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Post-Transplant

Medications

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Section 1: Immunosuppression

Tacrolimus (Prograf)


Tacrolimus (aka Prograf or FK506) is an anti-rejection or immunosuppressive medication that the majority of intestinal transplant patients take post-transplant that functions to prevent rejection of the graft by suppressing the immune system.

It usually comes in the form of a capsule that is swallowed and its absorption can be affected by changes in your diet and other medications that you take, so it is important that you follow any instructions that your transplant team or pharmacist gives you in regard to taking this medication.

Common Side Effects:

  • Increased risk of infection
  • High potassium
  • Low magnesium
  • High cholesterol
  • High blood pressure
  • Kidney problems
  • High glucose level (diabetes)
  • Abnormal dreams
  • Tremors/ tingling
  • Hair thinning/ loss
  • Headaches

Important Tips and Special Instructions:

  • Take around the same time each day to keep a constant level in the bloodstream.
  • Do not eat raw shellfish or oysters.
  • Avoid grapefruit or grapefruit juice (e.g. Sunny Delight, Ruby Red juice).
  • Do not have immunizations without doctor’s approval.
  • Avoid people with colds and other infections: Your immune system is not as strong as it once was because of this medication, be sure to be aware of this and wash your hands and stay away from those who are ill.
  • Always have enough supply of medicine on hand: Skipping this medicine means that you could be putting yourself at risk of going into rejection and losing your graft.
  • Missed Dose: If missed by less than 3 hours, take the dose; if close to the next dose do not take a double dose.




Prednisone


Prednisone is known as a corticosteroid and is an immunosuppressive medication. It works to prevent organ rejection by suppressing the immune system. Prednisone comes in tablet form. Dosing will be unique to each patient.

Common Side Effects- Both Short Term and Long Term

  • High blood pressure
  • Increase in appetite and weight gain
  • Steroid-induced diabetes
  • Vision changes
  • Skin changes (acne, thinning of skin, stretch marks)
  • Increased sensitivity to the sun
  • Thrush
  • Swelling of hands, ankles, face
  • Osteonecrosis

Important Tips and Special Instructions:

  • Have enough medicine on hand: Skipping this medicine means that you could be putting yourself at risk of going into rejection and losing your graft.
  • Do not have immunizations without checking with doctor.
  • Avoid infection: Your immune system is not as strong as it once was because of this medication, be sure to be aware of this and wash your hands and stay away from those who are ill.
  • Follow dosage schedule carefully.
  • Missed Dose: If missed take as soon as possible; if close to the next dose do not take a double dose.




Mycophenolate Mofetil (CellCept)


Mycophenolate Mofetil is an anti-rejection or immunosuppressive medication that intestinal transplant patients may take post-transplant that functions to prevent rejection of the graft by suppressing the immune system. It comes as a capsule, tablet, or liquid suspension. Take with water on an empty stomach or with food. Do not crush or break before swallowing.

Common Side Effects:

  • Loss of appetite
  • Stomach pain
  • Nausea, vomiting
  • Diarrhea
  • Weakness
  • Shakiness
  • Muscle or leg pain
  • Dizziness, drowsiness, headache
  • Tremors, sweating, flushing
  • Decreased white blood cell or platelet counts

Important Tips and Special Instructions:

  • Do not store in direct heat or light.
  • Do not store medicine in a bathroom or near kitchen sink as moisture can cause it to breakdown.
  • Always have enough supply on hand: Skipping this medicine means that you could be putting yourself at risk of going into rejection and losing your graft.
  • Inform provider if you are taking antacids with aluminum or magnesium or acyclovir, they interfere with CellCept.
Get doctor’s approval for vaccinations.




Sirolimus (Rapamune)


Sirolimus is an anti-rejection or immunosuppressive medication that intestinal transplant patients may take post-transplant that functions to prevent rejection of the graft by suppressing the immune system. It comes as a tablet or oral solution.

