Common Anti-rejection drugs

Cyclosporine
Other Names: CSA, Samdimmune"
Purpose CSA is an immunosuppressive medication that helps prevent rejection. Because absorption of cyclosporine is variable, blood levels must be monitored to guide the ordering of doses.
Dose (liquid or capsules)
Oral liquid preparation in an olive oil base

100mg in each ml.
Measure dose with a syringe, use a one cc syringe to measure doses less than 100mg. Mix with milk, chocolate milk, or juice. Serve at room temperature, not hot. Stir well and drink at once. Do not allow mixture to stand before drinking. Use a glass container. After you drink your dose add more milk or juice and drink it to be sure that you are getting your entire. Do not use Styrofoam cups. CSA can be taken "straight" followed by a drink of milk, chocolate milk or juice. Carefully follow directions on bottle for storage and precautions. Once the bottle is opened, the contents should be used within two months. Do not mic CSA in a baby bottle- it may change your Childs feeling toward the bottle and if (s)he does not drink all of the liquid, part of the dose will be missed.

Capsules - 100mg and 25mg
Carefully follow directions on box for storage and precautions. Use as soon as possible after removing the capsules from the blister pack.

When to take Cyclosporine
Am dose - in the morning with breakfast
Pm dose - 12 hours after the morning dose.

Missed Dose
If you happen to miss a dose, make up the missed dose as soon as you remember. If it is time for your next scheduled dose, take a double dose to make up a missed dose. If you have forgotten more than a dose, contact the Transplant Center. You need to take all the amount prescribed to prevent rejection. Do not have a CSA level done within 24 hours.

Generic Cyclosprine: Not recommended currently

Precautions
Some medications seriously change the effectiveness of CSA. Never take any medications without telling the transplant center. Blood potassium levels must be monitored and other medications that increase the potassium level should be used with caution. Diarrhea will affect your CSA blood level. Be sure to report any problems with diarrhea to the transplant center. Call your doctor or the transplant center if you have taken an overdose of CSA. If you are on dialysis it does not dialyze off and should be taken on a regular schedule. Check with your transplant doctor before planning a pregnancy.

Side Effects of Cyclosporine
Flushing. A brief period of warmth and / or redness in your face for one to two hours after taking CSA. This feeling disappears within a short time.
Hair Growth Increased hair on your face, arms and body is common but usually not a problem. Special bleach formulations made especially for the face are available if you choose to use a cream hair remover.
Mild tremor of hands. Usually occurs in the month or two and tends to disappear the longer you take CSA or with a decreased dose. If it continues to be a problem for you, please report it.
Gum Swelling and sensitivity to cold or heat. Dental Hygiene is necessary to keep gums in good health. Numbness, tingling, burning sensation, sensitivity to cold and or heat in hands and feet usually noticeable, but not too uncomfortable.
Hypertension or high blood pressure. Appropriate medications will be prescribed to control your blood pressure. It is important to follow other recommendations to help lower your blood pressure such as keeping your weight normal. Eating a low salt diet and exercising. These medications may require constant revision, as the blood pressure may return to normal with reduction in dosage of steroids and CSA.
Elevated serum potassium levels This is more common after you have been on cyclosporine for a few weeks. You might need to restrict the amount of potassium in your food and beverages.
Altered kidney function or nephrotoxicity. Laboratory tests are done to monitor your kidney function. If this side effect develops, your dose will be lowered. The transplant staff may ask you to return to the hospital for evaluation.
Altered liver functions Symptoms include elevated liver enzymes and bilirubin. This occurs rarely. Liver functions tests are done periodically.
Yeast infections in your mouth, esophagus, and stomach. Using an anti fungal medications as prescribed should prevent these infections. If your mouth is sore continously or there is a white coating on your tongue, let your doctor or nurse know.
Gastrointestinal Symptoms. Nausea, vomiting, diarrhea and decreased apetite are rare, but please report them if they occur.
Rash See your doctor and tell the transplant center if you have a rash.
Neurological Symptoms Headache and feelings that's its harder to remember things. Episodes of black out or seizure are rare and need. Both men and women should immediate medical attention and evaluation.
Lumps in your breast/Chest area examine themselves monthly for lumps and report them to their primary care physician if they occur.
Do not breast feed - cyclosporine can be transmitted to your baby in your breast milk. Allergic reaction very rare.

