Liver Transplant (cont.)
Robert M McNamara, MD, FAAEM
Francisco Talavera, PharmD, PhD
The first three months after transplantation is when the patient requires the most medication. After that time, some medicines can be stopped or their dosages decreased. Some of the medication is dosed according to the patient's weight. It is important for the patient to be familiar with the medications. It is also important to note their side effects and to understand that they may not occur with everyone. The side effects may lessen or disappear as the doses of medicine are lowered over time. Not every patient having a liver transplant takes the same medications. Some commonly used medications are as follows:
Cyclosporine A (Neoral/Sandimmune) helps prevent rejection. It comes in pill and liquid form. If the liquid is given, it is important to mix the liquid in
apple juice, orange juice, white milk, or chocolate milk. The patient can "shoot" it directly into the mouth and then follow it with any liquid. Cyclosporine should not be mixed in a paper or Styrofoam cup because they absorb the drug. It should only be mixed in a glass container directly before taking the drug.
Tacrolimus (Prograf) helps prevent and treat rejection and works in a similar way to cyclosporine. Certain medications and substances, including alcohol, antibiotics, antifungal medicines, and
calcium channel blockers (high blood pressure medications), may elevate levels of tacrolimus and cyclosporine. Other medications, including antiseizure medicines (phenytoin and barbiturates) and other antibiotics, may decrease tacrolimus and cyclosporine levels.
Prednisone (Deltasone, Meticorten), a steroid, acts as an immunosuppressant to decrease the inflammatory response. Initially, prednisone is given intravenously. Later, prednisone is given in pill form. Prednisone may cause the following side effects:
- Increased susceptibility to infection
- Weakened bones (osteoporosis)
- Muscle weakness
- Salt and water retention
- Easy bruising
- Gastric (stomach) ulcers
- Increased cholesterol and triglyceride levels
- Increased hunger
- Blurred vision
- Rounded face ("chipmunk cheeks")
- Enlarged abdomen
- Inability to sleep
- Mood swings
- Steroid dependency
Note: Patients must never stop or reduce the prednisone without medical advice. The body normally produces small amounts of a chemical similar to prednisone. When a person takes in extra amounts of this substance, the body senses this and may reduce or stop its natural production of this chemical. Therefore, if a person suddenly stops taking the medication form of prednisone, the body may not have enough natural prednisone-like chemical available. Serious side effects may result.
Azathioprine (Imuran) is an immunosuppressant that acts on the bone marrow by decreasing the amount of cells that would attack the new liver. The dose is based on the person's weight and
white blood cell count.
(Orthoclone OKT3) is an immunosuppressant used for people who are rejecting the transplant, for those in whom prednisone is not working well enough, and for those who cannot take tacrolimus or cyclosporine.
Mycophenolate mofetil (CellCept) is an antibiotic that acts as an immunosuppressant and is used for acute rejection.
Sirolimus (Rapamune) is an antibiotic used as an immunosuppressant.
- Sulfamethoxazole-trimethoprim (Bactrim, Septra), an antibiotic, acts to prevent
Pneumocystis carinii pneumonia, which occurs more often in people who are immunosuppressed.
Acyclovir/ganciclovir (Zovirax/Cytovene) acts to prevent viral infections in people who are immunosuppressed. These drugs work particularly against cytomegalovirus (a type of herpes virus) infection.
Clotrimazole (Mycelex) comes in a troche (lozenge) and prevents
yeast infection of the mouth.
Nystatin vaginal suppository is an antifungal that prevents
vaginal yeast infection.
aspirin is used to decrease blood clotting and to prevent
blood clots from forming in the new liver's arteries and veins.
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