Common Side Effects:

  • Acne
  • High cholesterol, high triglycerides
  • Constipation
  • Rash
  • Low potassium
  • Headache
  • Loss of energy
  • Muscle or joint pain
  • Mouth ulcers
  • Slow wound healing

Important Tips and Special Instructions:

  • Take around the same time each day to keep a constant level in the bloodstream.
  • Do not eat raw shellfish or oysters.
  • Avoid grapefruit or grapefruit juice.
  • Do not have immunizations without doctor’s approval.
  • Avoid people with colds and other infections: Your immune system is not as strong as it once was because of this medication, be sure to be aware of this and wash your hands and stay away from those who are ill.
  • Always have enough supply of medicine on hand: Skipping this medicine means that you could be putting yourself at risk of going into rejection and losing your graft.
  • Store at room temperature, away from moisture, direct sunlight, and excess heat.
  • Missed Dose: If missed take as soon as possible; if close to the next dose do not take a double dose.




Thymoglobulin


Thymoglobulin is an anti-human thymocyte immunoglobulin that is derived from rabbits and functions in the immunosuppression of a particular type of immune cell in the body called T cells. If you are in acute rejection, your transplant team may choose to use thymoglobulin as an addition to your maintenance immunosuppression to help save your graft. Thymoglobulin is given intravenously.

Common Side Effects:

  • High blood pressure (hypertension)
  • Joint or muscle pain
  • Abdominal pain
  • Increased levels of potassium in the blood
  • Low counts of platelets and white blood cells
  • Headache
  • Fever and/or chills
  • Shortness of breath




General Signs of Infection


For all immunosuppressive medications, be aware of the signs of infection, and notify your transplant team right away:

  • Pain, tenderness, redness, or swelling
  • Sweats or chills
  • Wound or cut that won’t heal
  • Red, warm, or draining sore
  • Sore throat, scratchy throat
  • Sinus drainage, nasal congestion
  • Persistent dry or moist cough lasting more than two days
  • Nausea, vomiting, diarrhea
  • Flu-like symptoms (chills, aches, fatigue)
  • Trouble urinating
  • Bloody, cloudy or foul-smelling urine
  • Black, tarry stools




What are immunosuppression medications (aka anti-rejection medications)?


  • When you receive an organ transplant, your body senses the new organ as foreign and your body's immune system attacks it.
  • Immunosuppressive medication helps reduce the risk of your body rejecting the new organ by lowering your immune response.
  • Since you have a lowered immune response, this also means that you are more susceptible to all types of infections.
  • You will have to take these medications for the rest of your life, and it is very important for the survival and longevity of your transplant.





Section 3: Other Medications

Pantoprazole (Protonix)


This is a common medication that you may have been on before transplant. The function of this medication is to treat acid reflux by reducing the amount of acid the stomach produces and is known as a proton-pump inhibitor (PPI). It usually comes in tablet form.

Common Side Effects:

  • Headache
  • Dizziness
  • Abdominal pain
  • Nausea and/or vomiting




Metoclopramide (Reglan)


The purpose of this medication is to speed up the emptying of the stomach and the movement of the upper portion of the small intestines. Your transplant team may prescribe this to you if you are having trouble with slow motility or nausea after your transplant. It usually comes in the form of a tablet.

Common Side Effects:

  • Tiredness
  • Trouble sleeping
  • Agitation
  • Headache
  • Diarrhea
  • Dizziness




Loperamide (Lomotil)


This medication functions to treat diarrhea by slowing down the movement of the gut. It comes in the form of tablets. Your transplant team might suggest this medication if you are having high output from your ostomy and frequent bouts of dehydration.

Common Side Effects:

  • Dizziness
  • Tiredness
  • Constipation




Warfarin (Coumadin)


This medication functions to prevent and treat blood clots by lowering the activity of clotting proteins in your blood. It comes in the form of a tablet. This medication requires close monitoring and usually will require you to have your blood drawn on a regular basis. You also need to be aware that you can bleed easily on this medication, so you should be careful if you become injured.

Common Side Effects:

  • Nausea, vomiting, stomach pain.
  • Bloating, gas.
  • Altered sense of taste.
  • Easy bruising, purple or red pinpoint spots on skin.

Important Tips and Special Instructions:

  • Interacts with many drugs, should check to see if any of your medications will interact.