FK-506 (PROGRAF)
Other Names: Prograf(tm), Tacromilus
Purpose It is an immunosuppressive medication that helps prevent rejection.
Dose: Capsules 1 and 5 milligrams.

Missed Dose
If you miss a dose, try to take it as soon as you remember or check with the Transplant center for further instructions. If you have forgotten more than one dose, contact the transplant center for instruction during hours. It is important to take your entire prescribed dose to prevent rejection.

Side Effects
Fk-506 is similar to cyclosporine. It may use as an alternative to prevent rejection.
Possibe side effects include: Headache, numbness, tingling, Nausea, vomiting, diarrhea and decreased appetite. High blood sugars, Flushing, High Potassium, High blood pressure, High Bun or creatnine levels, Rash.

Special Instructions
When sending blood samples to check for FK506, make sure you use a lab slip that FK506, not cyclosporine.

IMURAN
Other Names: Azathiaprine, AZA
Purpose
Immunosuppressive. This medication is routinely used to prevent rejection in other patients.

Dose
Individual dose is based on your weight and white blood count (WBC). Available only in 50m size tablets. A dose of 25 mg is a half tablet and a dose of 12.5mg is one fourth of a tablet.

When to take
Take the entire daily dose at one time in the evening.

Missed Dose
All of the prescribed amount must be taken to maintain enough immunosuppression to prevent rejection. Make up the missed dose as soon as you remember. If it is already time for your next schedule dose, it is permissible to take a double dose if your white blood count (WBC) is in your normal range. If you have forgotten more than one dose, contact The Transplant Center during regular hours for instructions.

Generic - Azoran

Precautions
Have white blood count (WBC) tests done as instructed.
Report all symptoms of infections immediately.
Take Imuran after dialysis, not before.
Use Allopurinol (Zyloprim) with extreme caution. It should only be taken under close medical supervision. It can cause a serious decrease in your white blood counts, hemoglobin and platelets. It may be serious enough to require hospitalization.

Side Effects
Decreased white blood count.
Liver toxicity. Liver function tests will be done at least twice a year when you take Imuran.

PREDNISONE
Other Names: Deltasone, Wysolone
Purpose It is a steroid immunosuppressive medications that helps prevent rejection.
Dose
Use only the five mg size tablets for adults. Small children can use one mg size tablets as necessary. Using one tablet size is extremely important to prevent mistakes.

When to take
During the first week after transplant or when prednisone is increased to treat rejection - divide your total daily dose into four proportions and take each one at four evenly spaced times during the day. After one week or when predinisone is being tapered - divide your total daily dose and take half in the morning and half in the evening. After three to four months - the total daily dose can be taken once a day. The transplant center will tell you when to switch to one dose a day.

Missed Dose
Take your missed dose as soon as you remember. If it is time for your next scheduled dose, you can take a double dose. If you have forgotten more than one dose, contact The Transplant Center during regular hours for instructions. It is important to take your prescribed prednisone dose to prevent rejection.

Generic - Check the brand of prednisone you are talking, and try to continue taking the same brand when you obtain a new supply. We recommended you use wysolone.

Precautions
Report all illness and fever and be sure to have your blood tests done if you just have the flu. Rejection can be missed until it is too late if you fail to monitor your blood tests during any illness.

Side Effects
Prednisone has many side effects. Those that our transplant recipient most commonly encounter are described here. The side effects are dose related - the higher the dose of prednisone or the more times you have been treated for rejection, the more you experience side effects. As the dose is gradually reduced, the more you experience side effects. As the dose is gradually reduced, the side effects diminish. The prednisone dose will be reduced so that it is will be discounted at a maintenace level by the end of one year.

