Understanding Your Anti-Rejection Drugs After Transplant

Understanding Your Anti-Rejection Drugs After Transplant

Understanding Your Anti-Rejection Drugs After Transplant

Managing your health after transplant can feel like a full-time job, especially in the beginning. And when it comes to caring for your new kidney, medications play no small part. Taking immunosuppressant (anti-rejection) drugs keeps your transplanted organ protected and healthy.

Whether you recently received a new kidney or are years out from your transplant, it’s always a good idea to take another look at these medications. Tapping the knowledge of two experts, we review the role immunosuppressants play, the different types available, and the best way to manage side effects.

Why Do You Need Immunosuppressant Medications After a Transplant?

Your immune system uses several different pathways to fight foreign invaders such as bacteria and viruses. So when you receive a new kidney, your body views it as a foreign object. Without immunosuppressant drugs, your immune system would attack.

“Our bodies are very smart,” says Giovanna Codispodo, PharmD, Clinical Pharmacy Manager at Weill Cornell Medical Center in New York City. “Our immune cells are designed to recognize and get rid of foreign materials. We essentially have to use medications to trick your body into not recognizing that the transplanted organ is there.”

Anti-rejection drugs achieve this goal by suppressing your immune system. Each drug you take works in its own way to keep your immune response in check. That variation is why you need a combination of medications instead of just one drug.

“Ultimately, the end goal of these medications is to prevent organ rejection,” says Matthew Gillespie, PharmD, Clinical Pharmacist at Cedar Sinai Medical Center in Los Angeles. “They work in synergy to help minimize your risk of rejection.”

As an organ recipient, you’ll take daily immunosuppressant medications for life. But as your body adjusts to the transplanted organ, your care team may decide it’s safe to reduce some of the doses.

Common Anti-Rejection Medications

Most people who’ve received a transplanted organ take two or more anti-rejection medications. The exact regimen varies from person to person, depending on factors such as:

  • Drugs preferred by your transplant center
  • How long it’s been since your transplant
  • Side effects you’re experiencing

Common post-transplant medications include:

  • Tacrolimus (brand names Astagraf, Envarsus® and Prograf®)
  • Mycophenolate (brand names CellCept® and Myfortic®)
  • Prednisone (brand names Rayos® and Sterapred)
  • Cyclosporine (brand names Gengraf®, Neoral® and Sandimmune®)
  • Sirolimus (brand name Rapamune®)
  • Everolimus (brand names Afinitor® and Zortress®)
  • Belatacept (brand name Nulojix®)

Among those medications, Codispodo characterizes tacrolimus and cyclosporine as the current “backbone of transplant medicine,” with tacrolimus the most widely used.

Still, some people don’t tolerate the two medications well. For these patients, doctors can turn to another drug on the list, at least for kidney transplants: Belatacept, the only intravenous (IV) anti-rejection maintenance medication approved by the FDA. Belatacept typically has fewer side effects than tacrolimus or cyclosporine, particularly neurologic and nephrological toxicities.

Another drug to know is prednisone, which is often paired with medications such as tacrolimus or cyclosporine. As such, you’re likely familiar with this steroid.

“Prednisone is a great anti-rejection medicine, though there can be some long-term complications,” Gillespie says. “Still, we find at our center that long-term steroid maintenance at a very low dose seems to be beneficial.”

No matter which medications you’re taking, regular blood tests are part of staying healthy. These tests help your transplant care team understand how well the anti-rejection drugs are working and determine your optimal doses.

Immunosuppressant Side Effects and How to Respond

Many people who’ve received a transplant experience side effects from their anti-rejection drugs. These side effects can range from mild annoyances to complications that interfere with daily life or even affect long-term health.

“All medications come with some side effects,” Codispodo says. “That doesn’t necessarily mean you will experience them. But it’s important to keep an open line of communication with your transplant team if you do.”

Common Side Effect Across Drugs: Higher Risk of Cancer

Suppressing your immune system lowers your body’s ability to destroy unusual cells — cells that could turn cancerous or already have. So post-transplant, it’s even more important to keep up with your regular cancer screenings such as pap smears and colonoscopies. Don’t skip the yearly checkups with a dermatologist — skin cancer is a particular risk.

Side Effects Tied to Particular Drugs

Side effects are often specific to each anti-rejection drug or class of drug and may include:

  • Appetite changes. Steroids may increase your appetite and lead to weight gain, while other immunosuppressants may decrease your appetite. Your care team can connect you with a nutritionist to help with diet, appetite and, if needed, weight gain.
  • Diarrhea or upset stomach. Your care team can recommend changes to your regimen to help with gastrointestinal side effects, or you may be able to try a different medication that doesn’t have these side effects.
  • Hair changes. Steroids can cause hair loss in some people, while cyclosporine can cause hair overgrowth.
  • Headaches.Some immunosuppressants, such as tacrolimus, can cause severe headaches, including migraines. Again, you may be able to avoid this reaction by changing medications.
  • Muscle tremors. Some medications (tacrolimus in particular) can cause involuntary tremors, or shaking in the hands, arms, legs or feet. If it’s interfering with your daily life, your care team may be able to switch you to a different medication.
  • Osteoporosis and bone loss. Long-term use of steroids, such as prednisone, can cause changes in bone health. This decline is less likely with lower doses of steroids, though. Your care team may recommend calcium and vitamin D supplements if you’re at risk for bone loss.

If side effects interfere too much with your life, speak up and let your care team know. “There are a number of options for immunosuppression,” Codispodo says. “As much as we care about making sure you’re on the best regimen, we also care about your quality of life.”

Interactions with Other Drugs

There are many drugs, both prescription and over-the-counter, that can interact with your transplant medications. Herbal supplements and vitamins can pose challenges, too. These reactions can increase or decrease the level of anti-rejection drugs in your system, potentially causing problems.

“There are a number of drug interactions to be aware of,” Codispodo says, naming anti-fungal medications, antibiotics, and some heart rhythm medications as common culprits.

Another important drug to be aware of is Paxlovid, a treatment for COVID-19. If you test positive for COVID-19 and receive a Paxlovid prescription, it’s critical to check with your transplant team before taking it. This drug is challenging to use in transplant patients because of significant interactions with other medications.

In fact, you should speak with your care team before trying anything new, even medicine for colds or diarrhea. It’s a good idea to reach out anyway if you’re feeling sick. It could indicate a side effect of an anti-rejection drug or something else serious.

“If you’re not feeling well, you should call your transplant team,” Codispodo says. “Since you’re immunosuppressed, it might be something that needs further treatment.”

“You’re the expert on your body,” Gillespie adds. “You know what’s normal for you and what’s not. If you’re experiencing something that’s not normal, let your care team know.”

Your Team is Ready to Help

While anti-rejection medications are part of your daily life, it may still feel overwhelming to stay on schedule and navigate potential side effects. You’re not alone on your transplant journey, though. Your care team is always available to answer questions and support you.

For more info about managing your transplant medications, take a look at these frequently asked questions.

The AlloCare® app is a free health tracker designed for people who have received an organ transplant. It can help you manage your medications and track important health metrics. Learn more about the AlloCare app.

This information is not intended or implied to be a substitute for professional medical advice from your healthcare provider. You should always seek the advice of your physician or medical team with any questions you may have regarding your specific medical condition.

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