Immunosuppressive Drugs
Your body recognises that the liver graft is foreign and your immune system will launch an attack against this 'invader' . Immunosuppressive drugs prevent the rejection of the liver transplant by weakening the response of your immune system. At the same time, however, immunosuppressive drugs can make you a little more susceptible to infections. Fortunately the amount of immunosuppressive medication necessary to preserve a functioning transplanted organ decreases after the first months following surgery, and so does the extra risk of infections. Nevertheless, some immunosuppression is always necessary even many years after transplant surgery, and you must never skip doses or reduce the amount of your medication without your doctor's permission.
Not all transplant patients receive all the drugs.
So do not be alarmed if one or the other drug does not form part
of your immunosuppressive regimen.
What follows is general information only which is
intended to supplement, not substitute for the expertise and judgment
of your physician. You must consult your physician for further details.
Most side effects of the drugs listed below can be
overcome by temporarily reducing or discontinuing the drug. However,
this should never be done without explicit instructions of the physician.
Consult your doctor or transplant team immediately
if you think you are pregnant.
Neoral
CYCLOSPORIN (Sandimmune / Neoral )
Cyclosporin works by preventing the activation of
the T-lymphocytes ( a type of white blood cell) so that they are
unable to attack your new liver. Neoral is usually given orally
in combination with azathioprine and / or corticosteroids. The concentration
of cyclosporin circulating in your body can be measured with a blood
test, and the result used to decide when and how to adjust your
dose if necessary.
Taking Neoral
- Take your medication with milk or apple juice at the same
times every day, 12 hours apart.
- On the day of your check up visit, give the first sample before
(C0) and second 2 hours after (C2) the Neoral dose.
- Do not store cyclosporin in the refrigerator. Keep your medicine
in a cool, dry place away from light.
- Neoral can interact with some frequently used medicines.
Always check with your doctors or transplant team before taking
any new medications.
Side Effects
These include abnormalities of kidney function, high
blood pressure, thickening of the gums, high blood sugar, increased
hair growth where hair is not normally present, shakiness of the
hands called tremor.
Most of these side effects can be avoided or reduced
if the dosage is decreased. Remember that you are not likely to
experience all, or even most of them and as your dose is reduced
with time, you will probably experience fewer side effects.
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TACROLIMUS
Like cyclosporin, tacrolimus also blocks the activation
of the T-lymphocytes thereby preventing them from attacking your
new liver. Tacrolimus is usually taken in combination with azathioprine
and / or corticosteroids. The concentration of tacrolimus circulating
in your body can be measured with a blood test and the results used
to decide when and how to adjust your dose if necessary
Taking Tacrolimus (capsules)
- Take your medication with milk or apple juice at the same
times every day, 12 hours apart.
- On the day of your check up visit, give the blood sample
before taking the Tacrolimus dose.
- The capsules should be taken at least one hour before or
2-3 hour before or 2-3 hours after a meal.
Side Effects
Tacrolimus may cause abnormalities of kidney function, high blood
pressure, sleep disturbances, high blood sugar levels, numbness
and tingling in hands and feet, shakiness of hands (tremor). Tacrolimus
can interact with some frequently used medicines. Always check with
your doctors or transplant team before taking any new medications.
Most of these side effects can be avoided or reduced if the dosage
is decreased. Remember that you are not likely to experience all,
or even most of them and as your dose is reduced with time, you
will probably experience fewer side effects.
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Rapamune (SIROLIMUS)
Sirolimus is a TOR inhibitor which results in inhibition
of both B and T lymphocytes which are special white blood cells
that are responsible for rejection. Its action is different from
Neoral and Tacrolimus and hence it is free of several of their side
effects such as kidney toxicity, diabetes and high blood pressure.
The concentration of Sirolimus circulating in your
body can be measured with a blood test and the results used to decide
when and how to adjust your dose if necessary
How to Take this Medication
Take this tablet (usually) once daily at the same
time every day, either consistently with or without food. If you
are prescribed cyclosporine along with sirolimus, take this medication
four hours after your cyclosporine dose.
Side Effects
The most commonly observed side effects are nausea,
diarrhea, mouth ulcers and acne. There may be increased levels of
blood cholesterol and triglycerides but this improves with time.
Decreased platelet or white cell count in the blood have also been
noted. Most of these side effects can be avoided or reduced if the
dosage is decreased.
Missed Dose
If you miss a dose, take it as soon as you remember.
If it is near the time of the next dose, skip the missed dose and
resume your usual dosing schedule. Do not double the dose to catch
up.
