MEDICATION

Overview

After the transplant you will take a lot of different medicine. Some of these medicines you will take for a short time and others you will take for the rest of your life. Your transplant success depends on you taking your medicines. It will be important to understand how they work and what side effects to expect.

In order for your body to accept your new organ, it must be suppressed with medicines called immunosuppressants. These medicines work by slowing down your body's immune system. If the body is not suppressed enough, it may try to reject the new organ. You may still experience a rejection and your doctor may change the amount of medicine or prescribe additional medicines to help prevent rejection. Additional medicines such as antibiotics or anti-ulcer drugs may also be used to treat infections or digestive problems that may occur because of immunosuppression. After a transplant, infections due to bacteria or viruses are of great concern, because the medication you will be taking to prevent rejection will increase your risk for infection. Therefore, it is important to prevent and treat any type of infection such as a cold, flu, sore throat, or open cut. If you believe that you have any infection or were exposed to someone with a contagious infection, notify your transplant center immediately.

Some medications may cause unwanted side effects and it is important that you ask questions and talk freely with your transplant coordinator about your medications and the effect they have on the way you feel.

Talk to you doctor, pharmacist, transplant nurse, and/or coordinator to understand fully:
• the name and purpose of each drug
• when to take them
• how to take them
• how long to continue taking them
• principal side effects of each drug
• what to do if you forget to take a dose
• when to order more medication so it doesn't run out
• how to order or get hold of your medicines
• what to avoid while taking medication

ANTI-REJECTION MEDICATION

Neoral (cyclosporine capsules for microemulsion)

Neoral is used to prevent organ rejection. Adverse effects may include: abnormal kidney function, high blood pressure, excessive hair growth, tremor, swelling or overgrowth of the gums, headaches and trouble sleeping.

Click here for further side-effect information

Does Neoral / Sandimmune have side effects?

Most people who are prescribed NEORAL benefit from it. Like all medicines though, it can cause unwanted side-effects in some people.

Once the ideal dose of NEORAL has been established, the number of side-effects with NEORAL is generally similar to that reported with SANDIMMUN Oral Solution and Soft Gelatin Capsules.

The dose of this medicine needs to be carefully adjusted by your doctor. Too much can affect the kidneys. You will, therefore, have regular blood tests and visits to the hospital, particularly after transplantation. Your blood pressure will also be measured regularly. These visits will give you the chance to talk to your doctor about your treatment and mention any problems you are having.

If you develop a sore throat, any infections or begin to feel generally unwell see your doctor immediately.

NEORAL may reduce the amount of magnesium in the body. Your doctor may, therefore, give you magnesium supplements to take, especially just after your operation if you have had a transplant.

Very common side-effects, reported in more than 1 in 10 people include:

Kidney problems, high blood pressure, headache, tremor and increased levels of lipids (for example cholesterol) in the blood.

Common side-effects, reported in between 1 in 10 and 1 in 100 people include:

Numbness or tingling, loss of appetite, feeling or being sick, stomach pain, diarrhoea, swollen gums, liver problems, high level of uric acid or potassium in the blood, low levels of magnesium in the blood, muscle pain or cramp, increased hair growth on the body and tiredness.

Uncommon side-effects, reported in between 1 in 100 and 1 in 1000 people include:

Seizures, confusion, disorientation, decreased responsiveness, agitation, sleeplessness, visual disturbances, blindness, coma, partial paralysis, loss of co-ordination, changes in blood (for example anaemia), allergic rash, water retention which may cause swelling, weight increase.

Rare side-effects, reported in between 1 in 1000 and 1 in 10000 people include:

Problems with the nerves that control muscles, inflammation of the pancreas, high levels of glucose in the blood, muscle weakness, wasting of muscles, destruction of red blood cells which may be associated with kidney problems, changes in the menstrual cycle in women and slight swelling of breast tissue in men and women.

