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Important Disclaimer:
The information provided on this page is for educational purposes only and should not be considered a substitute for professional medical advice. Always consult with your healthcare provider for personalized medical guidance and decisions regarding medications and transplant care.
Essential Tips for Maintaining Your Health Post-Transplant
1
Frequent Lab Monitoring
Typically, labs are required 2-3 times per week post-transplant to monitor medication levels and overall health. Lab results usually take about 4 hours to process.
The frequency of lab and clinic visits will gradually decrease over time as your condition stabilizes.
2
Post-Transplant Education
Before being discharged from the hospital, you will receive post-transplant education, including a session with a pharmacist to understand your medication regimen and how to manage your health effectively.
3
Outside Lab Testing
Once you reach a certain stability level, outside labs can be conducted, which may take 1-2 days for results to be sent to the transplant center.
4
Additional Medications
In addition to anti-rejection medications, you may be required to take other medications as prescribed by your healthcare provider. However, the dosages of these additional medications may lower or taper off, often within 6 months post-transplant.
Practice Good Hygiene
-
Wash your hands frequently with soap and water, especially after touching surfaces in public areas or after contact with potentially contaminated items.
-
Avoid close contact with individuals who are sick or have infections.
Monitor for Signs of Infection
-
Be vigilant for any symptoms of infection, such as fever, chills, unusual discharge, or increased pain at the surgical site.
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Report any signs of infection to your healthcare provider immediately for prompt evaluation and treatment.
Stay Up-to-Date on Vaccinations
Follow your healthcare provider's recommendations for vaccinations to help prevent common infections. Certain vaccines may be more critical post-transplant to protect against specific infections.
Risks of Infection
0-1 Month Post-Transplant:
-
High risk of surgical infections such as urinary tract infections (UTI), wound infections, and other surgical site infections.
1-6 Months Post-Transplant:
-
Increased risk of opportunistic infections due to the high levels of immunosuppressive medications. These infections may include:
-
Cytomegalovirus (CMV)
-
Pneumocystis jiroveci pneumonia (PJP)
-
Herpes infections
-
BK virus
-
Epstein-Barr Virus (EBV)
Greater Than 6 Months Post-Transplant:
-
The risk of infection becomes similar to that of the general population, although vigilance remains crucial.
Medication and Infection Risks
Immunosuppressive medications, while essential for preventing organ rejection, can significantly increase the risk of infections by lowering the body's natural defenses. This risk is particularly high in the first few months following a transplant, as medication levels are at their highest. To help manage and minimize the risk of infection, follow these guidelines.
Consistency is
Key
Take your medications every 12 hours at the same time each day. A one-hour window is acceptable if you cannot take them exactly at the 12-hour mark.
Food
Considerations
Decide whether to take your medications with or without food and stick with that decision.
Dosage
Flexibility
Certain medications, like Prednisone, Cellcept, or Mycophenolate, can be taken in the morning or at night. Consult your healthcare provider for specific guidance.
Swallow Capsules Whole
Do not break or crush capsules.
Communicate with Your Medical Team
Always consult with your healthcare provider about any new medications or if you have concerns about your current medications.
Guidelines for Medication Management
Understanding Anti-Rejection Medications
Calcineurin Inhibitors (e.g., Tacrolimus, Cyclosporine
Help prevent organ rejection by suppressing the immune response but can cause kidney toxicity and neurological side effects.
Antimetabolites (e.g., Mycophenolate Mofetil, Mycophenolic Acid):
Prevent immune cells from multiplying, reducing the risk of rejection but may cause gastrointestinal issues.
Corticosteroids (e.g., Prednisone):
Reduce inflammation and immune activity, with potential side effects including mood changes and elevated blood sugar.
TOR Inhibitors (e.g., Sirolimus, Everolimus)
Block T-cell activation to prevent rejection; side effects may include delayed wound healing and increased cholesterol levels.
Co-Stimulation Blockers (e.g., Belatacept)
Specifically used for kidney transplants to prevent rejection, with administration through IV infusions that can cause low blood pressure.
Anti-rejection medications, also known as immunosuppressants, are essential for transplant recipients. These medications prevent the body’s immune system from attacking the transplanted organ, which it perceives as a foreign object. Common anti-rejection medications are grouped into several categories.
