Liver Transplant (cont.)
What Are Pretransplantation Medications?
- Lactulose: It is important to continue taking this medication because it helps clear the toxins that cannot be cleared when the liver isn't working well. With the doctor's approval, the patient can adjust the lactulose dose to produce 2-3 soft bowel movements per day
- Diuretics: These medications promote removal of excess fluid from various parts of the body, such as the abdomen and legs. The excess fluid is lost through urination, and the patient may do this frequently. Daily monitoring of weight is helpful in determining the ideal dose. Routine monitoring of blood test results is an important part of diuretic therapy because important substances are also removed in the urine and may need to be replenished.
- Anti-ulcer medications: These medications are routinely given both before and after liver transplantation to prevent ulcers from forming in the stomach or bowels.
- Beta-blockers: These medications reduce the chance of bleeding from the gastrointestinal (feeding) tract. They also lower blood pressure and heart rate. They sometimes make the patient feel tired.
- Antibiotics: People with liver disease can be more susceptible to infections. The doctor may put the patient on long-term antibiotics if the patient gets repeated infections. The patient should call the doctor if feeling unwell or if he or she has symptoms of infection.
What Are Post-Transplantation Medications?
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 medications are 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 inapple juice, orange juice, white milk, or chocolate milk. The patient can "shoot" it directly into the mouth and then follow it with any liquid except grapefruit juice. 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:
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.
Medically Reviewed by a Doctor on 11/28/2016
Robert M McNamara, MD, FAAEM
Francisco Talavera, PharmD, PhD
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