Organ Transplantation Center

Drug Therapy for Organ Recipients

Organ transplantation is an essential treatment method that saves lives of patients with end-stage heart, kidney, liver, and lung diseases. In Korea, ever since its first kidney, liver, and heart transplants were successfully performed in 1969, 1988, and 1992, respectively, grafting of the kidney, liver, pancreas, small bowel, and lungs has been widely carried out. After transplantation, immunosuppressants are necessary for life and the long-term success in transplantation depends on an appropriate use of the medications. This page is to give detailed information about post-transplant medications and help recipients follow the regimen strictly and prevent any rejection reaction and adverse effects.
Post-transplant medications can be largely divided into immunosuppressants and drugs against complications. The following introduces immunosuppressants, drugs against complications, and daily dos and don’ts.

Immunosuppressants

Purpose

1. The human body has an immune system to protect itself and this system considers a new graft a foreign substance and attacks it, inducing rejection reactions.
2. Immunosuppressants protect a graft from immune cells by inhibiting T lymphocytes and weakening immune reactions.
   This type of medications is indispensible for prevention of rejection reactions and should be taken for life.

Importance of Dose Adjustment

1. If immunosuppressants are overly effective, the risk of infections grows, while otherwise, that of rejection reactions increases.
   Therefore, taking an appropriate dose is very important.
2. The dose is set based on the drugs’ blood level and the patient’s conditions.

Type

Cyclosporine

Brand Name	Cipol-N		Sandimmun Neoral
Manufacturer	Chong Kun Dang		Novartis Korea
Content	25mg	100mg	25mg	100mg
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Instruction	Once every 12 hours and twice a day after meal or on an empty stomach (at a regular time)

Tacrolimus (FK506)

Brand Name	Prograf		Tacrobell
Manufacturer	Astellas Pharma Korea		Chong Kun Dang
Content	0.5mg	1mg	0.25mg	0.5mg	1mg
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Instruction	Once every 12 hours and twice a day on an empty stomach

Sirolimus

Brand Name	Rapamune
Manufacturer	Wyeth Korea
Content	1mg
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Instruction	Once a day on an empty stomach or after meal (at a regular time)/If cyclosporine is concomitantly taken, use it 4 hours after cyclosporine.

Metabolic antagonists

Brand Name	Mycophenolate mofetil	Mycophenoleic acid		Azathioprine
Well-know Brand Name	Cellcept	Myfortic		Imuran
Manufacturer	Roche Korea	Novartis Korea		Samil
Content	250mg	180mg	360mg	50mg
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Instruction	Twice a day on an empty stomach (Cellcept, 250mg = Myfortic, 180mg)			Take it at a regular time everyday.

Steroid

Brand Name	Prednisolone (PD)	Methylprednisolone (MPD)	Deflazacort
Well-know Brand Name	Nisolone	Methylon	Calcort
Content	5mg	4mg	6mg
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Instruction	Twice a day after breakfast and dinner/In the case of once per day, after breakfast.

What to Keep in Mind

1. As rejection reactions are the strongest during the first three to six months, two to three kinds with different mechanisms are used together in this period. Usually, steroid is concomitantly taken with cyclosporine or tacrolimus and with azathioprine or Cellcept.
2. To minimize exposure to drug toxicity, the dose and the number of the drugs are gradually reduced from 6 to 12 months later. If the patient is on steroid, the dosage is phased down after the first administration.
3. The patient should make sure to remember the generic, brand name, and shape of the drugs he or she is on.
4. If on different doses, the recipient should be able to distinguish dosages by pill shape.

Directions

1. Check the dose of the drugs and take them always at a set time.
2. Do not change the dose or stop the administration without your doctor’s permission.
3. The dose of steroid is gradually reduced. If you use steroid once a day, take it before 9 a.m. after meal to reduce damage to the GI track.

When You Missed a Dose

If you missed a dose, take one dose immediately. If the time for the next dose is close, wait until the next one and make sure to use the drugs at a scheduled time. Never take two doses at once.

Possible Adverse Effects

The following is the most common adverse effects. Please contact your doctor immediately when you experience one of them:
a. Cyclosporine: Nephrotoxicity, hypertension, hyperlipidemia, hypertrichosis, gingival hypertrophy, hepatotoxicity, hyperuricemia, etc.
b. Tacrolimus: Nephrotoxicity, neurotoxicity, hyperglycemia, hypertension, hyperpotassemia, hypomagnesemia, etc.
c. Sirolimus: Hyperlipidemia, leukopenia, thrombocytopenia, nephrotoxicity, etc.
d. Mycophenolate: Gastrointestinal toxicity (e.g. diarrhea, nausea, abdominal pain), leukopenia, etc.
e. Azathioprine: Leukopenia, thrombocytopenia, gastrointestinal toxicity (e.g. nausea and vomiting), hepatotoxicity, etc.
f. Steroid: Weight gain, osteoporosis, hyperglycemia, swelling, acne, gastrointestinal disorders, physique changes, etc.

Cautions (Drug and Food Interactions)

1. If you are pregnant, breastfeeding, or experiencing some diseases, make sure to let your doctor know.
2. As immunosuppressants may interact with other drugs, inform your doctor of the drugs (including vitamin supplements, herbal medicines, and any other health supplements) you are on.
3. Vaccination during the use of immunosuppressants may weaken vaccines’ effect or cause some health issues. So, please consult your doctor before vaccination.
4. An intake of grapefruit or its juice with cyclosporine, tacrolimus, or sirolimus may raise the blood level. Therefore, do not take them with grapefruit.

Storage

1. Avoid direct sunlight or heat. Keep the drugs at a room temperature away from children.
2. Take the pill out of the packaging only right before the intake.