Medication to be used by liver transplantation patients

IMMUNOSUPPRESSIVE DRUGS

Immune system is the body’s defense system. It serves to the purpose of defending the body against factors causing diseases and ensures body’s resistance against these factors. If the immune system is strong, body overcomes these factors so that there won’t be a disease. After the heart transplantation immunosuppressive drugs are used to prevent the rejection of the transplanted organ by the recipient’s immune system. Therefore, while you are on immunosuppressive drugs, you have to protect yourself from diseases and related factors, better than you did before. Period of use and dosage of these drugs are determined/arranged by your physician and these are modified depending on your condition.

Immunosuppressive drugs repress your immune system and weaken it. In other words, they suppress your body’s defense mechanisms (which it normally has) that attack and reject foreign tissues. It helps your body to accept the new organ. While these drugs prevent organ rejection, on the other hand, these decrease your body’s defense against infections. While you are on immunosuppressive drugs, your body is open to infections; besides, while you are on this treatment, you should not be vaccinated with live viruses. You should consult to your doctor and transplantation team in every case of medication use and vaccination.

General Side Effects of Drugs

Opportunistic infections; cytomegalovirus, fungus, herpes simplex (blain, cold sore) are observed commonly
An increase in malignant diseases may occur. Therefore, you have your medical controls regularly.
Do not change or skip doses without consulting your doctor. Use medication according to recommended dose and directions. Even before using a simple drug -even if it is recommended by another physician- you should consult to your own doctor. Please remember to take your medication with you while travelling. Do not switch drugs with others. Even if they have the same content, before switching your drugs, please do consult with your physician.

Prednisolone (Deltacortril)

It has an immunosuppressive effect.
The dose of Prednisolone decreases to the maintenance dose. You will keep using prednisolone unless otherwise stated by your physician. If you receive the medication in a single dose, you should take it after breakfast with a full stomach.

Side Effects

It can cause water and salt retention, increase in gastric and perspiration acidity.
The risk of fungal infection in mouth increases. Increased hairiness and acnes on skin might be observed. It may cause muscle and bone weaknesses in the long term.

It may cause cataract and increased blood glucose. Psychological problems are observed more commonly.

Prograf (Tacrolimus)

By blocking T cells, it prevents T cells to damage the transplanted organ. Mechanism of action is similar to cyclosporine and cannot be used together with it.

The given circumstances for cyclosporine also applies to tacrolimus.

High blood levels disrupts the kidney functions. For this reason, blood values should be followed up closely. Please have your blood values tested whenever your physician instructs you. To obtain accurate and correct results, please use your medication on time and regularly. The dosage arranged according to tacrolimus level in blood. It has similar side effects with cyclosporine. Cosmetic side effects (pubescence, swollen gingiva etc.) are observed less, while drug related diabetes and neurological symptoms are observed more commonly.

Do not take the medication with grapefruit juice. Grapefruit juice affects blood levels. Do not drink grapefruit juice 2 hours before or after receiving medication. Certain drugs (such as ketoconazole, erythromycin) may have greater effect the level of tacrolimus. Therefore, as it was mentioned before, please do not take any medication without consulting your physician, even if it is recommended by another physician.

Take the drug only with water.

Cellcept(Mikofenolate Mofetile – MMF) and Myfortic (Mikofenolate Sodium)

Cellept, an inosine monophosphate dehydrogenase inhibitor, prevents the rejection of transplanted organ by body. Usually, it is taken with cyclosporine, tacrolimus and/or sirolimus. It should not be taken together with the anti-acids containing magnesium and aluminum hydroxide since it will decrease the absorption.

Most common symptoms are diarrhea, decrease in leukocyte count, nausea, vomiting. It causes an increased tendency to certain infections.

Cyclosporine (Neoral-sandmimmun)

It is an immunosuppressive drug. It shows its effect by blocking T cells. It has two forms: oily liquid and pills, both of which are taken orally. Capsule form is swallowed with a liquid like other medications. If you are using the fluid form, your physician or nurse will show you how to adjust the dosage. You should take the proper dosage of medication immediately after mixing it with milk (room temperature heat), chocolate milk or orange juice. Do not forget that you should never take cyclosporine with grapefruit juice! If you have taken the medication, please do not eat grapefruit for at least two hours.