Very rare side-effects, reported in less than 1 in 10000 people include:

Swelling at the back of the eye which may be associated with an increase in pressure inside the head (benign intracranial hypertension).

Like other medicines that dampen down the immune system, cyclosporin may cause tumours or other malignancies, particularly of the skin.

Tell your doctor or pharmacist if you suffer from any of these effects, or from any other side-effects not mentioned in this leaflet.

Sandimmune (cyclosporine capsules)

Sandimmune is used to prevent organ rejection. Adverse effects may include: high blood pressure, headaches, tremor, abnormal kidney function, excessive hair growth, trouble sleeping and swelling or overgrowth of the gums.

Click here for further side-effect information

Does Neoral / Sandimmune have side effects?

Most people who are prescribed NEORAL benefit from it. Like all medicines though, it can cause unwanted side-effects in some people.

Once the ideal dose of NEORAL has been established, the number of side-effects with NEORAL is generally similar to that reported with SANDIMMUN Oral Solution and Soft Gelatin Capsules.

The dose of this medicine needs to be carefully adjusted by your doctor. Too much can affect the kidneys. You will, therefore, have regular blood tests and visits to the hospital, particularly after transplantation. Your blood pressure will also be measured regularly. These visits will give you the chance to talk to your doctor about your treatment and mention any problems you are having.

If you develop a sore throat, any infections or begin to feel generally unwell see your doctor immediately.

NEORAL may reduce the amount of magnesium in the body. Your doctor may, therefore, give you magnesium supplements to take, especially just after your operation if you have had a transplant.

Very common side-effects, reported in more than 1 in 10 people include:

Kidney problems, high blood pressure, headache, tremor and increased levels of lipids (for example cholesterol) in the blood.

Common side-effects, reported in between 1 in 10 and 1 in 100 people include:

Numbness or tingling, loss of appetite, feeling or being sick, stomach pain, diarrhoea, swollen gums, liver problems, high level of uric acid or potassium in the blood, low levels of magnesium in the blood, muscle pain or cramp, increased hair growth on the body and tiredness.

Uncommon side-effects, reported in between 1 in 100 and 1 in 1000 people include:

Seizures, confusion, disorientation, decreased responsiveness, agitation, sleeplessness, visual disturbances, blindness, coma, partial paralysis, loss of co-ordination, changes in blood (for example anaemia), allergic rash, water retention which may cause swelling, weight increase.

Rare side-effects, reported in between 1 in 1000 and 1 in 10000 people include:

Problems with the nerves that control muscles, inflammation of the pancreas, high levels of glucose in the blood, muscle weakness, wasting of muscles, destruction of red blood cells which may be associated with kidney problems, changes in the menstrual cycle in women and slight swelling of breast tissue in men and women.

Very rare side-effects, reported in less than 1 in 10000 people include:

Swelling at the back of the eye which may be associated with an increase in pressure inside the head (benign intracranial hypertension).

Like other medicines that dampen down the immune system, cyclosporin may cause tumours or other malignancies, particularly of the skin.

Tell your doctor or pharmacist if you suffer from any of these effects, or from any other side-effects not mentioned in this leaflet.

Prograf (tacrolimus capsules)

Prograf is used to prevent organ rejection. Adverse effects may include: headache, nausea, diarrhoea, persistent high blood sugar, tremor, hair loss, trouble sleeping, numbness and tingling of hands or feet, and abnormal kidney function.

Click here for further side-effect information

Do Prograf tablets have side effects?

In common with many other medicines, PROGRAF ® may cause some unwanted effects. You will have regular blood tests and visits to the hospital particularly in the first few months after your operation. At these visits, you will be able to speak to the doctor and mention any problems you may be having including any not listed below.

Very common unwanted side effects include kidney problems, tremor, high blood pressure, changes to the blood salts, increased risk for infections, diarrhoea, sickness and/or vomiting, belly-ache, constipation or other stomach and bowel upsets, headache, diabetes mellitus or other blood sugar changes, insomnia, localised pain, changes to the blood cell counts.

