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Liver Transplant Drugs

Liver Transplant Drugs,Liver Transplant Medication,Liver Transplant Medicine Immunosuppressive Drugs
Your body recognises that the liver graft is foreign and your immune system will launch an attack against this 'invader' . Immunosuppressive drugs prevent the rejection of the liver transplant by weakening the response of your immune system. At the same time, however, immunosuppressive drugs can make you a little more susceptible to infections. Fortunately the amount of immunosuppressive medication necessary to preserve a functioning transplanted organ decreases after the first months following surgery, and so does the extra risk of infections. Nevertheless, some immunosuppression is always necessary even many years after transplant surgery, and you must never skip doses or reduce the amount of your medication without your doctor's permission.

Not all transplant patients receive all the drugs. So do not be alarmed if one or the other drug does not form part of your immunosuppressive regimen.

What follows is general information only which is intended to supplement, not substitute for the expertise and judgment of your physician. You must consult your physician for further details.

Most side effects of the drugs listed below can be overcome by temporarily reducing or discontinuing the drug. However, this should never be done without explicit instructions of the physician.

Consult your doctor or transplant team immediately if you think you are pregnant.

Neoral
CYCLOSPORIN (Sandimmune / Neoral )

Cyclosporin works by preventing the activation of the T-lymphocytes ( a type of white blood cell) so that they are unable to attack your new liver. Neoral is usually given orally in combination with azathioprine and / or corticosteroids. The concentration of cyclosporin circulating in your body can be measured with a blood test, and the result used to decide when and how to adjust your dose if necessary.

Taking Neoral

  • Take your medication with milk or apple juice at the same times every day, 12 hours apart.
  • On the day of your check up visit, give the first sample before (C0) and second 2 hours after (C2) the Neoral dose.
  • Do not store cyclosporin in the refrigerator. Keep your medicine in a cool, dry place away from light.
  • Neoral can interact with some frequently used medicines. Always check with your doctors or transplant team before taking any new medications.

Side Effects

These include abnormalities of kidney function, high blood pressure, thickening of the gums, high blood sugar, increased hair growth where hair is not normally present, shakiness of the hands called tremor.

Most of these side effects can be avoided or reduced if the dosage is decreased. Remember that you are not likely to experience all, or even most of them and as your dose is reduced with time, you will probably experience fewer side effects.

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TACROLIMUS

Like cyclosporin, tacrolimus also blocks the activation of the T-lymphocytes thereby preventing them from attacking your new liver. Tacrolimus is usually taken in combination with azathioprine and / or corticosteroids. The concentration of tacrolimus circulating in your body can be measured with a blood test and the results used to decide when and how to adjust your dose if necessary

Taking Tacrolimus (capsules)

  • Take your medication with milk or apple juice at the same times every day, 12 hours apart.
  • On the day of your check up visit, give the blood sample before taking the Tacrolimus dose.
  • The capsules should be taken at least one hour before or 2-3 hour before or 2-3 hours after a meal.

Side Effects

Tacrolimus may cause abnormalities of kidney function, high blood pressure, sleep disturbances, high blood sugar levels, numbness and tingling in hands and feet, shakiness of hands (tremor). Tacrolimus can interact with some frequently used medicines. Always check with your doctors or transplant team before taking any new medications.

Most of these side effects can be avoided or reduced if the dosage is decreased. Remember that you are not likely to experience all, or even most of them and as your dose is reduced with time, you will probably experience fewer side effects.

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Rapamune (SIROLIMUS)

Sirolimus is a TOR inhibitor which results in inhibition of both B and T lymphocytes which are special white blood cells that are responsible for rejection. Its action is different from Neoral and Tacrolimus and hence it is free of several of their side effects such as kidney toxicity, diabetes and high blood pressure.

The concentration of Sirolimus circulating in your body can be measured with a blood test and the results used to decide when and how to adjust your dose if necessary

How to Take this Medication

Take this tablet (usually) once daily at the same time every day, either consistently with or without food. If you are prescribed cyclosporine along with sirolimus, take this medication four hours after your cyclosporine dose.

Side Effects

The most commonly observed side effects are nausea, diarrhea, mouth ulcers and acne. There may be increased levels of blood cholesterol and triglycerides but this improves with time. Decreased platelet or white cell count in the blood have also been noted. Most of these side effects can be avoided or reduced if the dosage is decreased.

