The drugs most commonly given to prevent organ rejection are cyclosporin, tacrolimus, sirolimus, azathioprine, mycophenolate and prednisolone. You may also take additional medication to managesome of the effects of these and to keep out infections.
Cyclosporin and tacrolimus are known as calcineurin inhibitors (CNIs). They are most commonly used and work by blocking calcineurin (a protein) that sets off the sequence of cell activity that gets the immune system into action. CNIs work very well and have greatly helped to improve the success rates for transplantation.
Because some people cope less well with the side effects of these drugs, doctors may lower the dose or switch to the other antirejection drugs, each of which works slightly differently.
Another medicine used is called sirolimus. This is an effective immunosuppressant as it prevents the rapid multiplication of T-cells that the body produces when it senses an ‘invader’, and it is this reaction that causes rejection.
Azathioprine and mycophenolate are anti-proliferative immunosuppresants. These work through blocking the action of a compound which is required for making certain blood cells that regulate and trigger immune responses by the body against infection and foreign cells.
Prednisolone is a type of steroid known as corticosteroid, which also weakens the immune system. Use of corticosteroids is gradually reduced and may be stopped after six months.
Each of the drugs used will have its benefits and drawbacks. To make them most effective doctors will prescribe them in certain combinations, known as regimens. Most transplant units use a triple regimen, based on a CNI (cyclosporin or tacrolimus), antiproliferative immunosuppressants (mycophenolate or azathioprine), and a corticosteroid (prednisolone).
Most immunosuppression drugs can be taken in capsule or tablet form while others must be given by injection into the blood stream (IV). Certain drugs, such as cyclosporin and tacrolimus, are never giventogether.
I’ve heard I can’t drink grapefruit juice, is that true?
If you are taking tacrolimus then grapefruit or grapefruit juice can interfere with the absorption and effectiveness of the drug. If you really love grapefruit then make sure that you don’t have any one hour before or after taking your tacrolimus. If you are worried, discuss it with the transplant coordinators at your transplant centre.
Your hospital should provide you with a medication card to record information about your medication, dosages and the times drugs were administered. When you are discharged from hospital, exact information about your medication should also be passed from the transplant unit to your GP. It is important your GP continues to prescribe at the same dose and formulation as the transplant team advises. Modified or slow release (MR) versions and non-MR versions (which are usually taken more frequently) should never be confused. You can help by checking your prescription and the tablets dispensed by the pharmacist against the dose and formulation advised by your transplant centre.
Side effects are most common in the first months following your transplant when the highest doses are given. Your doctors will carefully consider the most suitable regimen and correct dosage for you to help avoid or manage any side effects.
You may have begun to self-medicate while in hospital, but once you are at home, taking medications is your responsibility. It is important that you continue taking them as directed.
If you have difficulty organising your medications you may find it easier to use a medication dispenser. Talk to your hospital team or GP about the most sensible dispenser for you.
Ten tips for taking your medication:
- Always take your medications at the time ordered and the exact dose prescribed
- Learn the names of your medications and their side effects
- Report all side effects to your transplant team
- Do not change dosage without consulting your transplant doctor
- Keep your medications in a dry place, out of sunlight and out of children’s reach
- Keep your medications in their original bottles or packaging
- If you miss a dose, do not double the next dose - tell your transplant team
- Use a high factor sunscreen while in sunlight when taking antirejection medication
- Carry a card or list with your medication details on it, particularly when travelling
- Consult your transplant doctor or pharmacist before taking any over the counter medications.
Medical staff should be aware of side effects and what steps to take to reduce them. They should be aware of any underlying conditions you have and will closely monitor the effects of any medication given to you.
You should still report side effects when they occur and ask for advice about managing them if you are unclear about the right steps to take.
During your follow-up visits, doctors will focus on liver function tests to check how well your new liver is working. For your part, it will not always be possible to control how things turn out but it is essential that you keep your clinic appointments. If you can’t make an appointment, you may find that many problems can be sorted out by telephone.
Medication side effects