Medications

After your transplant, you will have to take certain medicines for the rest of your life. These medicines are very important and must be taken exactly as prescribed and on time for the transplanted organ to work properly.

While you are in the hospital recovering from your surgery, our pharmacists and nurses will teach you and at least one family member about all your medications. We will review with you the purpose, dosage and possible side effects of each medicine.

To help you feel more comfortable taking these medications, we will ask you to begin administering and keeping your own medication records in the hospital a few days before your discharge.

All transplant patients take cyclosporine, CellCept® and prednisone to help prevent rejection of their new organs. You may also be placed on medications other than these after transplant.

Common Immunosuppressant Agents

Cyclosporine (Gengraf®) 25mg 100mg

Cyclosporine is a potent anti-rejection drug. It is given by vein initially and later taken in pill form. Cyclosporine comes in 25 mg and 100 mg capsules.

Special instructions:

• Must be taken every 12 hours.
• Do not store capsules out of foil wrappers.
• Do not store in refrigerator or leave in hot sun.
• The capsules have a funny smell. You may take your dose out of the foil and let the capsules stand for five to ten minutes if the smell offends you.
• Take each dose with a full glass of water.
• If possible, take your cyclosporine first thing in the morning on an empty stomach an hour before breakfast. This allows your body to absorb the medicine better and in lower doses.
• Take cyclosporine at the same times each day and in the same relationship to meals (if not an hour before meals) since food can alter how cyclosporine gets absorbed in your body.
• Do not consume grapefruit or grapefruit juice while you are on cyclosporine; the interaction can dangerously increase the medicine’s level in your blood.

Potential side effects:

• Increased risk of infection
• Damage to kidneys
• Elevated blood pressure
• Headaches
• Trembling hands and voice
• Tingling of hands and feet
• Increased body hair
• Thickening of gums
• Anemia
• Irritation of the liver
• Ringing in the ears

Tacrolimus (Prograf®) 0.5 mg 1 mg 5 mg

Prograf® (formerly known as FK 506) is a very potent anti-rejection drug that comes in 1 mg and 5 mg capsules. It is used for patients having difficulty tolerating cyclosporine. You will not be taking cyclosporine and Prograf® at the same time.

Special instructions:

• Must be taken every 12 hours.
• Must be taken one hour before eating or two hours after eating.
• Do not take with other medications.
• Notify your pharmacy several days before discharge so that this drug can be ordered for you.

Potential side effects:

• Increased risk of infection
• Damage to kidneys
• Increased potassium
• Increased blood pressure
• Increased blood sugar
• Nausea, vomiting, and poor appetite
• Trembling hands and voice
• Headache
• Difficulty sleeping
• Constipation

Azathioprine (Imuran®) 50 mg

Imuran® is an anti-rejection drug that reduces the number of white blood cells that attempt to reject an organ. Imuran® is given by vein initially and later taken once a day in pill form. The dose varies based on test results. Imuran® comes in 50 mg tablets.

Special instructions:

• Watch for increased bruising or bleeding and report to the transplant team.

Potential side effects:

• Increased risk of infection
• May lower your white blood cell or platelet count
• Predisposition to mouth ulcers
• Irritation of the liver
• Anemia
• Nightmares
• Nausea, vomiting, diarrhea, upset stomach

Mycophenolate Mofetil (CellCept®) 250mg 500mg

CellCept® is a very potent anti-rejection medication usually prescribed instead of Imuran.® The usual dose of CellCept® is 1000 mg to 2000 mg twice a day. CellCept® comes in 250-500 mg tablets.

Special instructions:

• Must be taken every 12 hours.
• Must be taken on an empty stomach one hour before or two hours after a meal.
• Do not take at the same time as cyclosporine or Prograf®.
• Notify your pharmacy several days before discharge so that this drug can be ordered for you.

Potential side effects:

• Nausea, vomiting, diarrhea
• Constipation
• Leg cramps, weakness
• Headaches
• Increased frequency of urination

Rapamune (Sirolimus®) 1mg 2mg

Rapamune (Sirolimus®) is an anti-rejection medication often prescribed in combination with a steroid medicine (i.e. prednisone) and cyclosporine (i.e. Neoral®, Sandimmune®). The usual dose is 1-3 mg per day. Rapamune comes in 1 mg tablets.

Special instructions:

• Do not consume grapefruit or grapefruit juice during treatment.
• Rapamune is usually taken once a day. It is recommended that Rapamune be taken four hours after taking cyclosporine (Neoral®, Sandimmune®), but always follow your doctor’s instructions.
• Rapamune can be taken either with or without food, but it is very important to take every dose of Rapamune in the same relation to food.