Reference Materials
-
Piedmont Transplant Institute: "Guidelines for Medication Management"
This resource, presented by Dr. Rosemary Cross, Transplant Clinical Pharmacist at Piedmont Transplant Institute, provides practical tips on how to manage post-transplant medications. It emphasizes consistency in taking medications, food considerations, and communication with healthcare providers about any concerns or new medications.
Source: Derived from a presentation by Dr. Rosemary Cross, Transplant Clinical Pharmacist at Piedmont Transplant Institute.
-
Transplant Living: "Post-Transplant Medications"
A comprehensive guide from Transplant Living that covers the various types of medications used to prevent organ rejection. It provides insight into how immunosuppressants work, their potential side effects, and the importance of regular monitoring to minimize risks.
-
Piedmont Transplant Institute: "Medication and Infection Risks"
A detailed overview of infection risks for transplant recipients, including practical guidelines for maintaining hygiene and recognizing symptoms of infection. The resource breaks down the timeline of infection risks from 0-1 month post-transplant to greater than 6 months, helping patients understand how to manage their health and minimize the risk of complications.
Source: Derived from notes taken from a presentation by Dr. Rosemary Cross, Transplant Clinical Pharmacist at Piedmont Transplant Institute.
Overview
Post-transplant care involves a lifelong commitment to medication management and health monitoring to ensure the success of your transplant. This section provides detailed guidelines and resources to help you stay on track with your medications, understand the importance of anti-rejection drugs, and reduce the risk of infections, particularly in the critical first months after your surgery.
Essential Medications for Transplant Success
Your Path to a Successful Transplant Journey
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General Information About Medication and Transplantation Process
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Overview
Medications play a crucial role in the success of organ transplants. For transplant recipients, adhering to prescribed medications is vital to prevent organ rejection and ensure the longevity of the transplanted organ. Proper medication management helps maintain the delicate balance between preventing rejection and minimizing side effects or complications.
Please Note: The following list includes some of the most common medications prescribed for transplant patients; however, individual prescriptions may vary. Always follow the specific instructions provided by your healthcare team.
General Information
During and after the transplantation process, every transplant recipient must take anti-rejection medications, also known as immunosuppressants, for the lifetime of the transplanted organ. These medications are crucial in preventing the body’s immune system from attacking and rejecting the new organ. However, these powerful drugs can have serious side effects, so it is essential for recipients to follow their medication regimen closely and attend regular follow-ups with healthcare providers to ensure the best outcomes.
Your doctor will carefully adjust the dosages of these immunosuppressants to strike a balance between protecting the transplanted organ and minimizing the risk of complications. It is vital to adhere to these medications exactly as prescribed to maintain the health and function of the new organ.
Azathioprine
Brand Name: Imuran
Helps suppress the immune system to prevent organ rejection. Possible side effects include nausea, vomiting, and increased risk of infection.
Overview: Azathioprine is an immunosuppressant used to prevent organ rejection in transplant patients, particularly after a kidney transplant. It is also used to treat conditions like rheumatoid arthritis and ulcerative colitis.
How It Works: Azathioprine reduces inflammation and interferes with the growth of immune cells that can attack a transplanted organ. It also suppresses bone marrow, which may lower the production of white blood cells that fight infections, so monitoring for infections is important.
Usage Instructions:
-
Take azathioprine exactly as prescribed by your doctor.
-
Store it in a cool, dry place away from children and moisture.
-
Dispose of any outdated or unnecessary medication safely.
Common Side Effects:
-
Cold hands and feet
-
Diarrhea
-
Joint pain
-
Upset stomach
-
Vomiting
Serious Side Effects: Contact your doctor if you experience:
-
Blood in urine or stools
-
Chills or fever
-
Mouth sores
-
Shortness of breath
-
Unusual bleeding or bruising
-
Yellowing of the skin or eyes
Drug Interactions: Inform your doctor if you are taking any other medications, such as allopurinol, corticosteroids, cyclosporine, warfarin, or any ACE inhibitors.
Basiliximab
Brand Name: Simulect
An antibody that helps reduce the risk of acute rejection immediately following the transplant. Side effects can include fever, headache, and gastrointestinal issues.
Overview: Basiliximab is an immunosuppressant used to reduce the risk of acute organ rejection, especially after a kidney transplant. It is often administered alongside other medications to enhance its effectiveness.
