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
8. Anti-Infection Medications
Immune Infections
System
Monitor anti-rejection Anti-infection
medications to balance medications help
between risk of rejection and prevent infection
11. Prograf® (Tacrolimus)
Anti-rejection Medication
Mostly used anti-rejection medication
Yellow = 0.5 mg
you are put on Prograf® OR
Typically
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
100 mg capsule without physician approval
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
5 mg tablet Best to take with food
10 mg tablet Side effects of prednisone can get
20 mg tablet better as the dose decreases
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®
250 mg 500 mg OR Azathioprine (Imuran®)
Myfortic® is a “slower release”
Myfortic® form 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
20. Mycophenolate (CellCept®, Myfortic®),
Azathioprine (Imuran®)
Side effects:
CellCept ®, Myfortic® Azathioprine
Nausea, cramping (Imuran®)
Diarrhea Decreased white
Decreased white
blood cell count
blood cell count Decreased red
blood cell count
21. Sirolimus (Rapamune®)
Anti-rejection medication
Take once daily, separate from
1mg tablet Cyclosporine (Neoral®) by 4 hours
Neoral® Rapamune®
8:00 AM 12:00 AM
2 mg tablet Many drug interactions, ask
Also available as a solution
transplant team before taking any
new medication
22. Sirolimus (Rapamune®)
Side effects:
Slow wound healing Increase in
Increase in
triglycerides
cholesterol Decrease in red
Decreased white
blood cell count
blood cell count Stomach cramping
Decrease in
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®)
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
Thiscould 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
42. Medication Calendar
PILL BOX SLOT: MORN NOON EVE BED
Used to treat / Noon / Supper / Special
Drug Name/Strength/Instructions 7-9 am Bedtime
prevent afternoon 7- 9 pm Instructions
***PROGRAF (TACROLIMUS); yellow = 0.5 mg
Take ____ MG in the morning and ____ MG in Rejection white = 1 mg
the evening, 12 hours apart pink = 5 mg
CELLCEPT 500 MG (MYCOPHENOLATE); Take
_____ tablets twice daily every 12 hours (each Rejection
dose = _____ MG)
PREDNISONE 5 MG; Take 5 tablets (25 mg)
Rejection Steroid Sparing Protocol
once daily on 2/7
Last dose on:
VALCYTE 450 MG (VALGANCICLOVIR) take
Viral Infections cmv d-/r+
one tablet every morning 05/03/10
CLOTRIMAZOLE 10 MG (MYCELEX); Take one Last dose on:
Fungal
tablet four times daily - do not eat/drink for 15
Infections 05/03/10
min. after each dose
Last dose on:
BACTRIM SS (SULFAMETHOX-TMP); Take one
Pneumonia
tablet everyday in the evening 05/03/10
PROTONIX 40 MG (PANTOPRAZOLE); Take Heartburn /
one tablet once daily Reflux
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?