Sodium retention. When your body retains sodium it also retains fluid, which can cause an increase in your blood pressure. To prevent or treat or treat elevated blood pressures, eat a salt (sodium) restricted diet (see Nutrition section).
Increased Appetite. There is no way that you can eat enough to make the hunger from prednisone go away. And if you eat more than you need, you will gain weight. Read the nutrition section or talk with a dietitian for information regarding your ideal weight. Food intake, and ways to improve your nutritional status.
Increased fat deposits, especially in the face and abdomen and sometimes on the back of neck.

Increased Acid in your stomach, which can cause ulcers. For this reasons it is important that you follow the antacid guide.
Mood swings or emotional highs and lows.
Thrush (candidi) growth in the mouth. To prevent this use you're anti fungal medications as directed.
Increased sweating especially at night. If you have diabetes be sure to check your blood glucose. Do not just assume you have low blood glucose.
Increased hair growth increased hair on your face, arms, and body is common but usually not a problem. Special bleach formulations made especially for the face are available if you choose top use a cream hair remover.
Acne on the face, back, and chest. Wash your skin two or three times a day. Keep the area as clean and dry as possible.
Bone and muscle problems.
Doing exercises or walking to strngthen these muscles can alleviate muscle weakness, especially in the thigh. Your muscle strength will improve as your prednisone dose is decreased, if you have excercised adeqautely.
Muscle cramps and aching, usually in the lower leg. If you experience muscle cramps and there are troublesome, contact primary care doctor. Quinine, and over the counter medication, may help.
Joint pain may mean you need to see an orthopedic physician. Prednisone affects how calcium absorbed and stored in your body. For this reason it is important that you take care of your bones.
Children may not grow while on high doses of prednisone. If you are under the age of 18, measures your height once a month and report it on a height. Weight chart. Report these measurements to the Transplant Center.
Eye problems Except blurred visison right after transplant, especially while you are taking high doses of prednisone. We recommend you do not change your glasses prescription for at least 6 months after the transplant. If your vision has been improving after an initial deterioration and then you notice an increased blurring or a decrease in your vision again, see your primary care eye doctor (ophthalmologist) Immediately. Other problems may be occurring in your eye.
Increased sugar in blood Many recipients have an increased blood sugar level after surgery. For most people this level returns to normal within a few days after transplant. If you have diabetes, you may notice higher blood glucose level when taking doses of prednisone.
Increased sensitivity to the sun- See the general section for recommendation to prevent skin changes and skin cancer.
Increased time for wounds to heal.
Decrease in the body's ability to fight infection. You is not necessarily going to catch flu's and colds. However, if you get an illness, your body is less able to fight it. Your body has an immune system that fights infection and rejects anything that is foreign. This system is suppressed by anti - rejection medications. It is extremely important that you notify the transplant staff of hay fevers or illness you have.

SIROLIMUS (Rapamune)
New Immunosuppression medication. Usually used along with cyclosporin as an antirejection medication. Occasionally used with Cellcept (MMF) and steroids.

Dose 2 mg/ Day maintenance dose. Upto 5mg/ day has been used. Take the dose recommended by your doctor.

Packing and Administration:
The drug is available in the form of a viscid fluid in a bottle or in sachets of 1ml and 2ml. The required dose for the day should be dispensed in a clear cup and stirred with 60ml of orange juice or water. After consuming, another 120ml of orange juice should be added to the cup, mixed and taken orally.

Side Effects
At higher doses (5mg/ Day)
Anaemia, arthralgia, diarrhoea, hypokalemia and thrombocytopenia.

At 2-5 mg/ day
Hypercholesterolemia, hyperlipemia, hypertension, rash and acne.

Avoid concomitant use of drugs which are nephrotoxic and prokinetic.