Islet Transplant Medications

Understanding your medication regimen is an important part of the transplant process. Some medications will only be needed for a short period of time after transplantation, and others will be taken for as long as the islets are functioning. Transplant coordinators work closely with patients to teach them about the medications and expected side effects.

After a transplant, medications called immunosuppressants are necessary. These medicines "quiet" the immune system and protect the islets from being attacked and destroyed. The job of the immune system is to fight off substances that are foreign to the body, such as infections, viruses, and some cancers. The body would normally recognize cells from another person as foreign and attack (reject) them. Immunosuppressants work in different ways to prevent rejection. By using a combination of these medications, the chance of rejection of the islets is decreased.

Because immunosuppressants suppress the immune system, transplant patients are at increased risk of infection. The risk for developing infections is greatest during the first months after the transplant. A variety of medications may be used to prevent or treat infections.

MedicationClassHow It WorksDosageSide Effects

Belatacept
(LEA29Y)

Immuno-
suppressant

Belatacept uses costimulation blockade to prevent white blood cells from attacking foreign cells.

Dosing is determined by patient weight. IV infusions of belatacept are given every 28 days.

• Severe infection
• Decreased white blood cell count
• Nausea, diarrhea
• Low phosphorous levels
• Heartburn
• Difficulty with wound healing
• Progressive Multifocal Leukoencephalopathy
• Post-Transplant Lymphoproliferative Disorder

Etanercept
(Enbrel)

Immuno-
suppressant
Anti-Inflammatory

Etanercept inhibits immune response activation.

TEnbrel is given as a single IV dose on the day of transplant, followed by 3 sub-cutaneous injections after transplant.

• Injection site reactions
• Increase in creatinine (this indicates kidney toxicity)
• Infection

Basiliximab
(Simulect)

Immuno-
suppressant

Basiliximab is a genetically engineered antibody that inactivates the building blocks of the immune system. This drug helps to decrease the risk of an acute rejection episode in the first few months after the transplant.

Basiliximab is given through an IV infusion over 20 minutes. Vital signs are checked before, during and after the infusion. Two doses are given. The first dose is given immediately prior to transplant. The remaining dose is administered on the fourth day after transplant.

• Possible allergic reaction (including shortness of breath, swelling, low blood pressure)
• Shaking
• Headache
• Dizziness
• Heartburn
• Nausea/vomiting
• Diarrhea
• Abdominal swelling or discomfort

Tacrolimus
(Prograf)

Immuno-
suppressant

Tacrolimus acts directly on the white blood cells to reduce their ability to identify foreign cells.

Tacrolimus is taken twice a day and must be taken 12 hours apart. The first dose is taken immediately prior to transplant. The dose is determined by the patient's weight. The transplant team will monitor side effects and drug levels carefully and adjust the dose until the level of the drug in the bloodstream stabilizes.

• High blood pressure
• Increase in creatinine (this indicates kidney toxicity)
• High potassium levels
• High blood sugar levels
• Sleeplessness, headache, shaking, nausea, vomiting, skin rash/itching
• Rarely, permanent nerve damage

Rabbit Anti-
thymocyteglobulin
(Thymoglobulin)

Immuno-
suppressant

Thymoglobulin reduces the number of white blood cells in the body and stops these cells from attacking foreign cells.

Thymoglobulin is given through an IV infusion over several hours. Five doses or infusions will be given around the time of the transplant. The dose of thymoglobulin is determined by the patient’s weight.

• Fever
• Chills
• Decreased white blood cell count
• Decreased platelet count
• Infection
• Abdominal pain
• Nausea/vomiting
• Diarrhea
• Shortness of breath

Mycophenolate
Mofetil (Cellcept)

Immuno-
suppressant

Cellcept acts directly on the white blood cells to reduce their ability to identify foreign cells.

Cellcept is taken twice a day. Doses must be taken 12 hours apart. The first dose is taken immediately prior to transplant. The transplant team will monitor side effects and drug levels carefully and adjust the dose as needed.

• Abdominal pain
• Diarrhea
• Nausea/vomiting
• Constipation
• Decreased white blood cell count
• Decrease in red blood cells
• Infection
• Kidney damage
• Ulcers
• Progressive Multi-focal Leukoencephalopathy (PML)
• Birth defects, pregnancy risks, and loss of fetus in pregnant women

Sirolimus
(Rapamune)

Immuno-
suppressant

Sirolimus prevents rejection by decreasing the immune system's ability to identify foreign cells.

Sirolimus is taken once a day. The first dose is taken immediately prior to transplant. The dose is determined by the patient's weight. The transplant team will monitor side effects and drug levels carefully and will adjust the dose until the blood levels stabilize.

• Low white blood cell count
• Anemia
• Elevated cholesterol
• Elevated blood lipid level
• Low potassium
• Decreased platelets
• High blood pressure
• Nosebleeds
• Mouth ulcers
• Rash
• Diarrhea
• Sore joints
• Pneumonia

Bactrim
(sulfameth-
oxazole, trimethoprim)

Antibiotic

Bactrim is a sulfa antibiotic commonly prescribed to treat various types of infections. It is used to prevent Pneumocystis carinii pneumonia, a type of lung infection.

Bactrim is taken orally once a day for at least 6 months after transplant. If the patient is allergic to sulfa drugs, another antibiotic will be used.

• Rash
• Increased sensitivity to sun exposure
• Nausea
• Low white blood cell count

Valcyte
(valganciclovir)

Antiviral

Valcyte is an antiviral medication that is used to prevent and to treat cytomegalovirus or CMV.

Oral Valcyte is taken once a day for at least three months after transplant. If the patient develops CMV infection, they may need to receive IV infusions of Cytovene.

• Low white blood cell count
• Low platelet count
• Nausea/vomiting
• Decreased appetite
• Phlebitis (IV Cytovene)

Lovenox
(enoxaparin)

Anticoagulant

Lovenox is an anticoagulant, or blood thinner. This is taken after each transplant to prevent blood clots.

Lovenox is an injection given twice a day for two weeks after transplant.

• Increased chance of bleeding

Aspirin

Anticoagulant

Aspirin is another anticoagulant that helps prevent blood clotting. It is taken after each transplant to prevent blood clots.

One aspirin a day is taken for 14 days after transplant.

• Increased chance of bleeding
• Nausea/vomiting
• Stomach cramps

Multivitamin

Supplement,
antioxidant

There is some evidence that vitamins may help islets survive after transplantation. When the islets are transplanted they are injured and produce free radicals, substances that harm cells. Some vitamins help decrease the level of free radicals.

One multivitamin a day is taken for as long as the islets are functioning. The transplant team can assist the patient in choosing a multivitamin.

• Nausea/vomiting


Where to Get Medications

All protocol-necessary medications are provided to the patient by Emory for 12 months following transplantation (the length of the study). During the evaluation process, a social worker will discuss issues of insurance coverage and the cost of these medications after 12 months.

A member of the transplant team may provide prescriptions for medications to treat conditions related to the transplant. For unrelated medical conditions, the patient may be asked to visit his or her primary doctor for treatment, but please notify the transplant team before taking any new medications or changing the dose of current medications.

It is the patient's responsibility to notify the islet transplant nurse when a refill is needed for a prescription. The patient should always keep a two-week supply of medications, and a minimum of 24 hours is needed to process refills.

Other Facts About Transplant Medications

• If the patient is sick or nauseated and cannot take the medications, they may need to be admitted to the hospital to receive medications through an IV.
• No new prescription or over-the-counter medications can be taken without checking with the transplant team. Many drugs interfere with the immunosuppressants.
• Medications must be stored in a safe, cool and dry place.

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.