores, ulcers, or white spots on the lips, tongue, or inside the mouth

tingling of the hands or feet

Less common

Bleeding gums

bloody urine

blurred vision

burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings

coughing up blood

extreme tiredness or weakness

fast, pounding, or irregular heartbeat or pulse

increased thirst or urination

irregular breathing

loss of appetite

nausea

nervousness

nosebleeds

prolonged bleeding from cuts

red or black, tarry stools

red or dark brown urine

slow heartbeat

stomach ache

sweating

unusual tiredness or weakness

vomiting

Incidence not known

Agitation

confusion

decreased awareness or responsiveness

depression

dizziness

hostility

irritability

muscle twitching

seizures

severe sleepiness

unusual drowsiness, dullness, or feeling of sluggishness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Change in taste

dry skin

itching skin or rash

lack or loss of strength

loss of taste

pain in the arms or legs

stomach pain

trouble sleeping

Less common

Back pain

blistering, peeling, redness, or swelling of the palms, hands, or bottoms of the feet

bumps on the skin

burning, dry, or itching eyes

discoloration of the fingernails or toenails

feeling of fullness

flushing or redness of the skin

jaw pain

numbness, pain, tingling, or unusual sensations in the palms of the hands or bottoms of the feet

passing of gas

redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

pros-and-cons

Pros and cons of Everolimus (Zortress)

thumbs-up

Pros

Can be taken with or without food

Available as a tablet that's taken by mouth

Comes in different strengths to allow for dose adjustments

thumbs-down

Cons

Raises the risk of infections

Commonly causes swelling in the arms and legs

Must be taken with other anti-rejection medications

pharmacist-tips

Pharmacist tips for Everolimus (Zortress)

pharmacist
  • Take everolimus (Zortress) at the same time as your other transplant medication (either cyclosporine (Sandimmune) or tacrolimus (Prograf)). You can take these with or without food, but stay consistent — always take them the same way.

    • Take everolimus (Zortress) twice a day, about 12 hours apart to keep a steady level of medication in your body.

      • Swallow the everolimus (Zortress) tablet whole with a glass of water. Don't crush or chew the tablet since this can affect how well it works.

        • You'll need to have regular lab tests done while you're taking everolimus (Zortress). These tests help make sure the medication is working properly and that you aren’t having serious side effects. Follow your prescriber’s instructions and don’t skip any lab tests.

          • Taking everolimus (Zortress) can weaken your immune system, raising your risk of infections. Watch for signs like fever, chills, cough, or feeling unusually tired. If you notice any symptoms of infection, contact your care team right away.

            • Taking everolimus (Zortress) can raise your risk of developing certain cancers, especially skin cancer. To help protect yourself, limit your time in the sun and avoid ultraviolet light. When outdoors, wear protective clothing and use sunscreen.

              • Everolimus (Zortress) interacts with many medications. Always check with your transplant provider before starting any new medication or supplement.

                • Avoid grapefruit, pomelo, pomegranate, and Seville oranges while taking everolimus (Zortress). These citrus fruits and their juices can raise the level of the medication in your body, which can be very dangerous.

                  • While taking everolimus (Zortress), vaccines might not work as well, so you won't get full protection. Avoid live vaccines since they can raise your risk of infection. Talk to your prescriber before getting any vaccines while taking this medication.

                    • Talk to your transplant team about family planning. Everolimus (Zortress) can affect fertility and harm an unborn baby. People who can become pregnant should use birth control while taking everolimus (Zortress) and for 8 weeks after stopping the medication.

                      faqs

                      Frequently asked questions about Everolimus (Zortress)

