In order for your organ transplant to be successful, you will need to take a variety of medications which include two important groups of medications.

They are

• immunosuppressive (anti-rejection) medications, which prevent your immune system from attacking or “rejecting” your transplanted organ, and
• antibiotics to prevent infections.

In this article, liver transplant pharmacists, Ms Yee Mei Ling, Dr Sia Wan Jin and Ms Song Jielin and kidney transplant pharmacists Dr Lee Puay Hoon, Dr Deepika Mallya, Ms Khoo Sher Ri and Ms Petrina Fan from the Department of Pharmacy, Singapore General Hospital, a member of the SingHealth group, answer commonly-asked questions about immunosuppressive medications for kidney and liver transplants.

FAQ about immunosuppressive medications for organ transplant

1. What type(s) of immunosuppressive medications will I be receiving after organ transplantation?

The type of immunosuppressive drug you will receive depends on

• your immune system,
• the type of organ(s) transplanted, and
• your other medical conditions. Treatment will typically involve a combination of different types of immunosuppressive medications to help you get the best treatment results, with minimal side effects.
2. How long do I have to take the immunosuppressive medications after organ transplantation?

For most organ transplant patients, immunosuppressive medications must be taken for the lifetime of your transplanted organ.

It is important to take these medications every day according to your transplant specialist’s instructions, even if you feel perfectly well.

3. How should I be taking my immunosuppressive medications? Will the dosage of immunosuppressive medications change with time?

Immunosuppressive medications must be taken

• every day,
• at the correct dose and
• at the same timings.

Do not miss any doses.

Your transplant specialist will adjust the doses of immunosuppressive medications over time according to the drug levels in your blood, the function of your transplanted organ, and your overall health condition.

Therefore, it is important to have accurate and regular blood tests for immunosuppressive medications taken before you see your transplant specialist. These tests will help the transplant specialist decide the most appropriate doses of medications for you.

4. What are the common side effects of immunosuppressive medications?

Common side effects of immunosuppressive medications include:

1. Cosmetic related side effects: Hair overgrowth or loss, acne, round face, overgrowth of gum tissue
2. Infections: urinary tract infection, lung infection, influenza
3. Metabolic side effects: Weight gain, high blood pressure, high cholesterol level, elevated blood sugar level
4. Gastrointestinal side effects: Diarrhoea, nausea and vomiting

The side effects may be short-term and less apparent when the doses of immunosuppressive medications are reduced.

If you are concerned about the side effects of the medications, let your transplant specialist know so that he/she can adjust your medications to minimise side effects without increasing your risk for organ rejection.

Do not stop taking or change the doses of the medications on your own.

5. What should I do if I miss a dose of my immunosuppressive medication?

If a dose is missed, take it as soon as you can remember.

If it is near the time for the next dose, skip the missed dose and just resume your regular dosing schedule.

You should inform your transplant specialist, nurses, transplant coordinators and/or pharmacists at your next appointment, as you may need to have blood levels of the immunosuppressive medications checked or other tests performed.

If you have trouble remembering to take your immunosuppressive medications, discuss this with your transplant specialist and pharmacists so that they can identify ways to help you overcome this.

See next page for precautions to take when consuming organ transplant medications.

Ref: O17