Side effects which have occurred commonly include increase in liver test values, skin sensation disorders e.g. tingling, fever, weakness, swelling of the lower limbs, laboured breathing, eye problems e.g. blurred vision, changes in body weight and appetite, anaemia, kidney failure, changes to the blood lipid or uric acid values or other changes to the blood components, itchiness, hair loss, rash, bleeding, confusion, dizziness, depression or other nervous system problems, rapid or irregular heart beats or other heart problems, yellowing of the skin, low blood pressure, blocked blood vessels or other vascular diseases, muscle cramps, bile duct abnormalities, sweating, sensitivity to light, agitation, convulsion, psychosis, loss of co-ordination, anxiety, nervousness, abnormal dreams, impaired consciousness, emotional lability, excess of body fluid or dehydration, problems in urination, acne, angina, hallucinations, hearing problems, degenerative brain disease.

Side effects which have occurred uncommonly include heart failure or cardiac arrest, infarction, shock, pancreatitis, paralysis, coma, deafness, liver damage, increased muscle stiffness, accumulation of abdominal fluid, joint disorders, loss of memory, speech disorders, bowel obstruction, asthma, abnormal hairiness, disorders of the female genitals.

Side effects which have occurred rarely include liver failure and severe lesions of the skin and mucous membranes.

The following very rare case had been reported: blindness.

Although the above effects have been reported in patients taking PROGRAF ® , they may in fact be related to treatment with some of the other medicines that were given.

Severe effects have been reported, including allergic reactions.

Benign as well as malignant tumours have sometimes been reported in
users of immunosuppressive therapy.

If you feel unwell or are troubled by any unwanted effects at any time, please inform your doctor.

Prednisolone

Prednisolone, a steroid medication, helps to prevent and treat organ rejection. Adverse effects may include: fluid and salt retention, muscle weakness, high cholesterol levels, elevated blood sugar, bone disease, stomach ulcers, difficulty with wound healing, acne, mood swings, anxiety, cataracts, glaucoma, weight gain, and slow growth in children.

Click here for further side-effect information

Do Prednisilone tablets have side effects?

Like all medicines, Prednisolone tablets may occasionally cause you some problems. It affects different people in different ways.

Your medicine may cause you to suffer from stomach or bowel trouble such as a feeling of fullness/being bloated or maybe some pain. If you notice any blood in your stools or vomit you should see your doctor. Sometimes the throat may become very sore. You may find that inside your mouth develops white areas on its surface, if this happens, you should see your doctor.

You may find that your appetite increases and that you gain some weight, perhaps around your face. Alternatively, you may find that you lose weight or feel weak. Osteoporosis may occur and sometimes it can become easier to fracture your bones and for your tendons to tear.

Women taking this medicine may find that their periods become irregular or stop altogether. Your hair may grow faster and thicker than before you started this medicine. It has also been noted that some people develop signs of diabetes, for example increased thirst and frequency of going to the toilet. If you are already diabetic, you may find that you need to take more medication to balance the effect of Prednisolone tablets. You should discuss this with your doctor. You may find that your blood pressure goes up and that you retain water. It could also be more likely that clots will form in your blood.

If you suffer from epilepsy, your doctor may wish to alter your dose of medication whilst you are taking Prednisolone tablets. This is because the symptoms of your epilepsy may become more prominent.

You may develop skin problems such as acne or find that any wounds or cuts do not heal as quickly as they did before you started your medicine. You may also find that your skin becomes flushed red and thinner than before and that stretch marks may appear.

You may notice that your moods change so that you feel either very happy or very depressed. You could also find it more difficult to fall asleep a night. These tablets affect people in many different ways.

If you find that your eyes are hurting, have any change in vision or that you have a bad headache, especially behind your eyes, you should check with your doctor. This may continue, or start to happen after you have been told to stop taking this medicine.

