Medications

How are my tablets going to change? 

Your medication will change after your transplant with some tablets, such as phosphate binders and vitamin supplements, stopping and new tablets starting. We will give you a list of your new medication before you leave the hospital. 

The most important new tablets you will be started on are called immunosuppressants. These tablets stop your immune system from rejecting the kidney and should be taken regularly every day you have a functioning transplant. Because these medications reduce your own natural immune system, you will also be given medication to prevent you getting some serious infections. 

What immunosuppressants will I take?

Initially you are likely to be on a combination of three medicines: 

• Tacrolimus
• Mycophenolate Mofetil 
• Prednisolone 

If you do not take these medications as prescribed, it will result in rejection and the loss of your new kidney. 

These drugs need to be finely tuned as too little may lead to rejection and too much may lead to infection. Early after the transplant the need for immunosuppression is high but this need lessens with time, so the drugs will be slowly reduced by your doctors. The level of these drugs have to be monitored in the blood. When you come to clinic, do not take your tablets until after you have had your blood taken. After the clinic, you may be telephoned to change the dose of the tablets you are taking or asked to return for further blood tests. 

What are the possible side effects? 

Immunosuppressants, like most medicines, can have some unwanted side effects. However, just because a medicine has the potential to cause adverse effects, it does not necessarily mean you will get them. All antirejection drugs will increase your risk of infection and some cancers. 

The individual immunosuppressives may have their own side effects as follows: 

Tacrolimus

Shaking of the hands, headaches, impaired vision, ‘pins and needles’, raised blood sugar levels (diabetes), hair loss and kidney damage at high levels of Tacrolimus in the blood. 

Ciclosporin

High blood pressure, increased or unusual hair growth, tender or swollen gums, shaking of the hands, raised blood sugar levels (diabetes) and kidney damage at high levels of Ciclosporin in the blood. 

Prednisolone

Irritation of the gut lining, indigestion, increase in appetite, weight gain, rounded face, thinning skin and bones and raised blood sugar levels (diabetes). 

Azathioprine

Side effects are unusual but can cause an upset in liver function and white blood cells in the blood. Mycophenolate Mofetil - diarrhoea, bloating, heartburn, nausea and vomiting. Inform the doctors if you experience side effects - they may want to cut down the dose or give you an alternative. Do not stop or alter the dose yourself. 

What other medications do I have to take? 

You may be asked to take the following: 

• Co-trimoxazole - an antibiotic to reduce the risk of bacterial infection 
• Omeprazole - to protect the stomach against ulcers and heartburn 
• Nystatin mouth wash - to prevent fungal infections of the mouth 
• Heparin - for the first week after transplant heparin may be given to prevent blood clots.

Can I take any other medicines? 

Some of these medicines are affected by, and do themselves, affect other medicines. Please discuss your current medication with the pharmacist if you need to buy ‘over the counter’ medicines for minor ailments. Your GP may wish to contact the transplant unit/renal ward before giving you any new prescription medicines. 

If you have any concerns about any aspect of your medicines, please do not hesitate to ask. If you are taking either ciclosporin or tacrolimus the following drugs may interact. Your renal/transplant doctor should be informed before these drugs are used. 

For example: 

• Erythromycin
• St. Johns Wort
• Clarithromycin 
• Herbal medicines 
• Fluconazole 
• Grapefruit juice 
• Ketoconazole 

Many other drugs also interact. If you or your doctor are unsure, please discuss with your renal/transplant doctor. 

Herbal medicines 

It is suggested that you do not take any herbal medicines (in particular St. Johns Wort should not be used) without first checking with your renal/transplant doctor.

Grapefruit juice 

Grapefruit juice taken with cyclosporin or tacrolimus can alter the levels of these drugs in your blood. It is probably best to avoid grapefruit juice but apple or orange juice is OK. For further advice speak to your renal/transplant doctor.