Transplant and Pulmonary Hypertension

Medications After TransplantPills

For transplant recipients, there are lots of pills to swallow — some people take 12 pills a day, some 40, depending on what their bodies need.

Immunosuppressive Drugs

One of the primary roles these drugs play is immunosuppression. Your immune system is what protects your body from infection by recognizing and fighting foreign substances such as viruses and bacteria that enter your body.

Unfortunately, your immune system will recognize your new lung as a foreign object. Therefore, your doctors will give you medicines to keep your immune system from fighting (rejecting) your new lungs. The process of preventing your body's natural immune response is called immunosuppression. Regrettably, these immunosuppressive drugs will reduce your body's ability to fight off bad foreign substances. Thus, it is very important that you take precautions to avoid infection whenever possible. Such precautions are discussed in the fact sheet "Living as a Transplant Recipient."

The main immunosuppressive drugs used in lung transplant patients are Cyclosporine, Imuran, Mycophenolate, Tacrolimus and Prednisone. See the table below for an explanation of these drugs. One thing that you will notice about the medications on this list is that some of them have many unpleasant side effects. On first looking at this list, the side effects of immunosuppressive drugs can seem more overwhelming than they usually are in real life. Not every patient experiences every side effect. Other drugs and things as simple as increased exercise can counter some of the side effects. Doctors are also learning to use multiple drugs to get a maximum anti-rejection effect with minimum side effects.

Other Drugs

In addition to the medications listed below, you may take a nystatin suspension to prevent fungus infections, Septra DS to prevent bacterial infections, Lasix to treat swelling and high blood pressure, Zantac to decrease the amount of acid in your stomach and metered dose inhalers such as albuterol and atrovent to help keep your airway open and make breathing easier.

Details About Immunosuppressive Drugs

Medication Dosage & Details Side Effects
Cyclosporine It is available as a liquid or a capsule, both of which have very specific dosage instructions. With either dosage form you use, it is very important that you take your Cyclosporine at regular twelve-hour intervals. Your transplant team will periodically measure the levels of Cyclosporine in your blood by doing a simple blood test.
  • Flushing
  • Hair growth on the face, arms, and body
  • Fine hand tremor - if this continues for more than one month after your transplant or if the trembling increases, notify your transplant coordinator
  • Swelling of the gums
  • Numbness, tingling or burning sensations in the hands and feet
  • Headaches
  • High blood pressure
  • High potassium levels
  • Altered kidney function
Imuran Imuran comes in a pill and is taken in one dose in the evening.
  • Decrease in white blood cell count
  • Hair loss
Prednisone Prednisone is typically taken as a tablet. You will initially take a high dosage of Prednisone, which will be tapered off to minimize the side effects.
  • Increased appetite - it will be very important that you watch your calories and maintain your ideal weight
  • Increased blood sugar level
  • Change in appearance, such as a rounded face, a larger abdomen and thin skin that bruises easily
  • Increased stomach acid
  • Increased sweating
  • Acne on the face, back and chest
  • Muscle weakness, particularly in the legs
  • Eye problems
  • Joint problems
  • Delayed wound healing
  • Emotional changes, such as increased restlessness or moodiness
Mycophenolate It is available in tablet or suspension and should be taken on an empty stomach 1 hour before or 2 hours after meals to avoid variable absorption. You may be given either Myfortic or CellCept which have different tablet doses.
  • High blood pressure
  • Risk of infection
  • Headache
  • Nausea and vomiting
  • Diarrhea
  • Swelling
  • Insomnia
Tacrolimus It is available in tablet or suspension and should be taken on an empty stomach 1 hour before or 2 hours after meals to avoid variable absorption. Take this medicine at regular twelve-hour intervals as your transplant team will periodically measure the levels of tacrolimus in your blood by a simple blood test.
  • High blood pressure
  • Worsened kidney function
  • Risk of infection
  • Headache
  • Nausea and vomiting
  • Diarrhea
  • Sunburn
  • Constipation

Language Based on Treatment Fact Sheet Issued by PHA's Scientific Leadership Council

To review Conflict of Interest Disclosures for PHA's medical leadership, visit: Disclosures
Last reviewed in 2009

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