How It Works: Basiliximab works by binding to and blocking the interleukin-2 receptor on the surface of activated T-lymphocytes, preventing these immune cells from attacking the transplanted organ.
Usage Instructions:
-
Basiliximab is given by injection under the supervision of a healthcare provider.
-
Avoid contact with people who have infections.
-
Maintain good dental hygiene and schedule regular dental check-ups.
Common Side Effects:
-
Acne
-
Constipation
-
Nausea and diarrhea
-
Headache
-
Muscle or joint pain
-
Weight gain
Serious Side Effects: Contact your doctor if you experience:
-
Abdominal or back pain
-
Blood in stool
-
Chest pain
-
Shortness of breath
-
Swelling of the ankles, face, or legs
-
White patches in the mouth or throat
Drug Interactions: Basiliximab does not generally interact with other transplant medications, but it's important to inform your doctor about all medications you're taking to avoid potential interactions.
Belatacept
Brand Name: Nulojix
Belatacept is an immunosuppressant specifically used for kidney transplant patients to prevent organ rejection. It is administered intravenously in combination with other medications.
How It Works: Belatacept is a co-stimulation blocker that reduces the immune system's activity, preventing it from attacking the transplanted kidney.
Usage Instructions:
-
Belatacept is given as an intravenous injection over 30 minutes, typically administered by a healthcare professional.
-
The injection schedule includes the day of the transplant, 5 days post-transplant, the end of weeks 2 and 4, and then once every 4 weeks.
-
Avoid unnecessary or prolonged exposure to sunlight, use sun protection, and discuss any planned surgeries or vaccinations with your healthcare provider.
Common Side Effects:
-
Constipation
-
Fatigue
-
Fast heartbeat
-
Headache
-
Muscle weakness
-
Swelling of hands, feet, ankles, or lower legs
Serious Side Effects: Contact your doctor if you experience:
-
Changes in mood, behavior, or personality
-
Visual or speech changes
-
Clumsiness or confusion
-
Weakness on one side of the body
-
Difficulty remembering
Drug Interactions: Inform your doctor of all medications, supplements, and herbal products you are taking. Your doctor may adjust your medication dosages or monitor you for side effects. Avoid vaccinations without consulting your doctor.
Cyclosporine
Brand Names: Neoral (Novartis Pharmaceuticals Corporation); Sandimmune (Novartis Pharmaceuticals Corporation)
Overview: Cyclosporine is a calcineurin inhibitor used to suppress the immune system and prevent organ rejection in transplant patients. It is commonly prescribed for kidney, liver, and heart transplants and may also be used for severe cases of psoriasis and rheumatoid arthritis. Discovered in 1972 and first used in humans in 1978, cyclosporine has significantly improved transplant success rates.
How It Works: Cyclosporine works by reducing the production of interleukins, which decreases the replication of helper and killer T cells that are responsible for attacking transplanted organs. This targeted immunosuppressive action helps prevent organ rejection while minimizing broader immune suppression.
Usage Instructions:
-
Take cyclosporine exactly as prescribed by your doctor. Do not adjust the dosage without medical advice.
-
Store cyclosporine at room temperature, away from heat and direct light. Do not refrigerate.
-
Keep the medication in its original container, tightly closed, and out of reach of children.
-
Discard any outdated medication and do not keep liquid formulations for more than two months.
Dosage Considerations:
-
If you miss a dose, follow your doctor’s instructions for what to do next. If you miss more than one dose, contact your doctor immediately.
-
In the event of an overdose, contact your local poison control center or emergency services.
Common Side Effects:
-
Breast enlargement
-
Diarrhea
-
Increased hair growth
-
Loss of appetite
-
Sinusitis
-
Upset stomach
-
Vomiting
-
Tender, swollen, or bleeding gums
Serious Side Effects: Contact your doctor if you experience:
-
Tremors or seizures
-
Overgrowth of the gums
-
Unusual bleeding or bruising
-
Sore throat, fever, or chills
-
Yellowing of the skin or eyes
-
Swelling of the feet, ankles, or hands
-
Weight gain
-
Headache or muscle aches
-
Changes in vision
-
Lack of control over body movements
-
Painful or decreased urination
-
Confusion
Drug Interactions: Cyclosporine may interact with various medications, including certain diuretics, antifungals, HIV protease inhibitors, and statins, among others. Always inform your doctor of all medications, supplements, and herbal products you are taking to avoid harmful interactions.
