Transplant anti-rejection medications. What's your advice?

Posted by jolinda @jolinda, Apr 23, 2020

Weight gain? Hair loss? Headaches? Never missed a beat? What has your experience with transplant medications been? Have you developed a methods to deal with a side-effect? Have your meds changed at all over time? What advice do you have for others in our community that may make their experience better?

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@jerrynord

I have heard this before but yesterday I got a message from CVS pharmacy with my Tacrolimus prescription. It said do not drink grapefruit juice or eat grapefruit while taking Tacrolimus. Has anyone heard this?

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@jerrynord, Thanks for the reminder!

I find it helpful if I re-read the papers that I get with my immunosuppressant medications. Mayo Specialty Pharmacy always includes printed information about my meds in my delivery orders. I get my other medications locally - and if I have an afterhour medicationi from a chain pharmacy I never get the papers. When I asked "Why" I was told that nobody reads them anyway! Hmmm? My independent local pharmacy always includes the paperwork!

For more information:
- Immunosuppression: Watching For and Managing Side Effects
"Some medications and foods may change how immunosuppressant drugs work. Before you use any other medications, talk to your nurse transplant coordinator or transplant pharmacist so they can make sure the new medication is safe to use with your transplant medications. You should do this for both prescription and over-the-counter medications. Over-the-counter medications would include vitamins, supplements, and herbal products. Some common foods and beverages that may affect how your body uses your immunosuppressant drugs include grapefruit or grapefruit juice, sodas with grapefruit juice in them (ie. Squirt™, Fresca™, or Sundrop™), Pomegranate and pomegranate juice (ie. Pom™), Seville oranges, also called Spanish, sour or bitter oranges, and more than 6 clementines per day. These foods should be avoided if you are taking a tacrolimus or cyclosporine product , sirolimus, or everolimus." https://connect.mayoclinic.org/page/transplant/newsfeed-post/immunosuppression-watching-for-and-managing-side-effects/

-Transplant Medications 101: Q&A
Foods to avoid, drug interactions, best time of day to take medications and what to do if I forget a dose.
https://connect.mayoclinic.org/page/transplant/newsfeed-post/transplant-medications-101-qa/
Does anybody else get notices with their meds? Do you read it? What have you learned or been reminded of by reviewing the information?

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@jerrynord

I have heard this before but yesterday I got a message from CVS pharmacy with my Tacrolimus prescription. It said do not drink grapefruit juice or eat grapefruit while taking Tacrolimus. Has anyone heard this?

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@jerrynord
There are several things that are dangerous to eat/drink if you are taking Tacrolimus! Grapefruit, grapefruit juice, pomegranates, pomegranate juice, Fresca soda and Seville oranges are for sure on the NEVER consume list. These foods and beverages are known to interfere with Tacrolimus and change the potency of the medication in unpredictable ways which leaves you venerable to organ rejection. I'm glad you've chosen a pharmacy that adds warnings to your meds. Did they have any other instructions that could be shared with the group to keep us healthy?

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@jerrynord

I have heard this before but yesterday I got a message from CVS pharmacy with my Tacrolimus prescription. It said do not drink grapefruit juice or eat grapefruit while taking Tacrolimus. Has anyone heard this?

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@jerrynord yes, there are a multitude of medications that do not interact well with grapefruit. Also, with tacrolimus you need to avoid pomegranates as well.

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I have heard this before but yesterday I got a message from CVS pharmacy with my Tacrolimus prescription. It said do not drink grapefruit juice or eat grapefruit while taking Tacrolimus. Has anyone heard this?

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@ladydidehart

My transplant team pharmacist did say that Biotin might help but didn’t recommend a dosage, only that it should be USP. I will be reaching out to my hairdresser as well. Yes, I’m returning for a 4 month visit in a few weeks. I just wanted the perspective of people who had actually gone through this themselves. Thank you!

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@ladydidehart, I'm just wondering, have you been able to go for your 4 month check-up yet?

The 4 month check-up is a big event and I want to invite you to share some of your exprience like the schedule of tests, .procedures, and maybe any suggestions for those who are anticipating their first follow-up. Here is a discussion - Transplant Surgery and Early
Recovery: What's normal? https://connect.mayoclinic.org/discussion/post-liver-transplant/

What did you learn about your hair loss?

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Transplant Medications, anti-rejection medications, immunosuppressant medications - We all take them! Here is a Trending Newsfeed Posts that I want to share with you:
Immunosuppression: Watching For and Managing Side Effects
https://connect.mayoclinic.org/page/transplant/newsfeed-post/immunosuppression-watching-for-and-managing-side-effects/
FYI -The Trending Newsfeed Posts are seen at the lower half of the opening Mayo Connect Page - or can be accesses at Pages>Transplant>Newsfeed https://connect.mayoclinic.org/page/transplant/
The transplant page is written ans presented by the transplant staff. It designed to bring relevant and informative transplant information directly to you.

Enjoy your day. I would love to hear from you. How are you handling or learning to live with any side effects?

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@cmael hi yes that is one way of trying to combat a virus. Mine is Parvo b19 and I actually get monthly ivig treatments but they cut back my immunsupresent to just 1.5 mg tacrolimus twice a day and no cellcept as long as there is no rejection issues to help your immune system combat the virus. Realize also I'm not a doctor and I'm also 2.4 years post transplant so each case may be different. But I hope that helps and I also have a lot of faith in my team at Mayo.
I hope you have a blessed day
Dana

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I was at Mayo Rochester last week for my two year checkup. Labs and other tests were good, buts my labs showed some signs of the BK virus. I’ll have it retested next week. She said if it comes back with signs of the virus again, she’ll lower my Cellcept dose. Has anyone else experienced this?

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From the beginning in 1981 I have been on 125mg imuran and 5mg of Prednisone for my kidney transplant. Only side affects that I am noticing is on my skin according to my dermatologist.

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@rosemarya

@stephanierp, It is awesome to hear that you are doing well! I'm curious, Have you been back to the transplant department to see your doctor in person since your return home?
I have been taking tacrolimus and cellcept since my transplant in 2009, with minor dosage adjustments along the way. These meds are working well for me with a liver and a kidney. I am going to share information on both meds, but I have not seen any research on the long term effects of one vs the other. I think that your transplant doctor could help you with that information as well as information for why one is best for you over the other.
https://www.mayoclinic.org/drugs-supplements/tacrolimus-oral-route/description/drg-20068314
https://www.mayoclinic.org/drugs-supplements/sirolimus-oral-route/description/drg-20068199
If you will accept a some advice that was shared with me - Find a time for taking your meds at a time that will be the most convienient for your schedule. Remember that you will need to take the anti-rejection medications for the rest of your life, so do what will work best for you as your life returns to normal and your activity increases. My selected time is 8:00 AM and 8:00 PM. I have the alarm set on my iphone.

I hope you have a good visit tomorrow! I have never had a video chat with any of my doctors. I would love if you would drop a line and tell me about how it works for you!

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Hello Rosemary!
I have been having my transplant meetings via video chats. This has worked wonderfully well, as it saves my husband and I ,6 hours of travel and an overnight hotel stay, each month. I really like it! I sign in a few minutes before the meeting time and have my questions or concerns written out ahead of time. I actually had never met my doctor before the video meetings and feel that it works well, because I can see his face and he can see mine.

Thank your for your advice concerning taking meds at the same time each day.

Have a great day!

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