Medications commonly prescribed after major organ transplant, their side effects, dosage, and other information. Presented by Methodist Hospital, Houston, TX
3. This presentation will…
Answer your questions on what medications you will
take after transplant
Why these medications are important
Proper ways of taking these medications
Explain to you the side effects associated with these
medications
4. Medications that you will be taking
Anti-rejection medications
Anti-infection medications
Medications to protect your stomach
Blood pressure medications
Medications for high blood sugars
Supplements
7. Anti-Infection Medications
s
Anti-Rejections drugs weaken In f e ction
the immune system
m
ne Syste
Immu
They increase your risk of
getting infections
8. Anti-Infection Medications
Immune System Infections
Monitor anti-rejection medications Anti-infection medications
to balance between risk of help prevent infection
rejection and risk of infection
11. Prograf (Tacrolimus)
®
Anti-rejection Medication
Mostly used anti-rejection medication
Yellow = 0.5 mg
Typically you are put on Prograf® OR
Neoral® (Cyclosporine)
White = 1 mg
Do not allow pharmacy to substitute
without physician approval
Many drug interactions
Red = 5 mg
12. Cyclosporine (Neoral ) ®
Anti-rejection medication
Neoral® or Prograf®
25 mg capsule Also comes as Sandimmune®, Gengraf®)
Do not allow pharmacy to substitute
without physician approval
100 mg capsule Store capsule in original package
Many drug interactions
13. Prograf® (Tacrolimus),
Neoral® (Cyclosporine)
Take every 12 hours at the same time every day
8:00 AM 8:00 PM
Levels are checked before morning dose and the dose
may be changed according to the drug level
On lab days, DO NOT take Prograf® or Neoral®
Instead, bring them with you and take after lab work
14. Prograf® (Tacrolimus),
Neoral® (Cyclosporine)
Side Effects:
Hand tremors Water retention
Headaches High potassium
Confusion Low magnesium
High blood sugar Low phosphorus
High blood pressure Kidney problems
16. Prednisone
Typically take once daily in the morning
Best to take with food
5 mg tablet Side effects of prednisone can get
10 mg tablet better as the dose decreases
20 mg tablet
40 mg tablet
17. Prednisone
Side effects:
Fluid, salt retention Facial puffiness
High blood sugar Increased appetite
High blood pressure Weak bones/bone
Mood changes loss
Insomnia
Weak muscles/loss
Weight gain
Stomach irritation
Acne
18. Mycophenolate
(CellCept®, Myfortic®)
CellCept® Anti-rejection medication
You may take either CellCept® OR
250 mg 500 mg Azathioprine (Imuran®)
Myfortic® is a “slower release” form
Myfortic® of CellCept®
Take every 12 hours, same time
180 mg 360 mg every day
19. Azathioprine (Imuran ) ®
Anti-rejection medicine
50 mg tablet
May take in place of CellCept ®
or Myfortic®
Once daily dosing
Drug interaction with allopurinol
Decrease azathioprine dose by ½
to 1/3 of dose
20. Mycophenolate (CellCept®, Myfortic®),
Azathioprine (Imuran®)
Side effects:
CellCept ®, Myfortic® Azathioprine (Imuran®)
Nausea, cramping Decreased white
Diarrhea blood cell count
Decreased white Decreased red blood
blood cell count cell count
21. Sirolimus (Rapamune ) ®
Anti-rejection medication
Take once daily, separate from
1mg tablet Cyclosporine (Neoral®) by 4 hours
Neoral® Rapamune®
12:00 AM
8:00 AM
2 mg tablet Many drug interactions, ask transplant
Also available as a solution
team before taking any new medication
22. Sirolimus (Rapamune®)
Side effects:
Slow wound healing Increase in
Increase in cholesterol triglycerides
Decreased white
Decrease in red blood
blood cell count cell count
Decrease in platelets
Stomach cramping
23. Drug Interactions for
Prograf®, Neoral®, Rapamune®
Drug/Food Interactions:
Blood pressure medications (diltiazem, verapamil)
Seizure medications (phenytoin, carbamazepine)
Anti-infection medications (voriconazole, fluconazole)
Grapefruit, careful of foods high in potassium
ALWAYS ask transplant team BEFORE taking a NEW
medication or stopping an OLD medication if it will affect
your anti-rejection medication
27. Risk of infection
Lower immune system can increase risk of infection
Infection can come from germs in and around the
body, environment, animals or people, food, insects
Signs of infections: fever, fatigue, diarrhea,
symptoms of upper respiratory infection,
frequency/burning when urinating, red/irritated
skin
28. Kinds of infections after transplant
that we try to prevent against:
Fungal infections:
Oral “thrush”, fungal infection invading body
Viral infections:
Herpes (simplex, zoster), Cytomegalovirus (CMV)
Bacterial infections:
Pneumocystic jiroveci pneumonia (PCP)
29. Anti-fungal medications
Oral “thrush” medications:
Nystatin swish and swallow 5 ml four
times daily
Clotrimazole (Mycelex®) troches four times
daily
Do not eat or drink for 15 minutes after
31. Anti-fungal medications
Key points:
Clotrimazole, fluconazole, itraconazole and voriconazole
WILL affect Prograf®, Neoral®, and Rapamune® levels
Always ask:
What will happen to my anti-rejection medicine?
Itraconazole (Sporonox®)
Capsules should be taken WITH FOOD
Solution should be taken on an EMPTY STOMACH
Voriconazole (Vfend®)
Can cause visual hallucinations
Should be taken on an EMPTY STOMACH
32. Anti-viral medications
Herpes virus, Cytomegalovirus (CMV)
Acyclovir (Zovirax®)
200mg-800mg two to four times daily
Valacyclovir (Valtrex®)
500mg-1000mg one to two times daily
Valgancyclovir (Valcyte®)
450 mg one to two times daily
33. Anti-viral medications
Key points:
Take medications WITH FOOD to help increase
absorption
Valcyte can decrease red and white blood cell
counts and dose may be adjusted accordingly
This could lead to infections and feelings of fatigue
34. Anti-PCP medications
Pneumocystis jiroveci pneumonia (PCP)
Bactrim DS on MONDAYS, WEDNESDAYS, FRIDAYS
Bactrim SS daily
Cannot take if you have an allergy to SULFA
Increase sensitivity to sunlight
Can decrease white blood cell counts
35. Anti-PCP medications
Other anti-PCP medications
Pentamidine Inhalation Treatments
Given once a month in a breathing treatment
May cause coughing, irritation
Dapsone
100 mg tablet given once daily
Atovoquone (Mepron®)
Banana flavored liquid, 750 mg two times daily
43. Medication Calendar
ALWAYS follow directions on Calendar and NOT
on the pill bottle
ALWAYS bring medication calendar to every clinic,
lab and hospital visit
ALWAYS make changes to medication on the
calendar
44. NEVER stop taking your
medications
Reasons
Changes in financial income, insurance policy, etc
Side effects from medications
Laziness, forgetfulness
Cost of medication
45. ALWAYS ask transplant
team when:
A NEW medication is started
An OLD medication is changed or stopped
Make sure the change in therapy will NOT affect
your anti-rejection medications
46. Suggestions:
Get to know your pharmacists
Check medications before leaving the pharmacy
Use an alarm device to remind you to take your
medications
Be proactive in your healthcare
47. Frequently Asked Questions
What do I do if I vomit after taking my medication?
What do I do if I forget to take my medications?
Is there a difference between brand and generic
medications?