Prednisolone tablets can lower your resistance to infections. This means that patients sometimes find that they catch a cold or symptoms of a previous infection such as tuberculosis (TB), occur more easily than they did before they started to take this medicine. This is especially important to remember regarding chicken pox infections.

If you have an operation whilst taking Prednisolone tablets then you may experience side effects such as muscle tiredness and weakness. This is because muscle relaxant drugs sometimes used in surgery and Prednisolone tablets can affect each other's action.

If you have any other problems and think that your medicine may be causing them, tell your doctor or pharmacist.

Imuran (azathioprine)

Imuran is given in combination with other immunosuppressant medications to help prevent organ rejection. Adverse effects may include: nausea, vomiting, and increased risk of infection.

Click here for further side-effect information

Do Imuran tablets have side effects?

A few people may be allergic to Imuran.

Tell your doctor immediately if you develop any of the following symptoms:

Feeling sick and/or being sick
Diarrhoea
Fever, shivering/chill and skin rash
Muscle and bone pain
Kidney problems (symptoms may include changes in the amount of urine passed and changes
in the colour of the urine)
Tiredness, dizziness

Tell your doctor immediately if any of the following happen to you while you are taking Imuran:

• You start to notice any signs of a fever or an infection
• You have any unexpected bruising or bleeding
• You develop bad diarrhoea and/or abdominal pain
• You develop jaundice (skin or whites of the eyes turn yellow)
• You develop a chest infection (pneumonitis)

You may notice some hair loss while taking Imuran. Often hair does grow again, even if you carry on taking Imuran. If you are worried ask your doctor.
Tell your pharmacist or doctor if you notice any other side-effects from your medicine which are not mentioned here.

CellCept (mycophenolate mofetil)

CellCept is given in combination with other immunosuppressant medications to prevent or treat organ rejection. Adverse effects may include: reduced white blood cell and/or platelets, nausea, vomiting, and diarrhoea.

Click here for further side-effect information

Do CellCept tablets have side effects?

Like all medicines, CellCept can have side effects, even when used as directed. Some of the more usual problems are diarrhoea, fewer white cells and/or red cells in your blood, infection and vomiting. Your doctor will do regular blood tests to monitor any changes in the number of your blood cells or changes in the levels of any of the substances carried in your blood, e.g. sugar, fat, cholesterol.

Children may be more likely than adults to have side effects such as diarrhoea, infections, fewer white cells and fewer red cells in the blood.

CellCept reduces your body's own defence mechanisms to stop you rejecting your transplanted kidney, heart or liver. Consequently your body will not be as good as normal at fighting infections. So if you are taking CellCept you may therefore catch more infections than usual, such as infections of the skin, mouth, stomach and intestines, lungs and urinary tract. As can happen in patients taking this type of medicine, a very small number of CellCept patients have developed cancer of the lymphoid tissues and skin.

General unwanted effects affecting your body as a whole could include fever, lethargy, difficulty in sleeping, pains (such as abdominal, chest, joint/muscle, pain on passing urine), headache, flu symptoms and swelling.

Other unwanted effects may include:
Disorders of the skin such as acne, cold sores, shingles, skin growth, hair loss, rash, itching.

Urinary disorders such as kidney problems or the urgent need to pass urine.

Disorders of the digestive system and mouth such as constipation, nausea, indigestion, pancreas inflammation, intestinal disorders including bleeding, inflammation of the stomach, liver problems, inflammation of the colon, loss of appetite, flatulence and mouth ulcers.

Disorders of the nerves and senses such as convulsions, tremor, dizziness, depression, drowsiness, numbness, muscle spasms, anxiety, changes in thinking or mood.

Metabolic, blood and vascular disorders such as weight loss, gout, high blood sugar, bleeding, clots and bruises, change in blood pressure, abnormal heart beat and dilation of blood vessels may be seen.

Disorders of the lungs such as pneumonia, bronchitis, shortness of breath, cough, fluid on the lungs/chest cavity, sinus problems.

