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All transplant patients take immunosuppressants to help prevent rejection of their new organ. Most people take a combination of three immunosuppressants.
Many patients will require additional medication for their blood pressure and to replace magnesium. Most patients also receive daily aspirin, a stomach acid reducer, a cholesterol-lowering agent, calcium supplementation and vitamins. Other medications will be prescribed based on patients’ individual needs.
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Medication |
Action |
Additional Information |
Potential Adverse Effects |
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Cyclosporine-Sandimmune and Neoral, Gengraf (or generic equivalent)
not interchangable
Gengraf
 25mg
 100mg
Neoral
 25mg
 100mg
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*Primarily T-lymphocyte selective
*Inhibits responsiveness of killer T-cells to Interleukin II |
*Metabolized by the liver
*Dosed according to 12 hour trough blood levels and renal function; target level 150-300 depending on interval post transplant
*IV dose is 1/3 of PO dose. |
*renal dysfunction, *HTN, headache, tremors, hirsutism, *decreased mg++, gallstone formation, *elevated cholesterol, gingival hyperplasia |
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Tacrolimus (Prograf)
 0.5 mg
 1 mg
 5 mg |
*Inhibits cytokine production (including IL2)
*Blocks cell division |
*Replaces cyclosporine when efficacy, absorption or tolerance is a problem
*Target level 8-15 depending on interval post transplant
*IV dose is 1/3 of
PO dose. |
*renal dysfunction, *HTN, headache, tremors,
*decreased mg++, gallstone formation,
*elevated cholesterol, glucose intolerance |
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Azathioprine (Imuran)
 50 mg |
*Inhibits RNA & DNA synthesis
*Decreases T-cell proliferation by inhibiting T-cell responsiveness to Interleukin II
*Decreases production of WBC's in bone marrow |
*Dosed according to white blood cell count; target level 4-6,000
* No IV preparation of this drug
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leukopenia, hepatic dysfunction, thrombocytopenia,
*skin cancer
*avoid allopurinol
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Mycophenolate Mofetil (Cellcept)
 250mg
 500mg
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*Inhibits purine synthesis
*Effective on both T & B lymphocytes |
Has been shown to inhibit development of transplant CAD in animal models
*IV dose is same as
PO dose |
leukopenia, nausea and abdominal distress |
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Methotrexate
|
*Inhibits folic acid reductase
*Inhibits DNA synthesis and cellular replication
*Decreases production of WBC's |
*Dosed according to white blood cell count - target 4-6,000 |
leukopenia, nausea and abdominal distress |
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Sirolimus (Rapamune, Rapamycin)
 1mg
 2mg
|
*Macrocyclic lactone, inhibits IL II signal transduction
*Effective on both T & B lymphocytes |
*Dosing based upon trough level
*Target level 7-10 |
thrombocytopenia, leukopenia, anemia, *hyperlipidemia |
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Methylprednisolone
(Prednisone)
 1mg
 2.5mg
 5mg
 10mg
 20mg
|
*Anti-inflammatory properties |
Weaned to a low daily dosage based upon rejection-free biopsies |
osteoporosis, hyperglycemia, *fluid retention, GI distress, *increased BP, cushingoid effect, *increased appetite |
(*denotes most commonly seen; often dose dependent)
Other Common Post-Transplant Medications
(treating the side effects of immunosuppressants
|
Medication |
Indication |
Dosing recommendations |
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Aspirin
 81mg
 325mg
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Anti-platelet therapy due to potential for development of transplant CAD |
Prescribed 81 mg daily |
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Bactrim DS
 800, 160 mg
Bactrim SS
 400, 80 mg |
Prophylaxis for pneumocystis pneumonia in patients on higher doses of immunosuppression early post-transplant |
Prescribed 1 tab QMWF for 1 year post transplant; continued at 3X/wk dosing for all patients on methotrexate and rapamycin (dapsone substituted if patient allergic to sulfa) |
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Pravachol
 20mg
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Treatment of drug induced hyperlipidemia. Prescribed as a result of data showing reduction in 12-month rejection in transplant recipients. *Preferred statin choice due to reduced incidence of myositis and rhabdomyolysis when used in conjunction with cyclosporine or Prograf. |
Prescribed initially at 20 mg QHS. |
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Calcium/Vit D |
Prophylaxis for drug-induced osteoporosis in transplant recipient on maintenance cyclosporine or Prograf and prednisone. |
Recommended dosing - 500 mg elemental calcium TID and 400 IU vitamin D BID |
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H2 blocker |
GI protection from effects of steroids |
BID dosing |
Medications to Avoid in Transplant Recipients Without Consultation with Transplant Office
(potential interactions with immunosuppressant agents)*
- Acyclovir
- Allopurinol
- Aminoglycosides
- Amphtericin B
- Antacids
- Anticonvulsants (phenobarbitol,
- primidone, carbamazepine)
- Bromocriptine
- Caspofungin acetate
- Celecoxib
- Chloramphenicol
- Chloroquine
- Chlortrimazole
- Cimetadine
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- Cicplatin
- Clarithromycin
- Danazol
- Dapsone
- Delavirdine
- Dexamethasone
- Diltiazem
- Efavirenz
- Ergotamine
- Erythromycin
- Ethinyl estradiol
- Fluconazole
- Foscarnet
- Ganciclovir
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- HMG-CoA Reductase Inhibitors (atorvastatin, cerivastatin, simvastatin
- Ibuprofen/NSAIDS
- Indivavir
- Itraconazole
- Ketoconazole
- Mefloquine
- Metronidazole
- Midazolam
- Nefazodone
- Nelfinavir
- Nevirapine
- Nicardipine
- Nifedipine
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- Omeprazole
- Pentamidine
- Phenytoin, fosphenytoin
- Rifabutin
- Rifampin
- Ritonavir
- St. John's Wort
- Troleandomycin
- Live vaccines (typhoid, BCG, yellow fever, small pox, measles, mumps, rubella)
- Vancymycin
- Verapamil
- Voriconazole
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Disclaimer: The product images are intended as a guide only. Reasonable effort has been made to ensure that the information provided is accurate, up-to-date, and complete, but no guarantee is made that up-to-date images will be available for every drug.
The appearance of any medication is subject to change. If you have questions about the drugs you are taking, check with your doctor or pharmacist.
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