Daclizumab
Brand Name: Zenapax, manufactured by Roche Laboratories Inc.
Overview: Daclizumab is an immunosuppressant antibody used to reduce the risk of organ rejection, particularly following a kidney transplant. It prevents T-cell activation, thereby inhibiting the immune response against the transplanted organ. This medication is known to help reduce rejection episodes, but it may increase the risk of infections due to its impact on the immune system.
How It Works: Daclizumab works by binding to and blocking specific receptors on white blood cells (T-cells), which are responsible for attacking transplanted organs. By preventing these cells from becoming active, daclizumab helps protect the transplanted kidney from immune rejection.
Usage Instructions:
-
Daclizumab is administered via injection by a healthcare professional, typically under the supervision of your doctor.
-
It is important to maintain good dental hygiene and see a dentist regularly while on daclizumab to prevent oral infections.
Common Side Effects: Inform your doctor if you experience any of these symptoms and they persist or worsen:
-
Constipation
-
Diarrhea
-
Headache
-
Heartburn
-
Joint and muscle pain
-
Slow wound healing
-
Trouble sleeping
Serious Side Effects: Seek immediate medical attention if you experience
-
Chest pain
-
Coughing
-
Dizziness
-
Fever
-
Frequent urination
-
Nausea or vomiting
-
Rapid heart rate
-
Red, tender, or oozing skin at the incision site
-
Shortness of breath
-
Swelling of the feet or lower legs
-
Trembling or shaking of the hands or feet
-
Weakness
Precautions:
-
Avoid contact with individuals who have colds or other infections.
-
Daclizumab may reduce the body’s ability to fight infections, so monitor for any signs of infection.
Drug Interactions: In clinical trials, daclizumab has not shown significant interactions with other common transplant medications. However, always inform your doctor or pharmacist of all medications, supplements, and over-the-counter products you are taking to avoid potential interactions.
Muromonab-CD3
Brand Name: Orthoclone OKT3, manufactured by Ortho Biotech
Overview: Muromonab-CD3 is an immunosuppressant monoclonal antibody used to prevent the body from rejecting a transplanted organ, particularly in cases of acute rejection episodes. It is effective in reversing rejection by targeting specific T-cells that are primarily responsible for attacking the transplanted organ.
How It Works: Muromonab-CD3 works by binding to the CD3 molecules on the surface of T-cells, which are specialized white blood cells involved in the immune response. By blocking these cells, the drug helps to suppress the immune system's reaction against the transplanted organ, reducing the likelihood of rejection.
Usage Instructions:
-
Muromonab-CD3 is administered via injection by a healthcare professional, usually under direct supervision in a medical facility.
-
The medication is typically used in a hospital setting during episodes of acute organ rejection.
Common Side Effects: Side effects are common with muromonab-CD3. Notify your doctor if you experience any of the following symptoms
-
Fever and chills
-
Headache
-
Nausea and vomiting
-
Diarrhea
-
Dizziness or faintness
-
Muscle or joint pain
-
Confusion or hallucinations
-
Cough or hoarseness
-
Skin rash or itching
-
Trouble breathing or tightness in the chest
-
Unusual tiredness or weakness
Serious Side Effects: Seek immediate medical attention if you experience
-
Chest pain
-
Rapid or irregular heartbeat
-
Shortness of breath or wheezing
-
Swelling of the face or throat
Precautions:
-
Avoid close contact with individuals who have recently received an oral polio vaccine or who have colds or other infections.
-
Muromonab-CD3 may impair mental alertness and coordination; avoid driving or operating machinery until you know how the drug affects you.
Drug Interactions: Inform your doctor about all medications you are taking, especially
-
Azathioprine (Imuran)
-
Chlorambucil (Leukeran)
-
Corticosteroids (cortisone-like medicines)
-
Cyclophosphamide (Cytoxan)
-
Cyclosporine (Sandimmune)
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Cytarabine (Cytosar-U)
-
Mercaptopurine (Purinethol)
-
Tacrolimus (Prograf)
Mycophenolic Acid
Brand Name: Myfortic®, manufactured by Novartis Pharmaceuticals Corporation
Overview: Mycophenolic acid is an antirejection medication prescribed to prevent the body's immune system from rejecting a transplanted kidney. It works by suppressing the proliferation of certain white blood cells that can attack the transplanted organ.
