Organ Transplant Drug Therapy

Our Specialty Pharmacy offers pharmacy services to patients who need long-term immunosuppressant drug therapy after solid organ transplantation. Our pharmacy staff can provide the medications you need for your condition after you return home from the clinic. Experienced pharmacy professionals work closely with your Mayo Clinic care team to develop a personalized medication management program at no additional cost. We coordinate all billing and claims on your behalf, relieving you of up-front costs and the headaches of completing insurance forms and filing claims.

About Organ Transplantation
The Role of Medications after Organ Transplantation
Side Effects, Cautions and Special Requirements
Always Ask Your Pharmacist

About Organ Transplantation

The first successful transplant, a kidney, was performed in 1954. Since then, solid organ transplantation has become a potentially lifesaving treatment for end-stage diseases of the kidney, liver, heart, lung and pancreas.

The United Network for Organ Sharing (UNOS) reported that 25,468 transplants were done in the United States in 2003. The need for organs far exceeds the number of donated organs. Currently, UNOS has a waiting list of over 87,000 patients who need a solid organ transplant.

The Role of Medications after Organ Transplantation

After transplant, you will need to take medications to prevent your body's immune system from attacking the new organ. These immunosuppressant medications must be taken every day for as long as you have a functioning transplant. Your transplant team will tell you what dose to take, based on the results of blood tests. Do not adjust the dose or stop taking these medications unless a member of your transplant team tells you to do so.

The most common oral immunosuppressant medications used in the United States include tacrolimus (Prograf), mycophenolate mofetil (CellCept), sirolimus (Rapamune), prednisone, cyclosoporine (Neoral, Sandimmune, Gengraf) and azathioprine (Imuran). You may take different combinations and doses of these medications at various times after your transplant. Your transplant team will tailor your medications to your needs. Depending on the type of transplant, two or three medications are commonly used for long-term immunosuppression.

In the first weeks and months after transplant, you also may need medications to help prevent infections. Because immunosuppressant medications interfere with your natural immunity, you are more susceptible to infection after transplant surgery. This risk exists as long as you take immunosuppressant medications, but decreases over time.

The medications to help prevent infections may include: antivirals like acyclovir (Zovirax), or valganciclovir (Valcyte) to fight viruses; antifungals like fluconazole (Diflucan), nystatin (Mycostatin, Nilstat), or itraconazole (Sporanox) to fight fungal infections, and antibiotics sulfamethoxazole/trimethoprim (Bactrim, Septra) to help fight bacterial infections.

Side Effects, Cautions and Special Requirements

As with any medication, side effects may be associated with your medication therapy after transplant. These side effects will depend on which combinations of medications are used, but no combination of drugs is free of side effects.

Some side effects, such as stomach upset, diarrhea, or difficulty sleeping may be noticed initially upon starting the medications and then subside. Other side effects may develop over months and years after solid organ transplantation. Long-term health issues that may arise and require follow-up care include osteoporosis, diabetes, high blood pressure and high blood cholesterol levels.

Other medications and some foods have the potential to interact with your post-transplant medications. Complications can arise from:

• Taking prescription medicines such as erythromycin, clarithromycin (Biaxin), diltiazem (Cardizem, Tiazac) and verapamil (Calan, Verelan).
• Using over-the-counter products such as cimetidine (Tagamet) or herbal products/natural remedies including St. John's Wort, Echinacea, black cohosh, and others.
• Eating grapefruit or drinking grapefruit juice, which interferes with how your body breaks down some medications.

You will be asked to give your transplant team a list of the medications and dietary supplements (such as vitamins and herbal preparations) you use. You also will be asked about any allergies you have. Do not begin taking any new medications without consulting your transplant team.

Always Ask Your Pharmacist

If you experience problems with your drug regimen after organ transplantation, your pharmacist is a reliable source of information and can help you monitor your condition, maximize the benefits of your medications, limit side effects and identify drug-drug or drug-disease interactions. Your pharmacist will work closely with your doctor to create a safe and appropriate care plan.

Optimal management of your health after organ transplantation requires the coordinated care of your health care team. Doctors, nurses and other caregivers must work closely with pharmacists and others to ensure therapy is safe and effective. Incomplete management of your medical condition may lead to serious complications.