If you do have any side effects, or if you notice any other problems not mentioned in this leaflet whilst you are taking CellCept, please inform your doctor or pharmacist. However, do not stop taking your medicine unless you have discussed this with your doctor first.

Rapamune (sirolimus)

Rapamune is given in combination with other immunosuppressant medications to prevent organ rejection. Adverse effects may include: high cholesterol, high blood pressure, rash, anaemia, joint pain, diarrhoea, low potassium levels, decreased blood platelets, and acne.

Click here for further side-effect information

Do Rapamune tablets have side effects?

Like all medicines, Rapamune can have side effects. However, since Rapamune is taken in combination with other medicines, the side effects cannot always be attributed with absolute certainty to Rapamune.

Possible side effects are listed according to the following categories:
Very common: greater than 10 %
Common: between 1% and 10%
Uncommon: between 0.1% and 1%

Body as a whole:
Very common: Fluid collection around the kidney, swelling of the extremities
Common: Abnormal healing (this may include separation of the layers of a surgical wound or suture line), swelling, fever, infections (including blood poisoning)

Cardiac disorders:
Common: Rapid heart rate

Gastrointestinal reactions:
Very common: Abdominal pain, diarrhoea
Common: Mouth sores
Uncommon: Inflammation of the pancreas

Blood and lymph disorders:
Very common: Low red blood cells, low blood platelets
Common: Kidney damage with low blood platelets and low red blood cell counts, with or without rash (thrombocytopenic purpura/haemolytic uremia syndrome)
Uncommon: Cancer of the lymph tissue (lymphoma/post-transplant lympho-proliferative disorder).
Combined lowering of red blood cells, white blood cells and blood platelets

Metabolism and nutrition disorders:
Very common: Elevated cholesterol, elevated fat in the blood, low blood potassium, elevated lactate dehydrogenase protein in the blood
Common: Abnormal tests of liver function, elevated SGOT and/or SGPT liver enzymes

Bone and joint disorders:
Very common: Joint pain
Common: Deterioration of bone

Respiratory tract disorders:
Common: Nose bleeds, pneumonia and other inflammations of the lung

Skin disorders:
Very common: Acne
Common: Rash

Kidney disorders:
Very common: Urinary tract infection
Common: Kidney infection

The above side effects may require medical intervention and some may be life-threatening or fatal. If you are concerned about any side effect or if you notice any other effects not mentioned in this leaflet, please inform your doctor or pharmacist.

Zenapax (daclizumab)

Zenapax is an intravenous immunosuppressant given with other medications to prevent organ rejection. Adverse effects may include: constipation, nausea, diarrhoea, vomiting, abdominal pain, heartburn, and gastrointestinal problems.

Click here for further side-effect information

Do Zenapax tablets have side effects?

Like all medicines, Zenapax can have side effects.

The most commonly observed undesirable effects during treatment with Zenapax are gastrointestinal disorders and infections. Symptoms may include constipation, nausea, vomiting, diarrhoea, and abdominal pain.

If you notice any side effects not mentioned in this leaflet, please inform your doctor or pharmacist.

Zenapax should not be given to you:

If you are hypersensitive (allergic) to daclizumab or any of the other ingredients.
If you are pregnant or breast-feeding.
Please read the section below on pregnancy and breast-feeding.

Take special care with Zenapax:

if you have ever had an allergic reaction to other immunosuppressive medicines which help to suppress the body's natural defence mechanism.
if you are taking other medicines, including those you have obtained without a prescription.

Therapy with medicines which help to stop the body's natural defence mechanism can increase the risk for developing malignancies or infections. However, Zenapax does not increase such a risk when given in addition to your other immunosuppressive drugs.

Serious allergic reactions may occur following the administration of proteins. Allergic reactions following the infusion of Zenapax have been reported rarely. In the event that you do develop an allergic reaction, your doctor will treat you with appropriate medication.

