MEDICATION

ACTION

ADDITIONAL INFORMATION

POTENTIAL ADVERSE EFFECTS
(*denotes most commonly seen; often dose dependent )

Tacrolimus (Prograf)

0.5 mg
1 mg
5 mg

*Inhibits cytokine production (including IL2)

*Blocks cell division

*Target level 8-14ng/ml depending on interval post transplant

*renal dysfunction, *HTN, headache, tremors,
*decreased mg++, gallstone formation,
*elevated cholesterol, glucose intolerance

Cyclosporine-Sandimmune and Neoral, Gengraf (or generic equivalent)
not interchangable

Gengraf
25mg
100mg

Neoral
25mg
100mg

*Primarily T-lymphocyte selective

*Inhibits responsiveness of killer T-cells to Interleukin II

* Replaces Prograf when efficacy, absorption or tolerance is a problem.

* Metabolized by the liver

*Dosed according to 12 hour trough blood levels and renal function; target level 300-400 ng/ml depending on interval post transplant

*renal dysfunction, *HTN, headache, tremors

*decreased magnesium, gallstone formation,

*elevated cholesterol, gingival hyperplasia

Mycophenolate Mofetil (Cellcept)

250mg
500mg

*Inhibits purine synthesis

*Effective on both T & B lymphocytes

* Used as triple immunosuppressive therapy or as and adjunctive immunosuppressant in rejection episodes.

* Dosed at 2 grams daily in two divided doses.

* leukopenia, nausea and abdominal distress

Imuran ® (azathiprine)

50 mg

* suppresses cell-mediated immunity and causes alterations in antibody production.

* Taken once a day 75 mg to 150 mg per day.

* Used in place of cellcept to prevent rejection

* low white blood cell count

* nausea and vomiting

Sirolimus
(Rapamune, Rapamycin)

1mg
2mg

*Macrocyclic lactone, inhibits IL II signal transduction

*Effective on both T & B lymphocytes

*Dosing based upon trough level

*Target level 8-12 ng/ml

thrombocytopenia, leukopenia, anemia, *hyperlipidemia

Methylprednisolone
(Prednisone)

1mg
2.5mg
5mg
10mg
20mg

*Anti-inflammatory properties

Weaned to a low daily dosage based upon rejection-free biopsies

osteoporosis, hyperglycemia, *fluid retention, GI distress, *increased BP, cushingoid effect, *increased appetite

Solu—Medrol ®

* Anti-inflammatory and immunosuppressive properties.

* Inhibitory effects on the production of prostaglandins, leukotrienes, and cytokines such as interleukin-1.

IV steroid that is given in high doses over 30 minutes for three days in mild rejection episodes.

* osteoporosis, hyperglycemia, *fluid retention, GI distress, *increased BP, cushingoid effect, *increased appetite

OKT-3 ®

It is an antibody that is targeted against the cells that are causing the rejection.

Given IV over 60 seconds for 7 to 14 days.

* side-effects similar to the flu

* high fevers, chills, headaches, diarrhea and shortness of breath.

ATGAM ® and Thymoglobulin ®

Potent immunosuppressant that is an antibody that is targeted against t-cells that cause rejections

Given over 4 – 6 hours for seven to 14 days.

* side-effects similar to the flu

* high fevers, chills, headaches, diarrhea and shortness of breath.

Medication

Indication

Dosing recommendations

Acyclovir

200mg

Herpes Prophylaxis

Take twice a day for 6 months post-transplant.

Valcyte ® (Valganciclovir) 450mg

Antiviral agent used to revent and treat cytomegalovirus

Given for 3 months to decrease the likelihood of CMV illness, given in 450 mg tablets.

Bactrim DS
160mg

Bactrim SS
80 mg

Prophylaxis for pneumocystis pneumonia in patients on higher doses of immunosuppression early post-transplant

Prescribed 1 tab QMWF for 1 year post transplant; continued at 3X/wk dosing for all patients on methotrexate and rapamycin (dapsone substituted if patient allergic to sulfa)

Ciprofloxacin

Antibacterial prophylaxis given for biliary complications.

Prescribed 500mg pill twice a day, avoid giving with products that contain calcium.

Fluconazole

Antifungal prophylaxis – given daily for candidates with high-risk of having biliary complications.

Prescribed 200 mg tablet daily for two to three months.

Calcium Channel Blocker – Norvasc/Procardia

New onset hypertension

Doses should be maximized before starting second line therapy.

Clonidine Tablets

Second-line therapy for hypertension

Beta Blockers – labetalol or propranolol

Third-line therapy for hypertension

Pravachol

20mg

Treatment of drug induced hyperlipidemia. Prescribed as a result of data showing reduction in 12-month rejection in transplant recipients. *Preferred statin choice due to reduced incidence of myositis and rhabdomyolysis when used in conjunction with cyclosporine or Prograf.

Prescribed initially at 20 mg every night.

H2 blocker – Pepcid, Zantac, and Axid

GI protection from effects of steroids

Twice a day dosing

K Phos Neutral ®

Phosphorous supplement

Two tablets thee times a day