Missed Dose

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

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CORTICOSTEROIDS (Wysolone - Prednisolone)

Prednisolone is a corticosteroid that can be used for life long immunosuppression to prevent organ rejection, or in higher doses, for the treatment of rejection. Corticosteroids are manufactured naturally in the body in a 24-hour rhythm. You should take your corticosteroid medication first thing in the morning so that you can copy your body's natural rhythm.

Taking Corticosteroids

Take your tablets with meals. If you take tablets once a day, take them in the morning with breakfast.

Side Effects

The short-term side effects of corticosteroids include:

  • Increased susceptibility to infection, impaired wound healing
  • Suppression of the normal fever response and other signs of infection
  • Elevation of blood sugar, particularly in patients who already have diabetes

Over the long-term, the side effects of corticosteroids are related to the dose taken. Only in high doses they may cause increase in appetite and weight, a shift in the distribution of body fat (development of Cushingoid features - puffy cheeks, rounded back), thinning of the skin and bones, muscle weakness, increased blood pressure, gastritis, ulcers and heartburn, Diabetes, cataracts, some increase in acne.

Although this list is awesome, it must be emphasised that with the relatively low doses of corticosteroids used nowadays, these side effects are quite uncommon.

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AZATHIOPRINE

Azathioprine works by interfering with the ability of cells of divide. It is always given in combination with other immunosuppressants.

Taking Azathioprine

You can take your tablets at any time of the day, but try to get into the routine of taking your medication at the same time every day.

Side Effects

For most people, Azathioprine is safe at the low doses required to prevent organ rejection. Bone marrow cells divide frequently and are very sensitive to the effects of azathioprine. Patients taking azathioprine may have increased susceptibility to infection or reduced haemoglobin, white cell or platelet counts. Effects of azathioprine on the bone marrow are reversible if the drug is stopped temporarily.

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Cellcept (MYCOPHENOLATE MOFETIL)

Cellcept inhibits the proliferation of lymphocytes which are vital for rejection.

Taking Cellcept

Take this medication as directed usually twice daily on an empty stomach one hour before or two hours after meals. Swallow this medication whole. Do not crush, chew or open it.

Side Effects

This medication may cause dizziness, drowsiness, headache, nausea, vomiting, diarrhea, gas, tremors, mood changes, or vision changes. It may also cause white cell or platelet counts in the blood to drop. The physician can usually overcome these problems by temporarily reducing or discontinuing the drug.

Missed Dose

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

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MYFORTIC

Recently, Myfortic has been developed as a new enteric-coated formulation of the above drug (Mycophenolate Sodium) in order to protect the upper gastrointestinal tract from damage and hence, lessen the stomach upset caused by Cellcept.

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Zenapax (DACLIZUMAB - INJECTION)

This medication is a humanized monoclonal antibody that binds the IL2 receptor on activated lymphocytes. This prevents the important action of IL2 in causing proliferation of cells (lymphocytes) that lead to rejection, hence blocking the rejection phenomenon. Given with other conventional drugs, it has been shown to augment their role in preventing organ transplant rejection.

How to Take this Medication

This medication is given by injection into a vein (IV) after proper dilution in a saline solution. 2-5 doses are given, each over a 15 minute period, every 14 days starting upto 24 hours before the transplant.

Side Effects

Nausea, vomiting, or stomach upset may occur. Allergic reaction (rash, itching, breathing trouble), headache, dizziness, chest pain, arm or leg swelling, cough, fever, poor wound healing, and muscle pain have also been reported.

Storage

Vials should be refrigerated between 2-8 degrees C away from light. Do not shake or freeze.

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Simulect (BASILIXIMAB - INJECTION)

This medication is a murine-human chimericl antibody that binds the IL2 receptor on activated lymphocytes. This prevents the important action of IL2 in causing proliferation of cells (lymphocytes) that lead to rejection, hence blocking the rejection phenomenon. Given with other conventional drugs, it has been shown to augment their role in preventing organ transplant rejection.

How to Take this Medication

This medication is given by injection into a vein (IV) after proper dilution in a saline solution. It is usually given in two doses: the first dose is given within 2 hours prior to transplant surgery and the second dose is given 4 days after surgery.

Side Effects

Nausea, vomiting, or stomach upset may occur. Allergic reaction (rash, itching, breathing trouble), headache, dizziness, fever, poor wound healing, vision problems, mood changes and irregular pulse have also been reported.

Storage

Vials should be refrigerated between 2-8 degrees C away from light. Do not shake or freeze.

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Liver Transplant Drugs
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About Dr. A. S. Soin, Chairman Connect with Us :
Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta
The Medicity, Sector 38, Gurgaon,
Haryana 122001, India.
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