Medications commonly prescribed after major organ transplant, their side effects, dosage, and other information. Presented by Methodist Hospital, Houston, TX

1. WHAT DO I NEED TO KNOW
ABOUT MEDICATIONS AFTER MY
ORGAN TRANSPLANT?

2. Meet the Pharmacists
Leamon Blanton Samir Patel
Kyle Dawson Jenny DeVos

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

5. Anti-Rejection Medications
Lungs Immune System
Heart
Liver
Pancreas Kidney

6. Anti-Rejection Medications
 Prograf® (Tacrolimus)
 Neoral® / Gengraf® (Cyclosporine)
 CellCept® / Myfortic ® (Mycophenolate)
 Imuran® (Azathioprine)
 Rapamune® (Sirolimus)
 Steroids (Prednisone)

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

9. Anti-Infection Medications
 Anti-fungal medications
 Fluconazole, Vfend®, nystatin, clotrimazole
 Anti-bacterial medications
 Bactrim®, pentamidine, dapsone, atovaquone
 Anti-viral medications
 Acyclovir, Valcyte®

10. Anti-Rejection Medications

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

15. Prograf® (Tacrolimus),
Neoral® (Cyclosporine)
Side Effects:
 Hair Loss (Prograf®)  Hair Growth (Neoral®)

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

24. Over-the-counter medications
to AVOID
 Anti-inflammtory drugs: ibuprofen, naproxen (Aleve®,
Advil®, Motrin®)
 Herbal supplements
 Decongestants (phenylephrine, pseudoephedrine)
 Diet pills
 Cimetidine (Tagament®)

25. Over-the-counter medications
that are OK
 Zyrtec®, Claritin®, Benadryl® - Allergies
 Pepcid®, Zantac®, Prilosec® - Upset stomach
 Immodium® - Diarrhea
 Bisacodyl, Senna, Docusate Sodium – Constipation
 Tylenol® - Headache, pain, fever

26. Anti-infection Medications

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

30. Anti-fungal medications
For invasive fungal infections:
 Fluconazole (Diflucan®)
 Itraconazole (Sporonox®)
 Voriconazole (Vfend®)

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

36. Other Medications

37. Supplements
 NeutraPhos (Phosphorus)
 MagOxide (Magnesium)
 Multivitamin
 Calcium
 Vitamin D

38. Other medications
 Blood pressure medications
 Norvasc®, Metoprolol, Hydralazine
 Blood sugar lowering medications
 Insulin, Januvia®, Actos®
 Osteoporosis prevention/treatment medications
 Boniva®, Fosamax®, Actonel®
 Take with full glass of water and sit/stand upright for 30
minutes

39. Other medications
 Acetylcysteine (Mucomyst) for inhalation – Lung
 Lung secretions
 Ursodiol (Actigal®) – Liver
 Prevention of bile stones
 Statins (pravastatin, simvastatin)
 Caution: May cause muscle pain
 Aspirin

40. Other medications
 Water pills (Lasix®)
 Ulcer prevention medications
 Prilosec®, Prevacid®, Nexium®, Pepcid®, Zantac®
 Pain medications
 May cause: constipation, nausea, confusion, drowsiness

41. Other information

42. Medication Calendar

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?

48. Questions?