Simulect (basiliximab)

Simulect is an intravenous immunosuppressant used with other medications to prevent organ rejection. Adverse effects may include: chest pain, fatigue, infection, high blood pressure, flatulence, irregular heart rhythm, anxiety, depression, rash, and cataracts.

Click here for further side-effect information

· Neoral
· Prograf
· Prednisilone
· Imuran
· CellCept
· Rapamune
· Zenapax
· Simulect

Do Simulect tablets have side effects?

Like all medicines, Simulect can have side effects.

Tell your doctor or nurse as soon as possible if you get any unexpected symptoms while you are being given Simulect, or during the 8 weeks afterwards, even if you do not think that they are connected with the medicine.

You will probably be taking several other medicines as well as Simulect. You may get side effects from these or feel unwell after your transplant.

In adults, the most commonly reported side effects were constipation, nausea, diarrhoea, weight ncrease, headache, pain, swelling of hands, ankles or feet, high blood pressure, anaemia, changes in blood chemistry (e.g. potassium, cholesterol, phosphate, creatinine), surgical wound complications and different kinds of infections.

In children, the most commonly reported side effects were constipation, excessive growth of normal hair,
runny or blocked nose, fever, high blood pressure and different kinds of infections.
Sudden severe allergic reactions have been reported in patients treated with Simulect. If you notice sudden signs of allergy such as rash, itching or hives on the skin, swelling of the face, lips, tongue or other parts of the body, fast heart beat, dizziness, light headedness, shortness of breath, wheezing or trouble breathing, tell your doctor or nurse immediately.

ANTI-INFECTIVE MEDICATION

Septrin, (trimethoprim/sulfamethoxazole)

Is an antibiotic that prevents and treats bacterial infections such as pneumonia and urinary tract infections, for which you may be at greater risk because your immune system has been slowed down. Major side effects include: nausea, vomiting, rash, itching, and loss of appetite.

Cymevene (ganciclovir)

Cymevene is an antiviral medication that may prevent or treat cytomegalovirus (CMV) infection and disease in organ transplant recipients. Adverse effects may include: weakened immune system, anaemia, and decreased blood platelets.

Zovirax® (acyclovir)

Zovirax is an antiviral medication that may be used to prevent or treat Herpes simplex infections in transplant patients. Adverse effects may include: skin rashes, headaches, nausea, vomiting, and diarrhoea.

Nystatin and Clotrimazole

Nystatin and clotrimazole are used to prevent thrush, a (oral) fungal infection. Adverse effects include: lost sense of taste and decreased appetite, nausea, vomiting, diarrhoea, and stomach pain.

Diflucan (Fluconazole)

Diflucan is also an anti-fungal medication that is used to prevent thrush. Adverse effects include: dizziness, headache, and nausea.

ANTI-ULCER MEDICATION

Zantac (ranitidine), Axid (nizatidine), Pepcid (famotidine)

Zantac, Axid, and Pepcid protect your digestive system from the effects of corticosteroids. Major adverse effects include: headache, nausea, vomiting, diarrhoea, constipation, and flatulence.

Losec (omeprazole), Zoton (Lansoprazole)

Losec and Zoton also protect your digestive system from the effects of corticosteroids. Major adverse effects include: headache, dizziness, abdominal pain, diarrhoea, nausea, and vomiting.

Kidney Side Effects

Living with the side effects of medication

For as long as you have a transplanted organ, you will have to take immunosuppressive medication to prevent rejection.

These drugs are associated with a range of side effects including:
• Weight gain
• Hair loss
• Hair growth
• Dry skin
• Acne
• Bleeding gums
• Skin cancer

Many of these may be considered ‘cosmetic’, but can be very distressing for you. There are several ways in which you can reduce the impact of any of these side effects, but the most important is to discuss them with your transplant team.

A change in medication or dosage might be all that is required! Your transplant team will also be able to provide advice and tips on managing the side effects, including help with diet and exercise programmes.