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What is Afinitor (Everolimus)?

Everolimus, also known as Afinitor, is an anticancer medication. This medication is most commonly used for cancer of the brain, kidneys, and breasts. The breast cancers treated are in postmenopausal women with advanced hormone receptor cancer. In these cases, Everolimus is used with exemestane after letrozole or anastrozole therapy failed.

Everolimus also treats specific types of tumors in the stomach, intestines, and pancreas. These specific tumors are advanced, progressive cancers. Everolimus is used for advanced pancreas cancer when the neuroendocrine tumors are unresectable.

Other conditions that Everolimus can treat include seizures and tuberous sclerosis complex (TSC). TSC is a genetic condition that causes benign brain and kidney tumors. Everolimus is used when surgery is not immediately necessary or when the tumors cannot be removed completely or safely.

Everolimus has also been used, off-label, in heart, liver or kidney transplantation and for Waldenstrom macroglobulinemia.

How Afinitor Everolimus works

Everolimus binds specific proteins in human cells. Binding to these cell proteins blocks cancer from interacting with specific genes in the cells. In this way, Everolimus leads to cell death, because the cancer cells are unable to reproduce without these genes. Everolimus also stops the cancer cells that develop their own blood supply. This is important because the cancer uses the body’s blood to spread cancer. Bottom line: these changes halt cancer cells from multiplying in the body.

Storage, dosage, and how to use Afinitor Everolimus

Take the tablet by mouth at the same time every day. Swallow it whole with a glass of water. Never crush or chew the tablets. Do not touch or breathe in the powder of any broken or chipped tablets. Take this drug with or without food; however, it is recommended that the drug is thereafter taken the same way.

Important – if a dose is missed, do NOT double-dose. If you accidentally take too many Everolimus tablets, contact your Provider immediately or go to the emergency department. Take the Everolimus package, so the attending emergency Provider knows exactly what has been overdosed.

Store Everolimus out of reach from others, keeping the lid secure. Children under the age of 18 cannot take this drug without a TSC specialist’s guidance. Keep the drug in its original package to protect Everolimus from light. There are no special temperature requirements.

Dosage is decided by the Prescribing Provider and based upon the condition treated. Everolimus comes in three strengths:

  • White to off-white oval 2.5mg tablets – E9VS on one side and 2.5 on the other side
  • White to off-white oval 5mg tablets – E9VS 5 on one side
  • White to off-white oval 10mg tablets – E9VS 10 on one side

There are 30 tablets in each package.

During Everolimus treatment, routine monitoring, assessments, and examinations will be scheduled. A number of blood labs may be routinely performed.


  • Drink at least 2-3 quarts of fluid every 24 hours
  • Avoid crowds or any persons with colds or signs of infections
  • Wash your hands often
  • Use a soft toothbrush and rinse your mouth thrice daily with baking soda water
  • Avoid contact sports
  • Eat small but frequent meals
  • Avoid sun exposure
  • Avoid alcoholic beverages or keep them to a minimum
  • Get plenty of rest
  • Maintain good nutrition
  • Discuss any side effects with the healthcare team
  • Do not hesitate to contact your assigned healthcare team with questions or concerns

Side Effects

The most common side effects of Everolimus are:

  • mouth sores
  • infection
  • rash, itching, dry skin
  • fatigue
  • diarrhea
  • swelling
  • stomach pain or cramping
  • nausea, vomiting, discomfort
  • fever
  • weakness
  • headache
  • blood test abnormalities

Any or some of the above is seen in more than 30% of the patients.

Less common side effects that occur in 10-29% of patients are:

  • cough
  • loss of appetite
  • shortness of breath
  • high blood pressure
  • bleeding problems
  • joint pain
  • muscle pain
  • loss of fertility

Rarely occurring side effects, occurring in less than 10% of patients, are unlisted in this drug sheet. Contact your Provider for any unusual or new symptoms.

Some symptoms are serious and should be reported to the Provider within 24 hours:

  • nausea that is preventing eating
  • vomiting more than 4-5 times in 24 hours
  • diarrhea 4-5 episodes within 24 hours
  • unusual bleeding or bruising
  • black or tarry stools
  • blood in urine
  • pain/burning with urination
  • extreme fatigue interfering with self-care
  • mouth sores that become red, painful, or create ulcers

Warnings & Precautions

WARNING: Contact the Provider IMMEDIATELY, day or night, if you experience a fever of 100.4F (38C) or higher, chills, or any other sign of infection.

WARNING: Everolimus is only administered to patients under the age of 18 by a Provider experienced in treatment of young patients with tuberous sclerosis complex (TSC). These patients must be avidly monitored as a safety precaution.

WARNING: This medication reduces the immune response. Immediately report any signs of infections, especially symptoms of respiratory infections. Non-infectious pneumonitis is a known effect of the rapamycin class of drugs. Concerning symptoms to report immediately include difficulty breathing, cough, shortness of breath, and signs of lack of oxygenation such as faintness, drowsiness, and dizziness.

During therapy the patient is at risk for infections that they would not normally experience. For example, a fungal infection may become systemic.

The patient is also at risk for new allergic type symptoms. Again, these would not necessarily occur when the immune system is functioning normally.


Let your Prescribing Provider know if you have any of the following conditions:

  • kidney problems or disease
  • liver disease
  • diabetes, pre-diabetes, or high blood glucose problems
  • high cholesterol or triglyceride levels
  • any infections
  • history of hepatitis B
  • skin cancer or family history of skin cancer
  • Lapp lactase deficiency
  • glucose-galactose malabsorption
  • upcoming vaccinations
  • scheduled or planned surgery
  • receiving radiation therapy or scheduled for radiation in future

Before beginning Everolimus therapy, report a full list of drugs being taken for any condition. This list should include over-the-counter medications, supplements, herbal products, alcohol and recreational substances.

