What are immunosuppressants?
Immunosuppressants are drugs that keep your immune system in check.
The body’s immune system helps fight off infections that cause illness. But sometimes, the immune system mistakenly attacks healthy cells and tissues. Immunosuppressants can slow or stop this response.
Who needs immunosuppressants?
Your healthcare provider may recommend immunosuppressants if you have:
- Autoimmune disease.
- Organ transplant.
- Stem cell or bone marrow transplant.
What’s the role of immunosuppressants in autoimmune diseases?
When you have an autoimmune disease, the immune system mistakes healthy tissue and cells for foreign invaders (like germs). The immune system essentially turns against the body and attacks it. Depending on which part of the body is under attack, this response can lead to different types of autoimmune diseases.
Immunosuppressants hold back the immune system, helping to prevent cell damage and inflammation. These drugs minimize symptoms. They can even put an autoimmune disease into remission (you have no signs of the disease).
You may need immunosuppressants if you have one of these autoimmune diseases:
- Alopecia areata.
- Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis.
- Multiple sclerosis.
- Psoriasis or psoriatic arthritis.
- Rheumatoid arthritis.
What’s the role of immunosuppressants in organ transplants?
For people who get organ transplants, immunosuppressants help prevent organ rejection. Your immune system knows the new organ isn’t part of your original body. It perceives the new organ as a threat and will try to destroy it. Immunosuppressants control this response, protecting the new organ.
You will receive strong doses of immunosuppressants (induction agents) at the time of the organ transplantation. This helps ensure transplant success. To prevent organ rejection, you’ll need to take immunosuppressants (maintenance drugs) every day for life.
The medication dosage may decrease over time as your immune system adjusts to the new organ. Healthcare providers commonly prescribe prednisone for organ transplantation.
What’s the role of immunosuppressants in stem cell (bone marrow) transplants?
Stem cell transplants can treat many conditions, including:
- Blood cancers like leukemia, lymphoma and multiple myeloma.
- Blood disorders like sickle cell disease and thalassemia.
- Bone marrow problems like aplastic anemia.
Some stem cell transplants use your own cells (autologous transplant). People who have an autologous transplant don’t need immunosuppressant medications.
Allogeneic stem cell transplants replace diseased cells in your body with healthy ones from a donor (called a graft). After a transplant, donor cells begin to build a new immune system in your body (the host).
Sometimes, this new immune system views your body as foreign. The immune system may attack healthy tissues and organs. This leads to graft-versus-host disease (GVHD).
Immunosuppressants lower the chances of GVHD. You receive different intravenous (IV) or oral immunosuppressants for several weeks to months during and after a stem cell transplant. You may need to take immunosuppressants for years until the new immune system settles down.
What are the types of immunosuppressants?
Corticosteroids, such as prednisone, are among the most common immunosuppressants that healthcare providers prescribe. But there are many types of immunosuppressants. Your provider will select a medicine (or a combination of immunosuppressants) based on your specific condition and symptoms.
You may receive immunosuppressants as a pill or liquid, IV or injection (shot). Types of immunosuppressants include:
- Biologics such as adalimumab (Humira®) and infliximab (Remicade®).
- Calcineurin inhibitors such as tacrolimus (Envarsus XR® or Protopic) and cyclosporine (Gengraf®, Neoral® or Sandimmune®).
- Corticosteroids (prednisone).
- Inosine monophosphate dehydrogenase (IMDH) inhibitors such as mycophenolate mofetil (CellCept®).
- Janus kinase inhibitors such as tofacitinib (Xeljanz®).
- Mechanistic target of rapamycin (mTOR) inhibitors such as sirolimus (Rapamune®).
- Monoclonal antibodies such as basiliximab (Simulect®).
Risks / Benefits
What are the potential side effects of immunosuppressants?
Immunosuppressants can have powerful effects on the body. Your healthcare provider will order regular blood tests to make sure medication levels don’t get too high. High doses can cause serious side effects.
Side effects vary depending on the type of immunosuppressant. These drugs can cause:
- Hair loss or growth.
- Headaches. Trouble concentrating or remembering.
- High blood pressure.
- Mouth sores.
- Thinning bones (osteoporosis).
- Weight gain.
- Stomach upset and nausea and vomiting.
What are the potential risks or complications of immunosuppressants?
A suppressed immune system has a hard time fighting off infections. You have a higher risk of developing:
- Blood infections like MRSA and sepsis.
- Fungal infections like thrush and skin fungus.
- Skin infections like cellulitis.
- Respiratory infections, including colds, flu and pneumonia.
When to Call the Doctor
When should I call my healthcare provider?
You should call your healthcare provider if you experience:
- Extreme fatigue or weakness.
- Lower back pain.
- Nausea, vomiting, abdominal pain or weight concerns.
- Painful urination or frequent urination.
- Signs of infection, including fever and chills.
What follow-up care do I need when taking immunosuppressants?
You’ll get more frequent blood tests to monitor drug effectiveness and side effects. Your healthcare provider may increase or decrease the dosage depending on symptoms and side effects.
People with autoimmune diseases and organ transplants often take these medicines for life. Stem cell transplant recipients may be able to stop taking the drugs after the risk of GVHD passes.
How should I take immunosuppressants?
Immunosuppressants have powerful effects. It’s important to follow your healthcare provider’s directives. You should take the prescribed medicine daily, preferably at the same time each day.
Skipping one day of medicine can cause an autoimmune disease flare-up (return or worsening of symptoms). For transplant recipients, a missed dose can put you at risk for organ rejection or GVHD complications. You should contact your provider if you miss a dose.
Is it safe to take immunosuppressants while pregnant or breastfeeding?
Anyone who takes immunosuppressants should talk to their healthcare providers before conceiving. Some immunosuppressants can cause birth defects. Some medicines may be harmful to take during pregnancy or while breastfeeding. You may need to switch to a different medicine.
Immunosuppressants offer lifesaving benefits for many people. But suppressing your immune system can lead to side effects and increase your risk of health complications. Your healthcare provider will carefully monitor your condition and check for medication side effects. You may change medicines or dosage amounts to get the most effective treatment with minimal problems. Let your provider know if you experience life-disrupting side effects or the medicine doesn’t provide symptom relief.
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