How It Works: Mycophenolic acid inhibits the multiplication of T and B lymphocytes, types of white blood cells involved in the immune response. This suppression helps control the immune system's reaction to the transplanted organ, reducing the risk of rejection.
Usage Instructions:
-
Take mycophenolic acid exactly as prescribed by your doctor, maintaining a consistent schedule regarding dosing and meals.
-
Always take this medication on an empty stomach, either 1 hour before or 2 hours after eating.
-
Swallow tablets whole without crushing, chewing, or cutting.
-
Store the medication at room temperature (77°F or 25°C) in its original container, tightly closed and away from moisture and heat.
-
Keep the medication out of reach of children.
Precautions:
-
Do not substitute mycophenolic acid with other medications without consulting your doctor due to differences in absorption caused by its enteric coating.
-
Avoid using mycophenolic acid if you have allergies to mycophenolate sodium, mycophenolic acid, mycophenolate mofetil, or any ingredients in the tablet. Check with your doctor or pharmacist if you need information on inactive ingredients.
-
Mycophenolic acid may increase the risk of infections and certain cancers, including lymphoma. Notify your doctor immediately if you develop symptoms like fever, chills, sore throat, unusual bleeding, or bruising.
Common Side Effects:
-
Constipation
-
Nausea
-
Diarrhea
-
Urinary tract infection
-
Upper respiratory infection
Serious Side Effects: Seek immediate medical attention if you experience
-
Allergic reactions (difficulty breathing, swelling of the face or throat, hives)
-
Unusual tiredness or weakness
-
Painful or difficult urination
-
Black, bloody, or tarry stools, or blood in vomit
-
Severe nausea, vomiting, or diarrhea
-
Symptoms of serious infections or potential cancers
Drug Interactions: Consult your doctor before starting any new prescription or over-the-counter medications while on mycophenolic acid. Inform any new healthcare providers about your use of this medication to prevent adverse interactions.
Mycophenolate Mofetil
Brand Name: CellCept, manufactured by Genentech, a member of the Roche Group
Overview: Mycophenolate mofetil is an immunosuppressant medication used to prevent the rejection of a transplanted organ. It is commonly prescribed alongside other immunosuppressants for patients who have received kidney, liver, or heart transplants.
How It Works: Mycophenolate mofetil works by decreasing the production of white blood cells that could attack the transplanted organ. It is particularly effective when combined with other immunosuppressive drugs.
Usage Instructions:
-
Take mycophenolate mofetil exactly as prescribed by your doctor. Consult your healthcare provider if you do not understand the directions.
-
Keep the medication out of reach of children.
-
Store mycophenolate mofetil away from heat and direct light. Avoid storing it in damp areas such as bathrooms or near kitchen sinks, as moisture and heat can cause the medicine to break down.
-
Dispose of any outdated or unused medication properly, and consult your pharmacist about the correct disposal methods.
Dosage:
-
Missed Dose: If you forget to take a dose, follow the instructions provided by your doctor. Do not take a double dose unless directed by your physician.
-
Overdose: In case of an overdose, contact your local poison control center immediately. If the person has collapsed or is not breathing, call 911 or your local emergency services.