Enoxaparin (Lovenox)


This medication functions to prevent and treat blood clots by lowering the activity of clotting proteins in your blood. It comes in the form of a subcutaneous (under the skin) injection. This medication requires close monitoring and usually will require you to have your blood drawn on a regular basis. You also need to be aware that you can bleed easily on this medication, so you should be careful if you become injured.

Common Side Effects:

  • Pain, bruising, swelling at the injection site
  • Nausea
  • Diarrhea
  • Swelling in hands or feet
  • Fever

Important Tips and Special Instructions:

  • Use extra caution with sharp objects to avoid getting cut, bruised or injured.
  • Avoid contact sports.





Section 2: Prophylaxis

What are prophylactic medications?


A prophylactic is a medication or a treatment designed and used to prevent a disease from occurring. You will take a variety of these medications after transplant to help prevent opportunistic infections you are now more susceptible to because of the immunosuppression medication you have to take.




Valganciclovir (Valcyte)


Antiviral used to treat or prevent cytomegalovirus (CMV). It comes in tablet form and should be taken with food or on a full stomach for full absorption.

Common Side Effects:

  • Headache

  • Diarrhea

  • Nausea

  • Vomiting

  • Upset stomach

  • Low white blood cells

  • Low platelets

Important Tips and Special Instructions:

  • Store at room temperature, away from excess heat, moisture, and direct sunlight.

  • Missed Dose: If missed take as soon as possible; if close to the next dose do not take a double dose.




Acyclovir (Zovirax)


Prophylactically used as an antiviral to prevent and treat infections caused by viruses, particularly herpes virus; also used to treat chicken pox and shingles. It comes in the form of tablets, capsules, or liquid suspension.

Common Side Effects:

  • Tiredness
  • Lightheadedness
  • Headache
  • Nausea or vomiting
  • Abdominal pain
  • Skin reactions
  • Kidney problems

Important Tips and Special Instructions:

  • Most effective when taken as soon as possible after you notice symptoms of herpes infection (i.e. pain, burning, blisters).
  • Does not prevent the spread of herpes virus.




Sulfamethoxazole/ Trimethoprim (Bactrim)


Prophylactic antibiotic used to prevent a type of pneumonia caused by Pneumocystis jiroveci and comes in the form of a tablet.

Common Side Effects:

  • Anemia
  • Sensitivity to sunlight
  • Dizziness
  • Diarrhea
  • Headache
  • Loss of appetite
  • Nausea, vomiting
  • Skin rash

Important Tips and Special Instructions:

  • Take exactly as prescribed with a full glass of water.
  • Drink enough fluids throughout the day.
  • Missed Dose: If missed take as soon as possible; if close to the next dose do not take a double dose.




Pentamidine (NebuPent)


Antibiotic used to prevent a type of pneumonia caused by Pneumocystis jiroveci used for patients with a sulfa allergy or who cannot tolerate oral Bactrim. It is inhaled into the body via a breathing treatment.

Common Side Effects:

  • Dizziness
  • Metallic taste
  • Fatigue
  • Loss of appetite
  • Diarrhea
  • Cough
  • Upset stomach
  • Congestion

Important Tips and Special Instructions:

  • Store in room temperature, away from excess heat, moisture, and direct sunlight.
  • Missed Dose: If missed take as soon as possible; if close to the next dose do not take a double dose.





Section 4: Additional Resources

Helpful Download from Transplant Unwrapped


Sign-Up or Log-In to Access: Medication Table: Listing of common post-transplant medications in a printable format. Exclusive download for members of our website.




Helpful Phone Application: Transplant Hero


Transplant Hero: iPhone application to help manage transplant medications.




Helpful Websites: Medication Assistance


Medication Assistance: Listing of websites that help with prescription drug costs.




Helpful Guide: University of Wisconsin Medication Guide


Medication Guide: A guide created by the University of Wisconsin. This is not specific to intestinal transplant but has very useful information related to transplant medications and how to manage possible side effects.




Transplant Unwrapped: Learn From Others


Learn From Others: Read stories, watch interviews, and listen to audio from numerous members of the intestinal community on a variety of topics. Useful for This Section: Learn from Others- Webinars-Post-Transplant Medications




Page References


References here.