Do not take the following medications without the Provider’s express permission:

  • aspirin or any product that contains aspirin
  • immunizations or vaccines

There are over 455 medications that may interact with Everolimus. Some of these drugs may cause Everolimus to be less effective. Others may exacerbate side effects. Many of the medications that interfere with Everolimus are common familiar medicines. Do NOT use medications, including over-the-counter medications, supplements, or herbal products without first asking the healthcare team overseeing your case.



Known hypersensitive reactions to these drugs and their ingredients strongly contraindicates receiving this treatment therapy.


Any drug hypersensitivity to rapamycin, or to a medication with rapamycin as an ingredient, strongly contraindicates the use of Everolimus therapy.


When receiving ACE Inhibitor treatment, the risk of airway and tongue swelling can increase. With or without respiratory involvement, this is considered a high risk to patient survival.


Everolimus may decrease haemoglobin, lymphocytes, neutrophils, and platelet production. Wound healing is impaired by rapamycin, and therefore, the manufacturer advises against its use in acute bleeding conditions.


Women of childbearing age must use a highly effective contraception during treatment and for 8 weeks after treatment ends.


This medication is NOT recommended for patients younger than 18 years of age who have known liver disease or history. For patients older than 18, Everolimus is only used when the benefits outweigh the risks. Dosing is determined based on the degree of liver impairment.

Frequently Asked Questions

No. Afinitor Everolimus specifically targets only the cancer cells in your body. Chemotherapy affects all the body’s cells that are continuously growing.

Yes. Avoid eating grapefruit. This food can cause Everolimus to increase to dangerous levels in your body.

Yes. St. John’s Wort makes Everolimus less effective. Contact your Provider to ask for other suggestions to treat anxiety.

Do not take the missed dose. Manufacturer’s instructions are to wait for the next scheduled dose to continue taking the medicine. Never double-dose this medication. If you miss a dose or accidentally double-dose, contact your physician immediately.

Practice good oral hygiene and eat healthy foods. Daily inspect the inside of your mouth to check for signs of raw, red, swollen, or blister areas. Report these symptoms to your Provider. An alcohol-free mouthwash is recommended. Additional tips that are currently under study, include – brushing and gargling with salt water, rinsing and swallowing a glutamine solution (found in drug stores), asking your Provider for a prescription to use either a hydrocortisone wash and rinse or an alcohol-free dexamethasone mouthwash. If mouth sores persist, ask your Provider about taking prednisone to prevent mouth sores.

Sun exposure must be avoided to prevent skin damage while receiving Everolimus treatment. Use your prescribed creams and moisturizers, reapplying after washing. Cover your face and body when you must be exposed to sunlight.

Yes. Exposure to the sun during Everolimus treatment can cause skin rashes. Skin rashes can become severe allergic reactions. Contact your Provider immediately if you experience worsening skin rash, chest pain, difficulty breathing or difficulty swallowing.

Everolimus is a long term treatment, taken daily as long as it is effective. If unacceptable side effects occur, the Provider will end the treatment. In clinical trials, the average length of treatment lasts 24 weeks.

Everolimus is the medicine that both Afinitor and Zortress are made from. Afinitor is approved for treating cancer. Zortress is Everolimus at lower dosages than Afinitor. Zortress is given in kidney and liver transplants to prevent organ rejection.

Yes. Afinitor (Everolimus) is approved to use with antiseizure medications that treat partial seizures and seizures associated with tuberous sclerosis complex (TSC).

Everolimus reduces the body’s immune response. A low immune response increases your susceptibility to infections, which can become serious. When receiving Everolimus treatment, it is important to report fever and symptoms to your Healthcare Team immediately.

Currently, this medication is not approved for non-menopausal patients. Clinical studies are underway to study using Everolimus for non-menopausal patients. To learn more about receiving this treatment, talk with your Provider.

No. Effective birth control must be used at all times during treatment to prevent pregnancy. Birth control must continue for at least 8 weeks after your last dose. Women are advised not to breastfeed while receiving this medication. Wait at least two weeks after the last dose before initiating breastfeeding.

Yes. Everolimus treatment can lower red blood cell production. If you experience signs of anemia, call your healthcare team Provider or Nurse within 24 hours. If your hematocrit and hemoglobin are low, the Provider will order a blood transfusion.

Diarrhea is a common side effect when receiving Everolimus treatment. Avoid coffee, all caffeine drinks, milk, and other foods that trigger diarrhea. These foods are not recommended during Everolimus treatment. Contact the healthcare team immediately if the diarrhea persists longer than 4-5 times over 24 hours. You may need medication and/or you may need to receive I.V. treatment to re-establish your body’s fluid balance.

Everolimus may raise blood sugar levels during treatment. Routine testing of your glucose level will be part of your care plan.

Yes. Headaches are a common side effect of receiving Everolimus treatment. A pain medicine that is safe to use while receiving Everolimus can be prescribed for your headaches.

Yes. All types of infections are more common during Everolimus treatment. Do not wait to report a worsening respiratory infection. Everolimus can cause serious and sometimes fatal symptoms. Call your doctor immediately if your breathing becomes difficult.

Yes. Increased cholesterol and triglycerides are a common side effect while taking Everolimus. Routine blood labs will be part of the care plan during Everolimus treatment. The healthcare team will provide support to address physical changes during treatment.

Your hair may become thinner. But losing all one’s hair is rare with Everolimus alone. When Everolimus is received along with exemestane, hair loss is more likely.