10 things Doctor Navarro Wants You to Know About Immunosuppressant Medicines

Posted November 1st, 2012 by Be The Match and filed in Patient Stories
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From the editor: We asked Willis Navarro, MD, NMDP Medical Director and Associate Clinical Professor at the University of California, San Francisco, to share his advice about immunosuppressant medicine.

If you have just started taking immunosuppressant medicines or if you have been taking them for a while, we’ve heard your questions about staying on track. Find tips to manage this type of medicine and learn how it plays an important role in your recovery.

 

1)      Know  what they do

First, they prevent graft rejection. That’s when your immune system rejects the transplanted cells. They can also prevent and treat graft-versus-host disease (GVHD). As you know, GVHD is a process where the donor’s immune system recognizes your body as “foreign” and attacks, particularly the GI tract (upper and lower), liver, and skin.

2)      Recognize which of your many pills are the immunosuppression medications

All of your medicines are important to take. But immunosuppressant medicine is so critical that if you can’t take it in pill form, you may need to get it through an IV. Commonly used oral immunosuppressant medications include tacrolimus (Prograf,“tac”), cyclosporine (Neoral, SandImmune, CsA), sirolimus (rapamycin, Rapamune), mycophenolate (MMF, CellCept), and steroids such as prednisone or methylprednisolone (Medrol, SoluMedrol).

3)      Create a system that works for you

A nice way to keep track of doses of all your medicines, including an immunosuppressant, is by using a system such as a refillable pill container. It’s really easy to lose track of whether a dose was taken so find a system that works for you.

4)      When your dose changes, keep track

Because the right amount of immunosuppression medications in your bloodstream is very important, your dose may need to be adjusted from time to time. A great way to keep track of meds and dose changes is by writing it down in a notebook. It can also help you remember to adjust your pre-filled pill boxes as needed.

5)      Missed a dose? Don’t keep it a secret.

Even missing one dose can result in low immunosuppression medication levels in your blood. This can lead to many serious complications like graft-versus-host disease or loss of the new graft. If you’re having nausea and/or vomiting that affects your medications, let your transplant team know right away, day or night, 24/7.

6)      Some food and meds just don’t get along

Many medications interact with immunosuppression drugs, including some over-the-counter supplements like St. John’s Wort. Even grapefruit and grapefruit juice interact with some medicines like tacrolimus and cyclosporine (you knew that, though, didn’t you?). Never start (nor let any health care professional start) any new medicines or supplements without checking with your transplant team first.

7)      Infection is the enemy

Immunosuppression is a very big part of the success of your transplant. However, it does increase your chances of infection (though it’s not the only reason that infections can happen). Catching and treating an infection early is important, so let your transplant team know of any symptoms that could be an infection such as fever, cough, or pain.

8)      Blood tests are a big factor

Blood tests are really important parts of your care after transplant. Your doctor wants to make sure that the immunosuppression medication levels are in the desired range and that your kidney and liver function tests are okay, too.

9)      Watch for GVHD when tapering off

Some people may be able to taper off and eventually stop immunosuppression medications over time. Never start this process without direction from your transplant team. If you start to taper off, watch closely for signs or symptoms that might indicate  early graft-versus-host disease, such as new nausea or vomiting, diarrhea, abdominal pain, jaundice (yellowing of the eyes and skin from liver problems), dark urine, or rashes. If you see any of these, let your transplant team know right away.

10)     Everyone is different

It’s normal to talk with other transplant patients about each other’s treatment and progress, but always keep in mind that each person’s situation is unique and what’s good for one person may not be good for someone else.

Keep in close communication with your transplant team by bringing up any questions or suggestions you have. It can be helpful to write your non-urgent questions down and take them with you to your next clinic visit.

14 Responses to “10 things Doctor Navarro Wants You to Know About Immunosuppressant Medicines”

  1. Wanda Witczak says:

    Thanks for sharing the tips. I was unaware of grapefruit’s association with Tacrolimus medication which I’m taking. I will definitely stop drinking grapefruit juice!

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