                      Can everolimus (Zortress) cause weight gain?
                      Weight gain wasn't reported as a side effect in clinical studies of everolimus (Zortress). But this medication can cause your body to hold onto fluid, leading to swelling in the arms and legs, which might cause weight gain. Contact your transplant provider if your weight changes very quickly. They'll want to check your labs to see if you have too much fluid build up.
                      How long does everolimus (Zortress) stay in your system?
                      Even though everolimus (Zortress) can stay in your body for about 5 to 6 days after a dose (time frame is based on its half-life), it's very important to take it every day. This medication has a narrow safety window, meaning that missing one dose can cause its level to drop and raise your risk for organ rejection. If you miss a dose, let your transplant team know right away.
                      Is everolimus (Zortress) chemotherapy?
                      No, everolimus (Zortress) is only approved to prevent kidney or liver transplant rejection. You might be thinking of everolimus (Afinitor), which is used for certain cancers. Although everolimus (Zortress) and everolimus (Afinitor) have the same active ingredient, everolimus (Afinitor) is usually taken once a day at a higher dose for cancer treatment. Speak to your prescriber if you have questions comparing both medications.
                      Does everolimus (Zortress) cause hair loss?
                      Hair loss can happen with everolimus (Zortress), but it isn't common. In clinical trials, less than 10% of people experienced hair loss while taking this medication. If you notice hair loss, talk with your transplant provider. They can help figure out the cause and discuss possible solutions.
                      Is everolimus (Zortress) an immunosuppressant?
                      Yes, everolimus (Zortress) is an immunosuppressant. It works by weakening your immune system to help prevent organ rejection after a transplant.
                      How long can you take everolimus (Zortress)?
                      Keep taking everolimus (Zortress) and your anti-rejection medications until your transplant provider tells you to stop. This usually only happens if you have a serious side effect and need to switch to a different medication. If you're ever unsure about how to take your medications, contact your transplant team.
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                      What are the risks and warnings for Everolimus (Zortress)?

                      Everolimus (Zortress) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

                      risk-warning

                      Cancer

                      • Risk factors: Long-term use

                        Long-term use of everolimus (Zortress) raises your risk of developing lymphoma and other cancers, especially skin cancer. To protect your skin, limit sun exposure by wearing protective clothing and using sunscreen whenever you go outside. Talk to your prescriber if you have concerns about your cancer risk while taking this medication.

                        risk-warning

                        Serious infections

                        • Risk factors: Taking other immunosuppressants

                          Immunosuppressants like everolimus (Zortress) can raise your risk of bacterial, fungal, and viral infections. Some infections can be serious or even life-threatening. Your transplant provider might prescribe medications to help prevent certain types of infections to lower your risk of serious illness. If you develop symptoms of fever, chills, fatigue, muscle aches, cough, sore throat, runny or stuffy nose, tell your care team right away.

                          risk-warning

                          Kidney or liver blood clot

                          • Risk factors: Recent kidney or liver transplant (within 30 days)

                            Everolimus (Zortress) can raise your risk of developing a blood clot in the vessels of your transplanted kidney or liver, which could put your transplanted organ in danger. It's most likely to happen within the first 30 days after your transplant. Your transplant provider might order blood tests and scans to check for any signs of a clot.

                            risk-warning

                            Kidney damage

                            • Risk factors: Taking cyclosporine (Sandimmune) or tacrolimus (Prograf) | Taking other medications that can damage your kidneys

                              Taking everolimus (Zortress) with other anti-rejection medications like cyclosporine and tacrolimus can harm your kidneys. Since these medications must be used together, your transplant provider will adjust the doses to help protect your kidney function. Your care team will check your lab tests regularly to monitor your kidney health and make sure your medication levels stay safe.

                              risk-warning

                              Allergic reaction

                              • Risk factors: Taking ACE inhibitors

                                Everolimus (Zortress) has been linked to angioedema, a serious swelling that can affect your face, lips, or throat. Taking everolimus (Zortress) with certain blood pressure medications, like angiotensin-converting enzyme (ACE) inhibitors, can raise your risk of developing this side effect. Let your care team know if you notice any unusual swelling, especially if it makes it hard to breathe or swallow.

                                risk-warning

                                Slower wound healing and fluid build up

                                Everolimus (Zortress) can slow down wound healing and raise the risk of problems like infections and your incision opening up. Some of these issues might require additional surgery.

                                You might also have fluid buildup in different parts of your body, causing swelling in your arms and legs, or fluid around your heart, lungs, or stomach. Let your care team know if you notice unusual swelling, fluid retention, or any changes in how you feel.

