This is the second of three articles in the Westmeath Topic about kidney transplants and the medication used. This week I discuss the medication used to prevent your body rejecting the new kidneys. Anti-rejection medication needs to be taken long term. While I specifically deal with kidney transplants, a lot of the advice given in this series of articles is true for any type of transplant (eg) Heart, lung, liver.
Cyclosporin prevents the body rejecting the new kidney. It is available in 100 mg and 25 mg capsules. If you ever forget to take a dose of Cyclosporin and it is less than 6 hours since the missed dose, take the missed dose and go back to normal schedule with the next dose. If it has been greater than 6 hours, skip that one dose and go back to normal schedule with the next dose. Never double up a dose.
Possible side effects with Cyclosporin include high blood pressure, hand tremors, tingling sensation in hands and feet, increased hair growth on face and gum problems. Increased creatinine levels can occur due to high Cyclosporin blood levels.
Tacrolimus prevents the body rejecting the new kidney. It must be taken twice a day.
If you ever forget to take a dose of Tacrolimus and it is less than 6 hours since the missed dose, take your missed dose and get back on schedule with your next dose. If it has been greater than 6 hours, skip that one dose and get back on schedule with your next dose. Do not double up.
Some side effects that have been reported with Tacrolimus are hand tremors, burning or tingling of the mouth, hand, or feet (this will likely improve as the dose is reduced), headaches, difficulty sleeping, high blood sugars, high blood pressure, nausea and/or vomiting (if this occurs, try taking with food) and an increase in creatinine.
Prednisone is a steroid because that prevents or treats rejection of the new kidney. The dose may be increased or decreased depending on your response. High doses of Prednisone may be prescribed immediately after the transplant to prevent rejection with the dose gradually reducing once the transplant is deemed successful. Prednisone may need to be taken long term. It should be taken with food to prevent stomach irritation. If you forget to take a dose of Prednisone, take your missed dose as soon as possible and get back on schedule with your next dose. Never double up a dose
The adrenal glands make a hormone called cortisol that is very similar to Prednisone and after a few weeks taking prednisolone the adrenal glands stops making this hormone. Prednisone should never be stopped abruptly; it should be gradually tapered off slowly to give the adrenal glands a chance to start making cortisol again. Sudden withdrawal can cause severe fatigue, weakness, body aches and joint pains and possibly even cause life-threatening symptoms. Notify your doctor if you take steroids and carry a “steroid treatment card” at all times. A “steroid treatment card” alerts any medic who treats you that they must keep administering steroids to you.
Side Effects prednisolone can include:
Stomach irritation; blurred vision or disturbed eyesight (long-term use gives risk of cataracts or glaucoma); bone or joint pain, especially in hips; raised blood pressure; diabetes; weight gain; rounded, puffy face (called “moon face”); acne; insomnia; low mood; muscle weakness; slow wound healing; bruising; stretch marks and dry skin
Sirolimus may be combined with other immunosuppressive medications to prevent organ rejection. If you forget a dose of Sirolimus, take your missed dose as soon as possible and get back on schedule with the next dose. Never double up a dose.
Side Effects of sirolimus can include:
Headaches; swelling; tremor; insomnia; diarrhoea, nausea, vomiting; constipation and bloating; low platelet count or anaemia; high or low potassium levels; diabetes; back or abdominal pain; cough; skin rashes; acne and high cholesterol
You blood counts (white blood cells, platelets, haemoglobin) need to be monitored while on Sirolimus. It can cause anaemia (low red blood cells), if it does, the Sirolimus dose will be lowered or held for a while and you may be prescribed Erthropoietin (Aranesp®). Erythropoietin is a naturally occurring hormone produced in the kidneys to produce red blood cells. Neupogen® may be prescribed if neutrophils (a type of white blood cell) are low as Sirolimus can cause neutropenia (low levels of neutrophils).
Mycophenolate Mofetil (Cellcept®)
Mycophenolate Mofetil (Cellcept®) may be combined with other immunosuppressive medications to prevent organ rejection. Cellcept® comes in 250mg capsules or 500mg tablets. It is usually taken two to four times a day and the usual total daily dose is 1000-2000mg.
Side Effects of Cellcept® can include:
Nausea and vomiting; diarrhoea or constipation; stomach pains and cramps; low white blood cell count; anaemia; high or low potassium levels; tremor; headaches; diabetes and insomnia. Blood counts (white blood count and haemoglobin) must be monitored regularly while taking Cellcept®. If blood counts are less than the normal range, Cellcept® may be lowered or held. Neupogen® will need to prescribed to increase white cell count or Erythropoietin (Aranesp®) will need to prescribed to increase red cell count.
To be continued…next week
Become a donor
Give the gift of life, become an organ donor today. For an organ donor card, contact the Irish Kidney Association on LoCall 1890 543639 or logon to www.ika.ie
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