Common Side Effects: Notify your doctor if you experience any of these symptoms, especially if they persist or worsen
-
Constipation
-
Diarrhea
-
Headache
-
Heartburn
-
Nausea
-
Stomach pain
-
Vomiting
-
Weakness
-
Acne
-
Dizziness
-
Skin rash
-
Trouble sleeping
Serious Side Effects: Seek immediate medical attention if you experience any of the following
-
Abdominal pain
-
Black, tarry stools
-
Blood in urine or stools
-
Bloody vomit
-
Chest pain
-
Cough or hoarseness
-
Enlarged, red, or bleeding gums
-
Fever or chills
-
Increased cough
-
Irregular heartbeat
-
Joint or muscle pain
-
Lower back or side pain
-
Painful or difficult urination
-
Pinpoint red spots on the skin
-
Shortness of breath
-
Sores inside the mouth
-
Swelling of feet or lower legs
-
Trembling or shaking of hands or feet
-
Unusual bleeding or bruising
-
White patches in the mouth, on the tongue, or throat
Drug Interactions: Inform your doctor if you are currently taking or plan to take any other medications, especially
-
Antithymocyte globulin (e.g., Atgam)
-
Azathioprine (e.g., Imuran)
-
Chlorambucil (e.g., Leukeran)
-
Corticosteroids (e.g., Cortef, Decadron, Deltasone, Medrol)
-
Cyclophosphamide (e.g., Cytoxan)
-
Cyclosporine (e.g., Neoral, Sandimmune)
-
Mercaptopurine (e.g., Purinethol)
-
Muromonab-CD3 (e.g., Orthoclone OKT3)
-
Tacrolimus (e.g., Prograf)
Prednisone
Brand Name: Deltasone, manufactured by Upjohn; Meticorten, manufactured by Schering; Orasone, manufactured by Solvay
Overview: Prednisone is an immunosuppressant corticosteroid commonly used to prevent organ rejection following a transplant. It is also effective in treating various conditions such as severe allergies, asthma, arthritis, and disorders affecting the skin, blood, kidneys, eyes, thyroid, and intestines.
How It Works: Prednisone mimics a natural hormone produced by the adrenal glands. It helps reduce inflammation and suppresses the immune system by inhibiting the secretion of interleukin-1, which decreases the replication of cytotoxic T cells. Additionally, it has a nonspecific anti-inflammatory effect and inhibits granulocyte function, which limits damage to the transplanted organ.
Usage Instructions:
-
Take prednisone exactly as prescribed by your doctor. If you have questions about the instructions, consult your doctor, nurse, or pharmacist.
-
Keep the medication in its original container, tightly closed, and out of reach of children.
-
Store prednisone at room temperature, away from excess heat and moisture.
-
Dispose of any outdated or no longer needed medication properly, and consult your pharmacist about the correct disposal methods.
Dosage:
-
Missed Dose: If you miss a dose, refer to the instructions provided by your doctor. Do not take a double dose unless directed by your physician.
-
Overdose: In case of an overdose, contact your local poison control center immediately. If the person has collapsed or is not breathing, call 911 or your local emergency services.
Common Side Effects: Notify your doctor if you experience any of these symptoms, especially if they persist or worsen
-
Acne
-
Anxiety
-
Depression
-
Dizziness
-
Easy bruising
-
Headache
-
Increased hair growth
-
Insomnia
-
Irregular or absent menstrual periods
-
Restlessness
-
Upset stomach and/or vomiting
-
Puffy, "moon-faced" appearance
Serious Side Effects: Seek immediate medical attention if you experience any of the following
-
Black or tarry stool
-
Persistent cold or infection
-
Muscle weakness
-
Skin rash
-
Swollen face, lower legs, or ankles
-
Vision problems
Drug Interactions:Before taking prednisone, inform your doctor if you are taking or plan to take any of the following medications
-
Anticoagulants (e.g., warfarin)
-
Arthritis medications
-
Aspirin
-
Cyclosporine (e.g., Neoral, Sandimmune)
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Digoxin (e.g., Lanoxin)
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Diuretics ("water pills")
-
Estrogen (e.g., Premarin)
-
Ketoconazole (e.g., Nizoral)
-
Oral contraceptives
-
Phenobarbital
-
Phenytoin (e.g., Dilantin)
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Rifampin (e.g., Rifadin)
-
Theophylline (e.g., Theo-Dur)
-
Vitamins
Tacrolimus
Brand Name: Prograf, manufactured by Astellas Pharma US, Inc.; ASTAGRAF XL, manufactured by Astellas Pharma US, Inc.
Overview: Tacrolimus, also known by brand names Prograf and ASTAGRAF XL, is an immunosuppressant medication commonly used to prevent organ rejection in patients who have received kidney, liver, pancreas, lung, or heart transplants. It works by reducing the body's natural immune response to the transplanted organ, thus minimizing the risk of rejection.
How It Works: Tacrolimus functions similarly to cyclosporine by inhibiting the production and activity of cytokines, including interleukin-2 (IL-2), and blocking the proliferation of T-cells, which are key players in the immune response that could lead to organ rejection.