                                risk-warning

                                Lung problems

                                Everolimus (Zortress) is linked to a lung condition called interstitial lung disease (ILD), which causes inflammation or scarring in the lungs. Let your prescriber know if you have symptoms like shortness of breath, cough, chest pain, or wheezing. Most people recover once they stop taking everolimus (Zortress), with or without additional treatment. But in rare cases, it can be very serious or even life-threatening.

                                risk-warning

                                High cholesterol and triglyceride

                                • Risk factors: High everolimus (Zortress) levels | History of high cholesterol

                                  Taking everolimus (Zortress) can raise your cholesterol and triglyceride levels, especially if your everolimus (Zortress) levels in the blood are too high. Your prescriber will check your labs for any changes in your cholesterol levels. They might also recommend diet changes, exercise, or cholesterol-lowering medications. If you already have high cholesterol, your transplant provider will weigh the risks and benefits before starting or continuing this medication.

                                  risk-warning

                                  Diabetes after transplant

                                  Everolimus (Zortress) can raise your risk of developing diabetes after a transplant. Your transplant provider will check your blood sugar levels closely while you're taking this medication. Let your care team know if you notice signs of high blood sugar, such as unusual thirst or hunger, frequent urination, blurred vision, or unusual tiredness.

                                  risk-warning

                                  Harm to unborn baby and fertility concerns

                                  Everolimus (Zortress) can cause harm to an unborn baby if taken during pregnancy. If you can get pregnant, use birth control while taking this medication and keep taking it for 8 weeks after stopping treatment to prevent pregnancy. If you're pregnant or planning to become pregnant, talk to your prescriber about the risks.

                                  Everolimus (Zortress) can lower sperm count, which can affect a person's ability to have children. This happens because the medication affects fast-growing cells, including those involved in sperm production. If you're planning to have children, discuss any fertility concerns with your prescriber before starting this medication.

                                  risk-warning

                                  Vaccines

                                  Transplant medications like everolimus (Zortress) can change the way your immune system responds to vaccines. Avoid live vaccines while taking this medication because they can raise your risk of infection. If you need a vaccine while taking this medication, talk to your prescriber or pharmacist first to make sure it is safe for you.

                                  dosage

                                  Everolimus (Zortress) dosage forms

                                  Typical dosing for Everolimus (Zortress)

                                  • Kidney transplant: The typical starting dose is 0.75 mg by mouth twice a day, starting as soon as possible after your transplant.

                                  • Liver transplant: The typical starting dose is 1 mg by mouth two times a day, starting at least 30 days after your transplant.

                                  interactions

                                  Interactions between Everolimus (Zortress) and other drugs

                                  Everolimus (Zortress) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Everolimus (Zortress). Please note that only the generic name of each medication is listed below.

                                  Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

                                  Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

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                                  contraindications-icon

                                  Everolimus (Zortress) contraindications

                                  Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Everolimus (Zortress) will not be safe for you to take.
                                  alternatives

                                  What are alternatives to Everolimus (Zortress)?

                                  There are a number of medications that your doctor can prescribe in place of Everolimus (Zortress). Compare a few possible alternatives below.
                                  Everolimus (Zortress)
                                  $115.94 Lowest GoodRx priceView Prices
                                  Used for:
                                  $79.24 Lowest GoodRx priceView Prices
                                  Used for:
                                  • Prevention of kidney, heart, or liver transplant rejection in people ages 3 months and older; taken with other anti-rejection medications

                                  $31.20 Lowest GoodRx priceView Prices

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                                  References

                                  Best studies we found

                                  American Kidney Fund. (2024). Kidney rejection after transplant.

                                  American Lung Association. (n.d.). Interstitial lung disease (ILD).

                                  Memon, R. J., et al. (2023). Angioedema. StatPearls.

                                  View All References (3)

                                  National Cancer Institute. (n.d.). Lymphoma – Patient version.

                                  National Health Service. (n.d.). Rejection of a transplanted liver.

                                  Novartis Pharmaceuticals Corporation. (2025). Zortress- everolimus tablet [package insert]. DailyMed.

                                  GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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