Swallow capsules whole (without chewing) with a glass of water.Cyclosporine should be taken 12 hrs apart - like 8am and 8pm.When you have to get your cyclosporine level checked, take the morning dose after the sample has been withdrawn (bring your morning dose with you to the lab).
If you are asked for a C2 level, give the blood sample 2 hours after taking the medicine. This level helps to know your immunosuppression status and adjust the dose accordingly, as there is risk of rejection if the level is too low and side-effects if the level is too high. You need to be at a safe level in the middle.
Side effects :
It may cause bone-marrow suppression which causes the hemoglobin level t drop down. A 'missed' dose should be taken at least six hours before the next dose is due. If there is less than six hours before your next dose do not take the 'missed' dose. Never try to make up by doubling the doses. Sirolimus, Everolimus (Rapammune, Certican) Everolimus is a newer drug that helps reduce acute rejection. Its main advantage is that it is not nephrotoxic and is accociated with a lower incidence of CMV (Cytomegalovirus) infection. It acts synergistically with cylosporine to prevent organ rejection and prolong the graft (transplanted kidney) survival. Everolimus and Cyclosporine are to be given at the same time.
- Tremors (shaking of hands)Increased hair growth of your face, arms and legs.
- Increase in BP which may need to be controlled by medicines.
- Upset stomach
- Swelling and tenderness of the gums, made worse by poor dental
- Numbness & tingling in the hands, feet & mouth .
- Hot flushes .
You may not experience any of these, but if you do they usually improve as the dose is gradually reduced.
Once opened, a bottle of cyclosporine remains stable for two months. After this the contents should be thrown away. Capsules should always be kept in the foil packaging and stored at room temperature, not in fridge. Always keep them out of direct sunlight and the reach of children.
is prescribed to prevent or treat organ rejection in people who have received a transplant. It is used for long-term (perhaps lifetime) immunosuppression. The capsules available are of 0.5, 1. and 5 mg.Tacrolimus should be taken 12 hrs apart - like 8am and 8pm.When you have to get your tacrolimus level checked, take the morning dose after the sample has been withdrawn ( bring your morning dose with you to the lab).
This level helps to know your immunosuppression status and adjust the dose accordingly, as there is risk of rejection if the level is too low and side-effects if the level is too high. You need to be at a safe level in the middle.Avoid taking any grapefruit products (including juice) at the same time of day as this medicine, as it can alter the amount of drug absorbed.
Prednisolone (Wysolone) :
Prednisone is a corticosteroid that helps prevent and treat rejection of transplanted organs. It may be used for long-term (perhaps lifetime). Tacrolimus (Pangraf/Prograf) 9immunosuppression or, in higher doses, for treatment of rejection. They should be taken with meals or just after meals , as they cause gastric irritation. It should be taken as a single dose in the morning, before 11am.
Common side effects of prednisolone are :
- Stomach irritation occasionally leading to ulcer. To prevent this are given .
- Weight gain caused by increase in your appetite. You should eat wisely and maintain a steady weight.
- Your face may become more rounded.
- Skin changes like acne, thinning of skin, easy bruising.
- An increase in blood sugar
- Eye problems - If your eye become sore or you have problems with your vision let your doctor know.
- The above side effects improve when the dose is reduced.
YOU MUST NOT ALTER THE DOSE OFPREDNISOLONE YOURSELF
Mycophenolate Mofetil (CellCept) :
Fights rejection by decreasing the number of white blood cells the immune system produces. The most frequent side effect seen is stomach upset ( eg. Diarhoea and vomiting) or effects relating to a reduced ability by the body to fight infections. It is given either in form of capsules or syrup.
Azathioprine (Imuran, Azoran) :
Azathioprine (Imuran, Azoran) :Azathioprine is given with other immunosuppressants to help prevent rejection of the new kidney. It may be used for long-term (perhaps lifetime) immunosuppression. It should be taken after a meal to reduce the chance of stomach upset. It may cause an increase in your liver function tests .
antacids Weakening of bones (osteoporosis/osteoporosis). Calciumsupplements are prescribed to prevent this.10IL-2 Inhibtors (Zenapax, Simulect)Simulect and Zenapaz are two IL-2 inhibitors that has been shown to reduce the incidence of acute rejection in the first six months. They are expensive and you should discuss with you doctor whether you should be on this induction therapy or not.
Some of the following drugs will be included in your prescription:
Anti ulcer drugs : Ranitidine (Rantac), 'Digene' Some of immunosuppressants prescribed can lead to irritation of the stomach, and in a small proportion of patients ulcer formation (hence Prednisolone and Azathioprine are taken after food).
Amlodepin, Atenolol, Minipress- XL (Prazosin), Arkamine (Clonidine), Betaloc Some patients will need to take medicines to lower the blood pressure which may be caused by the medications. Calcium supplements : Shelcal, alpha D-3, cholecalciferol granules.Calcium may be given to trengthen your bone which weakens gradually due to long term steroid (prednisolone) intake. A drugelandronate (Osterophos) may be prescribed if obsteopenia or osteoporosis is diagnosed.Antibiotics, antifungals, antivirals. As the immunosuppressive drugs increase the risk of infections, you may be prescribed antibiotics, antifungals or antivirals accordingly.
In general, the strict diet limitation patients may face pre-transplant do not apply post-transplant. Following transplantation, patients should limit the amount of fat and cholesterol in their diet because anti-rejection medications and the liberalized diet can cause elevated cholesterol and fat levels. Patients also need to be careful of weight gain that may occur from anti-rejection medications( prednisolone) which causes dramatic increase in appetite.