MEDICINES AFTER TRANSPLANT
The new liver is not your own. The body’s immune system treats it like a foreign body and attacks it. If this immune attack is significant we call it ‘ Rejection .’To prevent this happening, you will need anti-rejection medicines or ‘Immunosuppresants’. These will be started immediately after your transplant ,and at least one of them will continue lifelong.
Common immunosuppressants that you may be given are :
- Tacrolimus ( Prograf ©) capsules, which usually continue lifelong
- Mycophenolate ( Cellcept© or Myfortic ©) tablets, which you need to take for a few years
- Prednisolone ( Wysolone © or Omnacortil © )tablets, which are usually stopped in 3 – 4 months
- Occasionally these may be changed to Cyclosporin ( Neoral ©)capsules or to Sirolimus or Everolimus .
Tacrolimus & Mycophenolate are available as oral pills which need to be swallowed twice a day. The dose of Tacrolimus depends on the level of the medicine in your blood. Once you have recovered well from a transplant , you will be asked to do some simple blood tests and also the blood Tacrolimus level ( TAC level ) every 3 – 6 months ; these will help in adjusting the dose of Tacrolimus that you need to take.
Tacrolimus ( Prograf ©)
Prograf / Tacrolimus is usually given as a pill taken orally twice a day : either 1 hr before or 2 hrs after breakfast & dinner . This medicine inhibits certain types of white blood cells, called lymphocytes, that are involved in rejection. Side effects may include increased blood sugar, headache, body aches, hand tremors, increased potassium levels and increased blood pressure. In high doses, it can also be harmful to your kidneys. Blood levels of this medicine will be monitored to try to avoid this effect. When you are advised to check your Tac level ( level of the drug Tacrolimus in your blood ) , you need to reach a hospital to give your blood sample 15 mins before the time of the morning dose of Prograf . Do not take the morning dose of Prograf till you have given the blood sample. So if you are used to having Prograf at 10 am and 10 pm every day, your blood sample for Tac level should be drawn between 9.30 am and 10 am. Once your blood sample has been withdrawn, you can have your morning dose.
Cyclosporine ( Neoral© )
Neoral / Cyclosporine also works on the lymphocytes. This medicine reduces the number of these cells your body produces. It can be used to help prevent rejection or to treat rejection. Cyclosporine is usually given as a pill taken twice a day .It is given as an alternative to tacrolimus for the prevention of rejection. Side effects may include increased blood pressure, increased potassium levels, hand tremors, increased cholesterol, increased gum growth and increased hair growth. In high doses, it can also be harmful to your kidneys. Blood levels of this medicine will be monitored to try to avoid this effect.
Prednisolone ( Wysolone © or Omnacortil © )
Prednisolone are steroids which are usually given as oral tablets taken once daily to reduce inflammation and antibody production. By reducing antibodies, prednisone helps prevent rejection or control rejection if it has already started. Side effects may include upset stomach, stomach ulcers, acne, mood swings, increased appetite, weight gain, fluid retention, increased blood pressure, cataracts, muscle wasting, brittle bones and high blood sugar. Many of these side effects will disappear as your prednisone dose is lowered. Typically you will be advised to take Pantoprazole 40 mg tablets in the mornings on empty stomach every day so long as you are also on Prednisolone to reduce the chances of stomach ulcers caused by Prednisolone.
Myocophenolate (CellCept©or Myfortic©or Mofecon© or Renodapt © )
CellCept is usually given as a pill taken twice a day. This medicine inhibits Lymphocytes which take part in the rejection process. Side effects may include stomach upset, diarrhea, decreased blood counts and lowered resistance to infection.
Other medicines :
- Tablet Septran SS (sulfamethoxazole and trimethoprim): This is an antibiotic which helps prevent upper respiratory infections and urinary tract infections.
Let your doctor know if you are allergic to sulfa medicines. Take this medicine with a full glass of water. Side effects may include stomach upset and sensitivity to sunlight. Wear protective clothing and sunscreen with an SPF of 30 or greater when outdoors. You will be on this medicine for 3 – 6 months after your transplant.
- Tab Pantoprazole: This helps prevent stomach and duodenal ulcers. They reduce the amount of acid in your stomach.Side effects are not common but could include headache
Continue to follow these rules after your liver transplant:
- Keep a record of all the medicines you take, including the dose and frequency.
- Take all your medicines exactly as directed.
- Report any side effects .
- Do not take any over-the-counter medicines without talking with your doctor first.
- Some medicines can interact with your immunosuppressants and could harm your liver. If a doctor prescribes a medicine, check with your transplant doctor or transplant coordinator to make sure that it is okay to take.
Do not change the dose or stop taking Tacrolimus or Mycophenolate unless you have talked to your transplant physician or transplant nurse coordinator. All immunosuppressants lower your ability to fight infection. They also have the potential to make you more prone to cancer. You will be closely monitored after transplant. The goal is to give you just enough medicine to prevent rejection so these side effects can be avoided.