Transplant Medications

You have the right and responsibility to know what medications are being prescribed for you. The more you know about your medications and how they work, the easier it will be for you to control your symptoms.

The most important step in maintaining your health after your transplant is to take your medications exactly as prescribed. These drugs help prevent rejection and infection must be taken for the rest of your life.

What types of anti-rejection medications might I be taking?

The types of anti-rejection medications (immunosuppressives) you may be taking are prednisone, cellcept, cyclosporine, sirolimus or prograf. You may be prescribed any combination of these drugs.

What will I need to know about taking my medications?

Before any medication is prescribed, your physician will ask you:

• If you are allergic to any medications
• If you are currently taking any other medications (including over-the-counter medications)
• If you have problems taking any medications

The type of medications, the dosage and side effects may be different for each patient. While you are in the hospital, the Kidney Transplant Team will teach you about your medications and give you information sheets describing each drug and how to take it. Before you go home, the Transplant Team will make sure that you know:

• The name of the drugs prescribed and their action

Please note: all medications have two names -- the generic or chemical name (such as sirolimus) and the brand name (such as Rapamune). The Transplant Team will tell you both names of the medications.

• The dosages, the time of day and how to take them
• The side effects and how you can treat or prevent them

Your family members are also encouraged to learn about your medications.

Will the drugs I'm taking cause any side effects?

Some of the drugs you are prescribed may cause unwanted side effects such as weight gain, acne or excess hair growth. Despite these side effects, never change the dose or stop taking your medications without first checking with your physician.

Many of the side effects can be controlled -- your doctor may adjust your dosage or offer other suggestions for managing the side effects. Keep all appointments with your doctor and the laboratory so your response to the drug can be monitored.

The individual drug information sheets contained in this notebook describe the common side effects of each drug and how to manage them.

Does it really matter if I miss a dose?

Yes. It is very important to always follow the instructions for your medications every day to prevent rejection. The third major cause of transplant failure results from not taking anti-rejection medications as prescribed.

What if I forget to take my medications at the scheduled time?

If you miss a dose of your medication at the scheduled time, don't panic. Take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and return to your regular medication schedule.

As you begin to feel well it may be easy to forget to take your medications, but always remember that your body never stops requiring the transplant medications. By taking your medications consistently and following-up with your physician routinely, you are assuming the most important job after your transplant.

Dose changes

Your physician will periodically change the dose of your medications. The dose may be changed because you are having uncomfortable side effects or because blood test results indicate that a different dose is needed.

You will receive a medication dosage record to write down your medications and dosages. Every time your physician tells you to change the dose of your medication, cross out the previous dose and write in the new dose. (Use ink, not pencil, and do not erase previous information so you have a record of your earlier doses). Remember, never change the dose of your medication unless your physician has told you to.

Taking other medications

Never take other medications without first talking to your physician, including over-the-counter drugs (those you can buy without a prescription). Some over-the-counter drugs include aspirin, ibuprofen (Advil^®, Nuprin^®), vitamins, cold medicine, antihistamines, antacids, laxatives and sleeping pills. Some over-the-counter medications may decrease the effectiveness of your transplant medications and can cause unwanted side effects.

Can I get financial assistance to help pay my medication expenses?

Yes. Your health care providers realize your medications are expensive, especially since you must take them for the rest of your life. There are several government and state programs that offer financial assistance for medication expenses.

Please ask your social worker what programs are available for you. You can also ask to see a financial counselor who can answer questions about insurance coverage and Medicare benefits related to your medication expenses.

Will any new medications be available?

Exciting developments in drug research are creating new immunosuppressive medications. The Cleveland Clinic Kidney Transplant Program participates in new drug studies on a continuous basis. You may be asked to take part in one of these programs after your transplant. All programs are strictly voluntary and have no influence on your transplant status.

General Medication Guidelines

• Know the names of your medications and what they do. Know the generic and brand names, dosages and side effects of your medications.
• Always keep a list of your medications with you.
• Know what side effects to expect from your medications.
• Take your medications exactly as prescribed, at the same time(s) every day. Do not stop taking or change your medications unless you first talk with your doctor. Even if you feel good, continue to take your medications. Stopping some medications suddenly may make your condition worse.
• Have a routine for taking your medications. Consider getting a pill box that is marked with the days of the week. Fill the pill box at the beginning of each week to make it easier for you to remember.
• Keep a medicine calendar and note every time you take a dose. Your prescription label tells you how much to take at each dose, but your doctor may change your dosage periodically, depending on your response to the medication. On your medication calendar, you can list any changes in your medication dosages as prescribed by your doctor.
• Wash your hands before preparing or taking medications.
• Take your time. Double check the name and dosage of all your medications before using them.
• Regularly fill your prescriptions and ask your pharmacist any questions you have about refilling your prescription. Know your pharmacy phone number, prescription number, medication name and dose so you can easily call for refills. Try to fill all your prescriptions at the same pharmacy, so the pharmacist can monitor for interactions and provide proper dosing and refills. If your refill medication does not look right, ask your pharmacist to verify that you have received the correct prescription.
• Do not wait until you are completely out of medication before filling your prescriptions; call the pharmacy or doctor's office at least two business days before running out. If you have trouble getting to the pharmacy, have financial concerns or have other problems that make it difficult for you to get your medications, let your doctor know. A social worker may be available to help you.
• Do not decrease your medication dosage to save money. You must take the full amount to get the full benefits. Talk with your doctor about ways you can reduce the costs of your medications.
• If you have prescription coverage, make sure you know the terms of your policy. Remind your doctor about the type of insurance coverage you have.
• Never not stop taking your medications; talk to your doctor if you have concerns about how your medications are working.
• Keep medications stored in their original containers. Store according to the instructions given with the prescription.
• Do not keep outdated medication or medication that is no longer needed. Throw old medicines away.
• Check liquid medications often. If they have changed color or formed crystals, throw them away and get new ones.
• Do not take any over-the-counter drugs or herbal therapies unless you ask your doctor first.
• When traveling, keep your medications with you so you can take them as scheduled. On longer trips, take an extra week's supply of medications and copies of your prescriptions, in case you need to get a refill.

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 9/15/2008...#4683