How would you adjust the dose of everolimus for tuberous sclerosis in setting of asymptomatic rising liver enzymes, platelets, and lipid counts?

If a dose reduction of everolimus is needed because of asymptomatic lab value changes, I usually try reducing the dose by 25% for 2-3 months and then reducing by 50% of the original dose if the labs continue to worsen. A fairly moderate dose reduction is often sufficient and can still maintain effic...