Pharmacists will be on hand to provide you with the following services throughout your transplantation process:
- Education seminar on medication expectations after transplant
- Answers for any specific questions you have
- Discussion of your progress and any medication adjustments as required
- Introduction to the Redwood Pharmacy, a community pharmacy affiliated with University of Utah Health Care that supplies medications to the majority of our transplant patients through a mail-order service
- Review of your new medications prior to discharge, including the purpose, dose, potential side effects of each drug, how long to take them, and important drug interactions
- A list of medications complete with pictures and times to take each of your pills, as well as a pill box to simplify your medication regimen, and a blood pressure cuff to keep track of your blood pressure
- Medication counseling and answers for any questions
- Medication review with your specialist and any required adjustments as well as an updated list of medications following any changes
- Information about patient assistance programs for those who qualify
A financial counselor is also available for questions regarding insurance.
As a transplant patient it is your responsibility to take your medications daily as prescribed by your physician. Medication non-compliance is a major cause of graft dysfunction, which can easily be avoided. We understand that taking many medications multiple times a day may be a challenge. Our pharmacy team is here to help you understand the names of your medications, what they are for, when to take them, how long to take them, potential side effects, and drug interactions. Do not change doses or stop taking any of your medication without a physician’s approval, and do not start any new medications without checking with your physician or pharmacist for drug interactions.
(used to prevent and treat rejection of the transplanted organ)
- Thymoglobulin - An intravenous medication given immediately following the transplant surgery to prevent rejection, this medication may also be used to treat severe rejection episodes.
- Basiliximab (Simulect) - An intravenous medication given immediately following the transplant surgery to prevent rejection
- Tacrolimus (Prograf) - An oral or intravenous medication given as maintenance or long term, to prevent rejection of the transplanted organ, this medication is available as three different strength capsules: 0.5mg, 1mg, and 5mg. Tacrolimus is generally taken every 12 hours. Potential side effects include tremor, alopecia (hair thinning and baldness), nausea, vomiting, diarrhea, anemia, increased blood sugars, as well as an increased risk of infections and skin cancer. This drug requires special monitoring in order to prevent harm to your kidneys. This involves having your blood drawn to determine how much drug you have in your body. In order to get an accurate drug level it is important to have your blood drawn right before your morning dose of tacrolimus.
- Cyclosporine (Neoral/Gengraf) - An oral or intravenous medication given as maintenance or long term to prevent rejection of the transplanted neoralorgan; both Neoral and Gengraf (the generic formulation of Neoral) are available at 25mg and 100mg capsules. Cyclosporine is generally taken every 12 hours. Potential side effects include tremor, nausea, vomiting, diarrhea, gum swelling, high blood pressure, and an increased risk of infections and skin cancer. This drug requires special monitoring in order to prevent harm to your kidneys. This involves having your blood drawn to determine how much drug you have in your body. In order to get an accurate drug level it is important to have your blood drawn right before your morning dose of cyclosporine.
- Sirolimus (Rapamune) - An oral medication given as maintenance or long term, to prevent rejection of the transplanted organ, this medication is available as 1mg and 2mg tablets and is generally taken as one dose per day. Potential side effects include nausea, diarrhea, acne, sores in your mouth, headache, tremor, increased cholesterol, and an increased risk of infection and skin cancer. This drug requires special monitoring, a blood test, to ensure that an adequate amount of drug is in your blood stream. In order to get an accurate drug level, it is important to have your blood drawn right before your daily dose of sirolimus. If you are also taking cyclosporine, separate sirolimus by four hours (this does apply if you are taking tacrolimus).
- Mycophenolate Mofetil (CellCept) & Mycophenolate Sodium (Myfortic) - An oral or intravenous medication given as maintenance or long cellceptterm, to prevent rejection of the transplanted organ, CellCept is available as 250mg capsules and 500mg tablets, while Myfortic is myforticavailable as 180mg and 360mg tablets. This medication is generally taken twice a day, 12 hours apart. Potential side effects include nausea, vomiting, diarrhea, gas, and headache. Similar with other immunosuppressants, Cellcept and Myfortic may increase your risk of infections and skin cancer.
- Corticosteroids (Prednisone) - Aid in preventing rejection of the transplanted organ; in higher doses they may be used to treat transplant rejections. There are various regimens with corticosteroids tapering down to a small prednisonedose everyday and occasionally tapering completely off. Steroids are associated with numerous side effects including stomach upset, headache, dizziness, trouble sleeping, weight gain, increased blood sugars and cholesterol as well as an increased risk of infection and skin cancer.
Following transplant your immune system will be weakened by your medications in order to prevent your body from rejecting the transplanted organ. This immunosuppression also makes it harder for your body to fight infection, so the following medications may be given to you to prevent certain infections.
- Trimethoprim/Sulfamethoxazole (Bactrim or Septra) - An antibiotic to prevent pneumocystis carinii pneumonia (PCP/PUP) infections as well bactrimas urinary tract infections, this tablet is available in two different strengths: single strength (160mg/80mg) and double strength (360mg/160mg). Regimens differ depending on which organ you have received from taking a single strength tablet daily to taking a double strength tablet two to three times per week. Side effects include nausea, vomiting, headache, sun sensitivity, lethargy, diarrhea, as well as low white blood cell count, platelet count, and anemia.
- Valganciclovir (Valcyte) - An antiviral agent used to prevent cytomegalovirus (CMV) infections, Valcyte is available as a 450mg tablet. Dosing regimens are determined by the CMV status of the donor organ and the recipient as well as your kidney function. Potential side effects include diarrhea, nausea, vomiting, headache and white blood cell count(WBC).
- Acyclovir - An antiviral agent used in the prevention of herpes simplex and shingles infections; if both donor and recipient are CMV negative, then acyclovir may be used. Acyclovir is available as 200mg capsules and both 400mg and 800mg tablets. Similar to Valcyte, dosing will be dependent upon kidney function. Potential side effects include nausea, vomiting, and headache.
- Fluconazole (Diflucan) - An antifungal agent used to preventfluconazole fungal infections, Fluconazole is available as 50mg, 100mg, and 150mg tablets. Potential side effects include headache, nausea, diarrhea, and abdominal pain.
- Clotrimazole (Mycelex) - An anti-fungal agent used toclotrimazole prevent oral and esophageal candidiasis (thrush), it is available as a 10mg troche, which dissolves in your mouth and is dosed multiple times per day. Potential side effects are rare but may include local redness and stinging.
- Nystatin Suspension - An antifungal agent used to prevent oral and esophageal candidiasis (thrush), it is available as a suspension which you swish around in your mouth and swallow multiple times per day. Potential side effects include diarrhea, nausea, vomiting and gas.
Additional medications are likely to be dependent on your medications pre-transplant and may include blood pressure medications, pain medications, stool softeners, diabetes medications, such as insulin, vitamins and supplements, as well as medications to protect your stomach from ulcers.