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CORTICOSTEROIDS (Wysolone - Prednisolone)
Prednisolone is a corticosteroid that can be used
for life long immunosuppression to prevent organ rejection, or in
higher doses, for the treatment of rejection. Corticosteroids are
manufactured naturally in the body in a 24-hour rhythm. You should
take your corticosteroid medication first thing in the morning so
that you can copy your body's natural rhythm.
Taking Corticosteroids
Take your tablets with meals. If you take tablets
once a day, take them in the morning with breakfast.
Side Effects
The short-term side effects of corticosteroids
include:
- Increased susceptibility to infection, impaired wound healing
- Suppression of the normal fever response and other signs
of infection
- Elevation of blood sugar, particularly in patients who already
have diabetes
Over the long-term, the side effects of corticosteroids
are related to the dose taken. Only in high doses they may cause
increase in appetite and weight, a shift in the distribution of
body fat (development of Cushingoid features - puffy cheeks, rounded
back), thinning of the skin and bones, muscle weakness, increased
blood pressure, gastritis, ulcers and heartburn, Diabetes, cataracts,
some increase in acne.
Although this list is awesome, it must be emphasised
that with the relatively low doses of corticosteroids used nowadays,
these side effects are quite uncommon.
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AZATHIOPRINE
Azathioprine works by interfering with the ability
of cells of divide. It is always given in combination with other
immunosuppressants.
Taking Azathioprine
You can take your tablets at any time of the day,
but try to get into the routine of taking your medication at the
same time every day.
Side Effects
For most people, Azathioprine is safe at the low doses
required to prevent organ rejection. Bone marrow cells divide frequently
and are very sensitive to the effects of azathioprine. Patients
taking azathioprine may have increased susceptibility to infection
or reduced haemoglobin, white cell or platelet counts. Effects of
azathioprine on the bone marrow are reversible if the drug is stopped
temporarily.
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Cellcept (MYCOPHENOLATE MOFETIL)
Cellcept inhibits the proliferation of lymphocytes
which are vital for rejection.
Taking Cellcept
Take this medication as directed usually twice daily on an empty
stomach one hour before or two hours after meals. Swallow this medication
whole. Do not crush, chew or open it.
Side Effects
This medication may cause dizziness, drowsiness, headache, nausea,
vomiting, diarrhea, gas, tremors, mood changes, or vision changes.
It may also cause white cell or platelet counts in the blood to
drop. The physician can usually overcome these problems by temporarily
reducing or discontinuing the drug.
Missed Dose
If you miss a dose, take it as soon as you remember. If it is near
the time of the next dose, skip the missed dose and resume your
usual dosing schedule. Do not double the dose to catch up.
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MYFORTIC
Recently, Myfortic has been developed as a new enteric-coated
formulation of the above drug (Mycophenolate Sodium) in order to
protect the upper gastrointestinal tract from damage and hence,
lessen the stomach upset caused by Cellcept.
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Zenapax (DACLIZUMAB - INJECTION)
This medication is a humanized monoclonal antibody
that binds the IL2 receptor on activated lymphocytes. This prevents
the important action of IL2 in causing proliferation of cells (lymphocytes)
that lead to rejection, hence blocking the rejection phenomenon.
Given with other conventional drugs, it has been shown to augment
their role in preventing organ transplant rejection.
How to Take this Medication
This medication is given by injection into a vein (IV) after proper
dilution in a saline solution. 2-5 doses are given, each over a
15 minute period, every 14 days starting upto 24 hours before the
transplant.
Side Effects
Nausea, vomiting, or stomach upset may occur. Allergic reaction
(rash, itching, breathing trouble), headache, dizziness, chest pain,
arm or leg swelling, cough, fever, poor wound healing, and muscle
pain have also been reported.
Storage
Vials should be refrigerated between 2-8 degrees C
away from light. Do not shake or freeze.
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Simulect (BASILIXIMAB - INJECTION)
This medication is a murine-human chimericl antibody that binds
the IL2 receptor on activated lymphocytes. This prevents the important
action of IL2 in causing proliferation of cells (lymphocytes) that
lead to rejection, hence blocking the rejection phenomenon. Given
with other conventional drugs, it has been shown to augment their
role in preventing organ transplant rejection.
How to Take this Medication
This medication is given by injection into a vein (IV) after proper
dilution in a saline solution. It is usually given in two doses:
the first dose is given within 2 hours prior to transplant surgery
and the second dose is given 4 days after surgery.
Side Effects
Nausea, vomiting, or stomach upset may occur. Allergic reaction
(rash, itching, breathing trouble), headache, dizziness, fever,
poor wound healing, vision problems, mood changes and irregular
pulse have also been reported.
Storage
Vials should be refrigerated between 2-8 degrees C away from light.
Do not shake or freeze.
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