Potential side effects:

• Nausea, vomiting, diarrhea
• Constipation
• Headaches
• Increased blood pressure
• Increased cholesterol or triglyceride levels
• Water retention or swelling
• Leg cramps, weakness
• Rash or acne
• Fever

Prednisone (Deltasone®)
1mg2.5mg 5mg 10mg 20mg

Prednisone is a steroid drug that helps prevent and treat rejection. The dose of this drug will be slowly decreased over time. Most of the side effects of prednisone are dose-related. As the dose is lowered, the side effects decrease. Prednisone comes in 1 mg, 5 mg, 10 mg, 20 mg and 50 mg tablets.

Special instructions:

• Take with food.
• Monitor your weight and report gains of 2-3 lbs. in 24 hours or more than 4-5 lbs. in 2-3 days.
• Have an annual eye exam with your local eye doctor.
• Wait four to six months before changing your eyeglass prescription, because prednisone can change your vision.

Potential side effects:

• Stomach irritation
• Increased appetite, weight gain
• Fat deposits
• Water retention and round, puffy face
• Cataracts
• Weakening of the bones (osteoporosis)
• Acne
• Fragile skin with bruising and skin tears
• Muscle weakness
• Night sweats and trouble sleeping
• Blurred vision
• Increase in blood sugar (diabetes)
• Mood swings
• Increased blood pressure (hypertension)
• Sun sensitivity

Methylprednisolone (Solu-Medrol®)

Solu-Medrol®, available in IV only, treats acute rejection and has side effects similar to prednisone.

Antithymocyte Globulin Sera (ATGAM®)

ATGAM® is an antiserum raised in horses which treats recurrent or refractory rejection. It is given by IV and, once used, can only be repeated with great caution. Tylenol,® Benadryl,® and other medications are given to relieve its side effects.

Potential side effects:

• Decreased white blood cells and platelets
• Rash and itching
• Fever

Thymoglobulin (RATG®)

RATG® is an antiserum raised in rabbits. It is also used to treat recurrent or refractory rejection and has side effects similar to ATGAM®.

Muromonab-CD3 (Orthoclone OKT3®)

OKT3® treats recurrent or refractory rejection. It is given by IV. Tylenol,® Benadryl® and other medications are given to relieve its side effects.

Potential side effects:

• Chills and fever
• Diarrhea
• Headache
• Shortness of breath

Anitbiotics

The antibiotic trimethoprim-sulfamethosazole (Bactrim®) is prescribed to prevent a life-threatening pneumonia called Pneumocystis carinii (PCP).

Potential side effects:

• Nausea and vomiting
• Rash
• Lowered white blood cell count

Anitviral Drugs

Antiviral drugs such as acyclovir (Zovirax®) are prescribed to help prevent and treat herpes-related infections such as fever blisters and shingles.

Ganciclovir (Cytovene®)

Ganciclovir (Cytovene®) is an antiviral drug that helps prevent and treat cytomegalovirus (CMV). It is given by IV. Ganciclovir is used to prevent CMV if lung transplant recipients are CMV positive by blood test or when a CMV positive graft is implanted into a CMV negative recipient.

Special instructions:

Ganciclovir is administered over one hour. Do not administer with other medications.

Potential side effects:

• Decreased white blood cells and platelets

Antifungal drugs such as nystatin (Mycostatin®) are prescribed to help prevent and treat fungal infections of the mouth and throat.

Itraconazole (Sporanox®)

Itraconazole (Sporanox®) is an antifungal agent that helps prevent and treat the fungus Aspergillus. The usual dose of Sporanox® is 200 mg once a day. Sporanox® comes in 100 mg tablets. You will take this medication the first 3-6 months after transplant to prevent Aspergillus.

Special instructions:

For patients taking the capsule form: take with a meal or snack so that the medicine is fully absorbed in the body.

Potential side effects:

• Constipation
• Diarrhea
• Nausea or vomiting

Voriconazole (VFEND®)

Voriconazole (VFEND®) is a new medication just approved as a second-line antifungal agent to treat Aspergillus. The usual dose of voriconazole comes in 200 mg or 50 mg tablets; the oral form is just as effective as the IV form of the drug.

Special instructions:

• Take voriconazole at least one hour before or after a meal.
• Take each dose with a full glass of water.
• Take all of the voriconazole that your doctor prescribes for you even if you start to feel better.

Potential side effects:

Continue taking voriconazole and talk to your doctor if you experience:

• Blurred vision, increased sensitivity to light, or other visual changes
• Nausea or vomiting
• Diarrhea
• Swelling or water retention

Anti-hypertensives

Anti-hypertensives are drugs that help control blood pressure. Among the more commonly prescribed are nifedipine (Procardia XL®), amlodipine (Norvasc®), and lisinopril.

Potential side effects:

• Low blood pressure
• Dizziness
• Weakness
• Fatigue
• Possible sexual dysfunction
• Fluid retention

Mineral-based Replacement Drugs

Magnesium is prescribed to replace this normal body salt that is wasted in your kidneys when you take certain immunosuppressive medications.

Transplant Center