Your Meds

As explained on the last page, you must take drugs to minimize organ rejection. Every heart recipient is expected to have at least 2 episodes of rejection. Hopefully, they will be mild enough that you can be treated as an outpatient by juggling meds. If your symptoms are severe acute rejection you will be hospitalized and IV drugs used. If that fails, you may need to be placed back on the waiting list for another heart.
     Noncompliance is the third most common reason for transplant failure! You must take your meds exactly as prescribed exactly on time if you want to live and live well! If you forget to take a dose and then remember that you didn't take it, call your transplant coordinator immediately. If you vomit a dose up or have diarrhea, call your transplant coordinator. Don't just decide on your own to skip a dose, change a dose, or repeat a dose - very bad idea.
     You will need regular blood tests to check your blood level of certain drugs. Those tests are explained on each individual drug page (see below). First, here are some general do's and don'ts concerning your transplant meds:

Do's

• Memorize your meds by name and look, and know why take you each one
• Take meds exactly as prescribed, on time, in the proper dose
• Report all side effects to your transplant team - all side effects
• Keep these meds very much out of reach of children and pets
• Keep all your meds in their original containers with the original labels

Don'ts

• If you miss a dose, do not double the next dose. Take your next dose as directed and call your transplant team contact about missing one
• Do not keep meds in your bathroom, not even in the medicine cabinet there. They will be affected by the moisture and humidity
• Do not take any over the counter medications or prescription drugs unless first approved by your transplant cardiologist
• Do not take any drugs from the Erythrocin family such as Erye or E-Mycin. They interfere with cyclopsorine absorption

Transplant Meds and Side Effects

You will not take all these meds. You may not even hear some of them mentioned. Due to the importance of these meds to your life after transplant, I am devoting quite a bit of space to the more common drugs that can be taken orally. Click on the drug name to go to the page describing it in detail. 

• Cyclosporin (CSA, Neoral, Sandimmune, SangCya)
• Prednisone (Medrol)
• Tacrolimus (FK 506, Prograf)
• Cell-Cept (MMF, mycophenolate mofetil)
• Azathioprine (AZA, Imuran)
• Rapamune (rapamycin, sirolimus) - FDA approved 8/25/2000 for kidney transplant
• Cyclophosphamide - an anti-cancer drug ocassionally used as an immunosuppressant
• Monoclonal and Polyclonal Antibodies - used as "rescue" drugs for acute rejection episodes - IV only
  • Muromonab-CD3 (Orthoclone, OKT3): monoclonal antibody derived from mice. Drug insert in PDF form here
  • ALG (antilymphocyte globulin)
  • ATG (Atgam): antithymocyte globulin from horses immunized with human thymocytes - very potent and also used as induction therapy. Drug insert in PDF form here
  • Thymoglobulin: antithymocyte from rabbits - very potent
  • Daclizumab (Zenapax): modified human IgG1 monoclonal antibody - 90% human and 10% mouse/rat gene sequences
  • Basiliximab (Simulect): chimeric monoclonal antibody obtained from mouse myeloma cells
• Experimental drugs
  • FTY720 by Novartis
  • ISA(TX)247 by Roche/Isotechnika
  • Everolimus (SDZ RAD, Certican) by Novartis: similar to Rapamune
  • BTI-322 (MEDI-507) by BioTransplant Inc/MedImmune: Anti-CD2 monoclonal antibody derived from mice
  • Anti-CD154 antibodies
• Also see http://info.chfpatients.com/Transplant-Immunosuppressants.txt

Other Meds Headed Your Way

You will need some other drugs to counter the side effects of the ones listed above. Again, you may not take all of these, and you may take different ones at different times.

• Antihypertensives - to lower your blood pressure
• Diuretics - to get rid of fluid
• Supplements - to offset losses caused by meds
• Ulcer/stomach upset medication to ease drug side effects; must be taken with care since they can interfere with anti-rejection drugs
• Antibiotics - to prevent and stop infections caused by a weakened immune system
• Laxatives - to ease constipation caused by meds
• Aspirin
• Clotrimazole Troches (Nystatin) - to treat fungal infection of the mouth and throat

Material taken from manuals given to potential transplant recipients at transplant centers in the USA, and from heart transplant recipients - Updated July 20, 2005

All information on this site is opinion only. All concepts, explanations, trials, and studies have been re-written in plain English and may contain errors. I am not a doctor. Use the reference information at the end of each article to search MedLine for more complete and accurate information. All original copyrights apply. No information on this page should be used by any person to affect their medical, legal, educational, social, or psychological treatment in any way. I am not a doctor. This web site and all its pages, graphics, and content copyright © 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005 Jon C.