Understanding your transplant medications

Receiving a transplant is a life-changing milestone — and the medications you take are just as important as the surgery itself. After a transplant, careful balance and regulation of the immune system is critical, and medications are one of the most important tools to help achieve long-term success. Because your immune system is built to protect you from anything it doesn’t recognize, a brand-new organ can become a target. This is called rejection. Luckily, that’s where anti-rejection medications, or “immunosuppressants,” come into the equation.

Here's a quick look at three types of transplant medications your care team may prescribe and how they work together in different but coordinated ways to help keep you healthy.

Tacrolimus and cyclosporine (Calcineurin inhibitors)

Calcineurin inhibitors are anti-rejection medications that form the backbone of treatment following most organ transplants. They include two drugs with several different brand names: tacrolimus (Prograf ®, Astagraf ®, or Envarsus ®) and cyclosporine (Neoral ®, Sandimmune ®, Gengraf ®)

Today, tacrolimus is more commonly prescribed, but cyclosporine was one of the first drugs to make transplant widely successful. Your team will let you know which is right for you after your transplant, because you only ever need to take one of them at a time. They work by blocking calcineurin, a messenger in the immune system that acts like a spark, igniting the immune response against the transplanted organ.

When you take either tacrolimus or cyclosporine, that spark is dampened, making it less likely that your immune system will attack. This helps to prevent rejection, lets the new organ work to its full potential, and lets your body heal after surgery. Both medications have a narrow therapeutic range, and the dose that works best varies from person to person.

To make sure you’re taking the right amount, your care team will regularly check the drug levels in your body through blood tests. These lab tests, called “trough levels”, are essential because other medications, your unique genes, certain foods, and even changes in how hydrated you are can change how much you need to take. Too little puts you at risk for rejection. Too much can affect your kidneys or cause increased side effects including: tremors, headaches and high blood pressure.

Mycophenolate

Mycophenolate is typically prescribed alongside tacrolimus or cyclosporine as part of a multi-step approach to suppress the immune system. After the transplant of a new organ, your body will start rapidly making a large number of white blood cells, the “fighter” cells that help defend against the unknown.

Mycophenolate helps by stopping these fighter cells from multiplying by blocking a key part they need to make new cells. You can think of it as unplugging the copy machine that they rely on to make more copies of themselves. With fewer attack cells being produced, your body’s immune response is reduced, and your organ remains protected.This drug comes in two common forms: mycophenolate mofetil (CellCept®) and mycophenolate sodium (Myfortic®).

Gastrointestinal side effects — such as nausea, diarrhea and stomach cramps — are common, especially when starting the medication. Taking it with food can help. Because mycophenolate suppresses white blood cell production, you may also be more susceptible to infections, so it's important to report any signs of illness to your care team promptly.

Prednisone

Prednisone is a man-made version of a hormone, specifically a steroid, that your body already makes naturally. When you get a transplant, your immune system sends out an alarm signal to call the immune cells to action, and create inflammation. Prednisone helps prevent organ rejection by calming the immune system and making it less likely to recognize the transplanted organ as a threat.

However, prednisone also reduces inflammation and immune system action generally, not just the specific cells that need to be quieted for your transplant. That means you can get other side effects related to your body getting more hormones than it typically needs.

Prednisone can increase your appetite, raise blood sugar levels, increase blood pressure, cause mood changes, to name a few side effects. For this reason, the transplant team will use as low a dose as possible, and ideally stop the medication when it is no longer needed to protect you from rejection.

How they work together

Together, these three types of anti-rejection medications are carefully balanced by your transplant team to prevent your immune system from harming your new organ. Each drug works on a different part of the rejection process, to create a more effective treatment when taken together. This “triple therapy” approach lets you take a lower dose of each medication, reducing the risk of side effects, but still excellently protecting your transplant.

Taking your medications safely

Managing multiple transplant medications takes consistency and communication. A few key habits can make a real difference:

• Take your medications at the same times every day, usually every 12 hours
• Never stop, skip or change doses of your transplant medications without talking to your care team
• Always remember to refill your medications on time. It's vital to ensure you never run out
• Keep an updated list of all medications, including program-approved over-the-counter medications or vitamins
• Attend all follow-up appointments and always go get your labs drawn as instructed by your transplant team

Your transplant team is your partner in this process. If you have concerns about side effects or costs, speak up — there may be options that can help.