Usage Instructions:
-
Take tacrolimus exactly as prescribed by your doctor. If you do not understand the instructions, consult your doctor, nurse, or pharmacist.
-
Store the medication in its original container, away from heat, moisture, and direct light.
-
Keep out of the reach of children.
-
Do not store in the bathroom, near the kitchen sink, or in any other damp place.
-
Discard any expired or unused medication properly. Consult your pharmacist for disposal instructions.
Dosage:
-
Missed Dose: If you miss a dose, follow your doctor's instructions. Do not double up on doses without consulting your healthcare provider.
-
Overdose: In the event of an overdose, contact your local poison control center immediately. If the person has collapsed or is not breathing, call 911.
Common Side Effects: Report any persistent or severe symptoms to your doctor, including
-
Diarrhea
-
Insomnia
-
Loss of appetite
-
Stomach pain
-
Upset stomach
-
Vomiting
Serious Side Effects: Seek immediate medical attention if you experience
-
Difficulty breathing or wheezing
-
Itching
-
Painful, frequent, or decreased urination
-
Seizures
-
Severe or persistent headaches
-
Skin rash or hives
-
Sore throat, fever, or chills
-
Swelling of feet, ankles, lower legs, and hands
-
Tremors
-
Unusual bleeding or bruising
-
Weakness
-
Weight gain
-
Yellowing of the skin or eyes (jaundice)
Drug Interactions: Before taking tacrolimus, inform your doctor if you are taking or plan to take any of the following medications
-
Antacids
-
Bromocriptine (e.g., Parlodel)
-
Carbamazepine (e.g., Tegretol)
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Cimetidine (e.g., Tagamet)
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Cyclosporine (e.g., Neoral, Sandimmune)
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Fluconazole (e.g., Diflucan)
-
HIV protease inhibitors (e.g., indinavir)
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Ketoconazole (e.g., Nizoral)
-
Oral contraceptives
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Rifampin (e.g., Rifadin, Rimactane)
-
Spironolactone (e.g., Aldactone)
-
St. John’s Wort and related products
-
Vitamins
Avoid grapefruit and grapefruit juice as they can increase the effects of tacrolimus by raising the levels of the medication in your bloodstream.
Precautions:
-
Avoid raw oysters and shellfish to reduce the risk of infection.
-
Practice good personal hygiene, especially for the mouth, teeth, skin, hair, and hands.
-
Discuss the risk of certain types of cancer with your doctor.
-
Avoid contact with individuals who have received the oral poliovirus vaccine or who have infections.
Sirolimus
Brand Name: Rapamune, manufactured by Wyeth
Overview: Sirolimus, also known as Rapamune, is an immunosuppressant medication used primarily to prevent organ rejection in kidney transplant recipients. It works by inhibiting T-cell activation, thereby reducing the body's immune response against the transplanted organ. Sirolimus is often used in combination with other immunosuppressive drugs to enhance its effectiveness.
How It Works: Sirolimus blocks the activation of white blood cells (T-cells) that would otherwise attack the transplanted organ, helping to prevent rejection.
Usage Instructions:
-
Take sirolimus exactly as prescribed by your doctor. If you have questions, consult your healthcare provider or pharmacist for clarification.
-
Keep the medication in its original container, tightly sealed, and out of reach of children.
-
Store tablets at room temperature, away from excess heat and moisture.
-
Liquid medication should be stored in the refrigerator, tightly closed. Dispose of any unused liquid one month after opening. Do not freeze.
-
Discard any expired or unused medication properly, and consult your pharmacist for proper disposal methods.
Dosage:
-
Missed Dose: If you miss a dose, follow the instructions given by your doctor. Do not take an extra dose without consulting your healthcare provider.
Overdose: In the event of an overdose, contact your local poison control center immediately. If the individual is unconscious or not breathing, call 911.
