Transplant – Medication

Hi, I’m Erica Maceira, the pharmacist that works with the transplant clinic. And I’m gonna review the medications that you’re gonna be taking after transplant. If you have any questions on any of these medications please ask the physicians, ask the nurses, or ask me. So, typically, after transplant, you’re gonna start at least eight new medications. Generally, three of them are used to prevent rejection, three are used to prevent infections, one is for stomach upset, and one is to help prevent heart disease. The rejection medications are taken for life. And the transplant team will follow these levels of some of your medications, and these doses will be adjusted in clinic or over the phone. So, I’m gonna start talking about these in groups. And the first group we’re gonna talk about is preventing rejection. One of the medications you’ll take is Prograf, otherwise called Tacrolimus, and it’s used to prevent rejection. You take it twice a day, and we ask you to take it 12 hours apart. We tell you to take it with food consistently and, on mornings when you’re having blood work, take it after your blood work. This is one of the medications that we talked about that requires blood levels. So doses will be changed according to levels, and your levels are followed for life. Some of the common side effects that you can see with Prograf are diarrhea, elevated blood pressure, and increased blood sugar levels. When your levels are high, then you might notice some additional side effects including a headache and tremor. This is the reason that we follow your levels and we adjust them in clinic. CellCept. CellCept is also known as mycophenolate, and this is another one that we use to prevent rejection. It’s a compliment to tacrolimus, and it’s the reason we usually give them together. You take it twice a day, and you take it 12 hours apart. You take one in the morning, and then you take one before you go to bed. And some of the common side effects seen are nausea, diarrhea, and we can see drops in your blood count. So, we also follow these levels, along with your levels of your medications. Rapamune, or sirolimus, is another one of the medications that prevents rejection. You only take this one once a day in the morning, and you take it with food. And, just like Prograf, when you are having blood levels done, you take this in the morning after your blood work. You don’t chew this, crush it, or break it. And this requires blood levels, and doses are changed according to levels. And these, again, are followed for life. Rapamune has some common side effects. And the most common side effect we see is mouth sores. So, please tell the transplant team right away if you have any of these. For prevention, we end up giving you Peridex, or chlorhexidine, and you use it as a mouth rinse twice a day, and we generally have you take this for three months. Some of the other side effects that you can see are anemia, high blood pressure, high cholesterol, belly pain, it can affect how your wounds heal, and it can affect your kidneys. Prednisone is a steroid that helps prevent rejection. And we typically give this to you, and we taper the dose. So, you start at a higher dose just after your transplant, and then we gradually taper it down. And most of the time you don’t go home on it. It’s taken once a day in the morning, and the side effects are common with the higher doses. And, since we don’t use those doses, we typically don’t see as many side effects. For prednisone, some of the side effects that we can see for patients who are gonna take this long term are elevated blood sugars. So, we’ll ask you to monitor your glucose at home. You can notice edema, so water retention in your legs. Weight gain, bone disease, elevated blood pressure, elevated cholesterol, and possibly mood instability. Now we’re gonna talk about the medications that we add for preventing infection. Bactrim is another medication that you’re gonna be taking to prevent infections. It’s used to prevent two main infections. It helps to prevent against a specific infection of the lungs called PCP pneumonia, and it can help prevent urinary tract infection. It’s taken once a day, or as directed by the transplant team. The most common side effects that you’ll see will be rash or elevated potassium. Valcyte, or valganciclovir, helps prevent viral infections. And it prevents two of the main viral infections that we see in our patients. CMV, or cytomegalovirus, or HSV, herpes simplex virus. This medication you take once a day for the first three to six months after transplant. And not all patients have to be on this medication, some patients will be on acyclovir instead. The common side effects seen with Valcyte are decreases in blood count and nausea. Nilstat is a nystatin oral suspension, and it’s used to prevent and treat fungal infections. You swish and swallow it four times a day duration depends on the patient, and it may have an unfavorable taste. Now I’m gonna talk about the other medications that we add. Antacids. Antacids are used in our transplant patients to help prevent stomach complications and acid reflux. It’s generally taken once a day in the morning, and the most common one that you’ll be on is proton pump inhibitors. And the proton pump inhibitor that you’re on depends on your insurance. Most commonly it will be Protonix, Prevacid, Nexium or Prilosec. Aspirin. All of our patients are asked to take a baby aspirin, 81mg a day, and it’s taken for prevention of heart disease. Common side effects include bleeding problems, bruising, belly pain, nausea or vomiting. Some patients may need an injection to improve their blood count. Aranesp or Procrit injections may be used for a certain period of time based on your hemoglobin levels. Aranesp is given as a subcutaneous injection, and you only have to do that one once a week. Procrit, on the other hand, is a subcutaneous injection, but you have to take it two to three times a week. The most common side effect that most of our patients see is injection site discomfort or burning, but that only lasts for a short period of time right around the injection. Now onto some of your responsibilities. All of your medications must be taken according to their directions. So you need to take all of your doses when you’re supposed to take them. If you miss a dose, rejection or infection can occur, and you can end up back in the hospital. If a dose is missed, do not double up doses. This can cause increase in your side effects. And if you have any problems with any of your medications you need to report them to the physicians or the nurses. Some more of your responsibilities. You need to call the transplant team if any other doctor starts a new medication. So, the medications we’re prescribing have a lot of drug interactions, so we need to know all of your current medications. It also helps to use the same pharmacy all the time for two reasons. One, they will have all of your transplant medications in stock, so they won’t run out. And two, it’ll help keep track of all medications that you’re on, so they will help monitor for interactions. And if we ever have a question about your dose, we can always call the same person. And please contact the clinic if there are any problems. So, now onto your do not list. Do not stop taking any medication unless instructed by the transplant team. Most importantly, do not take any herbal medications. Many of these medications interact with transplant medications, and many of them interact in ways that we are unsure of. Do not drink grapefruit or pomegranate juice. These juices have enzymes that interact with several of your medications. Any of your other fruit juices are okay, so feel free to drink your orange juice. Do not take any over the counter medications without consulting the transplant team. We ask you to only take Tylenol for pain, it should never be taken for a fever. If you ever experience a fever you must call the clinic right away.