Please take your medication regularly and at the same hour everyday, as it will help you to keep the medication in your blood at the same level at all times. If you forget to take the medication and you remember in 1-2 hours, take the missing dosage immediately, keep your regular schedule. If you don’t remember to take it until the time of the next dosage, do not take two dosages at once, and consult with your doctor. If you have diarrhea and/or vomit, inform your doctor immediately. Diarrhea causes disposal of drug before it affects your system. So that, it may cause rejection of transplanted organ. In this case, the drug will be given to you through an intravascular line. At this period you should avoid using laxatives.

Keep your medication in dry place, and in room temperature. Direct exposure to sun, storage in the fridge, extreme hot or cold weather will cause the drug lose it efficiency. Also, if you are using the fluid form of the drug, do not use it once it has been 60 days after opening it. You will be required to check cyclosporine level in your blood regularly. On the test days you have to take and bring your medicine as you were told to do. Please have your blood values tested whenever your physician instructs you. To obtain accurate and correct results, please use your medication on time and regularly.

Do not take the medication with grapefruit juice. It affects blood level. Do not drink grapefruit juice two hours before and after the time of medication. Certain drugs (such as ketoconazole, erythromycin) can have greater effect on the level of cyclosporine. Therefore, as it was mentioned before, please do not take any medication without consulting to your physician, even if it is recommended by another physician. You may take the medication with orange juice or milk.

Side Effects

Cyclosporine may have severe side effects. Commonly, it may cause hypertension. After you start taking the medication, your blood pressure should be monitored regularly. If it is necessary, your physician may recommend you to take your pills for blood pressure. Blood cholesterol and triglyceride levels might increase. Kidney and liver functions might increase. For this reason, you should do your laboratory checks regularly. Your hands may start shaking as well as headache, cramps in legs, swollen gingiva, nausea and vomiting. Also, your hair may get thick and wayward and shape and its form and dispersion may change to some extent.

You should be careful about the oral hygiene since long-term use of the drug may cause swelling in gingiva. You should brush your teeth after each meal and have your teeth checked once in every 4 to 6 months. Your dentist should also know about this medication.

You have to tell every side effect you are experiencing to your doctor. There might by grow of hair, kidney function disorder, nausea and vomiting and headache may occur. Please do not forget that the problems related to this drug will decrease in time with the decrease in dosage.

Rapamune (Sirolimus)

Rapamune (Sirolimus) prevents rejection of transplanted kidney by suppressing your immune system. In certain circumstances, it is used to treat acute rejection. It is used with cyclosporine and prednisone.

Rapamune (Sirolimus) in 1-5 mg dosage. It has liquid and tablet forms. Liquid form can only be mixed with orange juice or only water. It should be mixed in a glass and consumed before it precipitates. If Rapamune (Sirolimus) is used with cyclosporine (neural), it should be taken once in a day after four hours of the morning dosage of Neodal. Liquid form should be maintained inside fridge and the tablet form should be maintained somewhere dry and cool.

Side Effects

Rapamune may decrease white blood cell count, therefore it increases the risk of infection. Also, it may cause risk of bleeding by lowering the thrombocyte count. By adjusting dosage these two side effects may be decreased.

Rapamune may cause indigestion, diarrhea, nose bleeding, headache, joint pain, and increased level of cholesterol and lipid.

Certican (Everolimus)

It is an immunosuppressive drug which suppresses T cell activation and reproduction. It is only for oral use and should be taken two times a day. Tablets are taken with water without crushing and should be swallowed in one piece. It should be taken at the same time everyday. It should only be taken with water. When it is taken with fatty foods or grapefruit or grapefruit juice, its absorption decreases.

Side Effects:

General: pain (in general), muscle weakness, swollen hands, feet, arms and legs, wheezing, dyspnea, sudden urge to urinate, influenza symptoms, fever, chill, sore throat, joint pain, swollen glands, new moles and swellings, sudden bleedings and bruises, fatigue, headache, dysphagia caused by swollen face, lips, mouth, tongue, shortness of breath, increase in blood lipids may occur.

Dermatological

Acne, heat rash and sensitivity in certain parts of the body.
Hematological: Decrease in blood levels caused by repression of bone marrow.
Gastrointestinal: Stomachache, diarrhea, nausea and vomiting.