Common Side Effects: Notify your doctor if you experience any of these symptoms, especially if they persist or worsen
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Back pain
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Difficulty sleeping
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Fever
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Headache
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Joint pain
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Rash
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Stomach pain, constipation, diarrhea, or vomiting
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Swelling in hands, feet, ankles, or lower legs
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Tremor
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Weakness
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Weight gain
Serious Side Effects: Seek immediate medical attention if you experience any of the following
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Cough
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Pale skin
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Shortness of breath
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Unusual bleeding or bruising
Drug Interactions:Before taking sirolimus, inform your doctor if you are using or plan to use any of the following medications
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Antifungals (e.g., fluconazole, itraconazole)
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HIV protease inhibitors (e.g., indinavir)
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Cyclosporine (e.g., Neoral, Sandimmune)
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Tacrolimus (e.g., Prograf)
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Other medications that may interact with sirolimus.
Avoid grapefruit and grapefruit juice while taking this medication, as they can increase sirolimus levels in your body.
Precautions:
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Avoid raw oysters and shellfish to reduce the risk of infection.
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Avoid contact with individuals who have received the oral polio vaccine or who have infections.
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Avoid sunlight exposure; use sunscreen and protective clothing as sirolimus can increase sensitivity to sunlight.
Reference Materials
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Transplant Living: "Post-Transplant Medications"
This comprehensive guide from Transplant Living explains the importance of medication adherence in preventing organ rejection post-transplant. It includes detailed information on how immunosuppressants work, common side effects, and medication management strategies to ensure transplant success.
Source: Transplant Living - Post-Transplant Medications -
Transplant Living: "Azathioprine"
This resource covers the usage, side effects, and administration of azathioprine, an immunosuppressant often prescribed for kidney transplant recipients. It also highlights the importance of monitoring for infection due to the drug's impact on white blood cell production.
Source: Transplant Living - Azathioprine -
Transplant Living: "Basiliximab"
An antibody medication, basiliximab is often used to reduce the risk of acute organ rejection after a kidney transplant. This guide outlines its usage, common side effects, and interactions.
Source: Transplant Living - Basiliximab -
Transplant Living: "Belatacept"
This immunosuppressant medication, commonly administered intravenously to kidney transplant patients, is designed to prevent organ rejection. It also discusses the side effects and special considerations associated with the drug.
Source: Transplant Living - Belatacept -
Transplant Living: "Cyclosporine"
Learn about cyclosporine, one of the most commonly prescribed immunosuppressants for transplant patients, with information on dosage, potential side effects, and precautions.
Source: Transplant Living - Cyclosporine -
Transplant Living: "Daclizumab"
This reference outlines daclizumab’s role in preventing organ rejection post-kidney transplant. It provides usage instructions, common and serious side effects, and drug interactions.
Source: Transplant Living - Daclizumab -
Transplant Living: "Muromonab-CD3"
Muromonab-CD3 is used to prevent organ rejection by targeting T-cells. This guide covers how the medication works, possible side effects, and necessary precautions.
Source: Transplant Living - Muromonab-CD3 -
Transplant Living: "Mycophenolic Acid"
Mycophenolic acid is prescribed to prevent organ rejection after a kidney transplant. This guide offers insights into proper medication management and possible interactions.
Source: Transplant Living - Mycophenolic Acid -
Transplant Living: "Mycophenolate Mofetil"
This resource provides detailed information on mycophenolate mofetil, its administration, and the risks and benefits of using it post-transplant.
Source: Transplant Living - Mycophenolate Mofetil -
Transplant Living: "Prednisone"
Prednisone is a corticosteroid used to prevent organ rejection. This guide includes information on how to take the medication, potential side effects, and important precautions.
Source: Transplant Living - Prednisone -
Transplant Living: "Sirolimus"
Sirolimus is often prescribed to kidney transplant recipients to prevent organ rejection. This resource provides information on its usage, potential side effects, and necessary precautions.
Source: Transplant Living - Sirolimus -
Transplant Living: "Tacrolimus"
This guide covers the immunosuppressant tacrolimus, explaining its role in preventing organ rejection and offering practical advice on medication management and side effect monitoring.
Source: Transplant Living - Tacrolimus -
Piedmont Transplant Institute: "General Medication Management Guidelines"
These guidelines provide tips on how to manage post-transplant medications, including consistency in taking doses and important safety practices like consulting with a healthcare provider about any new medications.
Source: Derived from a presentation by Dr. Rosemary Cross, Transplant Clinical Pharmacist at Piedmont Transplant Institute.
Additional Resources
Perelman School of Medicine NonTransplant Medications That Should be Avoided