Transplant Medications 101: Q&A

Hi! I’m Christina, a transplant specialty pharmacist here at Mayo Clinic. Through my job, I’ve met hundreds of patients who are hoping to have a transplant or have already had one. Each patient is unique – people come from all around the world; range in age from teens to 80s; some are new to transplant and others who have had over five! One thing that all the post-transplant patients have in common is they have to take medication for the rest of their life. I’m here to share answers to common questions transplant patients have about medications and how to make taking them easy.

How many pills a day will I be on after a transplant?

On average, patients take 10-15 new medications per day which amounts to about 30 pills a day after a transplant.  It may be more or less depending on the individual, and that doesn’t account for pills you are taking for other reasons. These 10-15 new medications include between one to three medications to keep your transplanted organ working properly. These are called “anti-rejection” or “immunosuppressive” medications or simply the “transplant medications”. The other standard pills are for preventing infection, treating pain, and protecting from stomach ulcers.

Will I have to take that many pills forever?

You would have to take at least one “anti-rejection” medication for as long as your transplanted organ is working, which we hope is for the rest of your life. If the transplant medications are stopped for any reason, the new organ will stop working. Missing occasional doses can also be dangerous and lead to the organ not working. In fact, it has been shown that stopped transplant medication is the most common reason a transplanted organ is lost. It is important to never miss doses of the transplant medications and take the exact dose and at the exact times they are prescribed.

 
“I was really overwhelmed by all the pills at first. But then I got a system to help me remember them and it’s just part of my life now.” - Transplant Recipient
What are some of the common side effects of the transplant medications?

For the most commonly used transplant medications, side effects could be heartburn, diarrhea, severe headache and tremor. You should report any side effects to your doctor or other healthcare provider. Other possible side effects include high blood sugar and high blood pressure. You will be at higher risk for getting infections.

Are the transplant medications expensive?  Are they available as generic?

The good news is almost all transplant medications are available as generic. Unfortunately, they are still expensive and without insurance the medications can be over $1,000 a month. We recommend patients carry good prescription insurance coverage during and after a transplant.

What are some ways that I can make taking medications easy?

Here are some tips:

• Find a pillbox with an AM and PM slot so you know exactly what to take, and when.
• Try an automated reminder on your watch or cellphone. There are also medication reminder phone apps.
• Keep medications out or put a sticky note reminder somewhere you look every day.
• Set up text reminders or automated refills with your pharmacy.

Are there any foods I should avoid with transplant medications?

We ask you not to have any grapefruit, pomegranate, Seville oranges, or related products for example pomegranate juice. These can lead to your transplant medication becoming toxic. You should also avoid any supplements, vitamins, or herbs unless they’ve been approved by your transplant doctor.

Are there drug interactions with transplant medications?

Yes, there is potential for many drug interactions with the transplant medications. Before starting any new medication, you should tell your healthcare provider about your transplant medications. The provider and your pharmacist should screen for drug interactions. This includes over the counter medications, such as ibuprofen and naproxen, which should not be taken with transplant medications unless it is specifically approved by your transplant doctor.

What is the best time of day to take the transplant medications?

Whenever works best for your schedule. We just ask that you take the doses exactly 12 hours apart. For example, take your transplant medication at 8 a.m. and again at 8 p.m. This helps to keep the drug levels even in your blood which is important to avoid side effects.

What if I forget a dose?

You will be given specific instructions on how to make up doses after a transplant by your pharmacist. It is important to avoid forgetting doses and catching them up because your medication schedule can get complicated and it could lead to medication side effects.

Can I take the transplant medications with food?

We recommend being consistent with regards to food. This means you may take most medication with or without food, but you should take them with a similar amount of food every day. Mayo Clinic will be measuring levels of the medications in your blood and adjusting your dose using those levels to account for your food intake with pills. Other transplant centers may have different approaches to this.

HELPFUL LINKS

• Learn more about food/medication interactions.
• Explore Mayo’s Transplant Center.
• Request an appointment.