Post Transplant Immune Suppression Lung Transplant Education Series Valerie Durney, NP, CCTC

OVERVIEW Post Transplant Immune Suppression Why do I need these medications? Which of my medications suppress my immune system? What are common side effects of these medications? What symptoms should I be aware of? What are important things to know about these pills? Post Transplant Immune Suppression

Post Transplant Immune Suppression After lung transplant your immune system needs to be altered to prevent rejection or your own body trying to fight the new lung(s) Ideally, your body will become tolerant to the new lung Post Transplant Immune Suppression

Post Transplant Immune Suppression We achieve this goal with the medications you are prescribed, they work in combination to suppress your immune system It is extremely important to take your medications as directed Once you are home develop a system to ensure you take your medications on time Post Transplant Immune Suppression

Post Transplant Immune Suppression The transplant team will monitor your blood levels to achieve the most appropriate level of immune suppression for you This may place you at risk for catching illnesses from others Post Transplant Immune Suppression

PRECAUTIONS Precautions need to be instituted at home to help prevent the spread of infection Good hand-washing is the #1 precaution in stopping the spread of infection Post Transplant Immune Suppression

WHICH OF MY MEDICATIONS SUPPRESS MY IMMUNE SYSTEM Prograf CellCept Prednisone Post Transplant Immune Suppression

PROGRAF Post Transplant Immune Suppression Most important medication! Needs to be taken every 12 hours Interacts with many medications Post Transplant Immune Suppression

PROGRAF: COMMON SIDE EFFECTS Tremors Headache GI: Nausea/diarrhea Kidney problems Low magnesium Elevated blood sugars Mag in foods: green leafy veggies, string beans, legumes, bananas, nuts, avocados Post Transplant Immune Suppression

Formulations: 0.5mg, 1mg & 5mg capsules PROGRAF Formulations: 0.5mg, 1mg & 5mg capsules BRAND NAME NECESSARY Acceptable alternative to Prograf is: Hecoria (this a newer brand name medication) Post Transplant Immune Suppression

PROGRAF Post Transplant Immune Suppression We will check blood levels of Prograf to ensure your level is within a target range Blood levels need to be a 12 hour trough-this means your blood is drawn 12 hours after your last dose Please eat/drink as usual prior to your clinic labs as you do NOT have to be fasting Post Transplant Immune Suppression

PROGRAF Post Transplant Immune Suppression You can take your AM Prograf dose after your blood is drawn Please avoid grapefruit juice, as this can elevate your blood level of Prograf Fresca contains grapefruit! Post Transplant Immune Suppression

Alternative to CellCept is Myfortic. This is enteric coated CellCept Formulations: 250 & 500mg capsules Taken every 12 hours Important to take with food Should be separated from antacids Generic Ok Alternative to CellCept is Myfortic. This is enteric coated CellCept Post Transplant Immune Suppression

CELLCEPT: COMMON SIDE EFFECTS Nausea/vomiting Diarrhea Low blood counts *Pregnancy concerns* Post Transplant Immune Suppression

PREDNISONE Post Transplant Immune Suppression Tapered dosing over the first 4 months after transplant Goal dose = 5mg Taken every morning Generic Ok Post Transplant Immune Suppression

PREDNISONE: COMMON SIDE EFFECTS Elevated blood sugars Elevated blood pressure Weight gain Puffy face Insomnia Irritability/moodiness Bone weakness/osteoporosis Post Transplant Immune Suppression

GENERAL TIPS Post Transplant Immune Suppression Keep out of reach of children Check with transplant team before starting a new medication prescribed from another provider Always swallow capsules whole and never chew/crush or open capsules Post Transplant Immune Suppression

GENERAL TIPS Post Transplant Immune Suppression Purchase a pill box to keep organized Consider setting an alarm to avoid forgetting doses Discuss with transplant team any concerns about side effects to medications Avoid herbal supplements Post Transplant Immune Suppression

GENERAL TIPS Post Transplant Immune Suppression Always keep an up to date medication list with you at all times Plan ahead for refills! Please purchase a medical alert bracelet in case of emergencies that states you are a transplant patient and keep a list of your medications in your wallet Post Transplant Immune Suppression

Post Transplant Immune Suppression Always contact your transplant coordinator for with any questions or concerns! Linda: 617-732-7299 (last names starting with A-K) Betsy: 617-732-5971 (last names starting with L-Z) or via Patient Gateway

REFERENCES Transplantation Drug Manual, 5th Edition J. Pirsch, H. Sollinger, X. Liang Landes Bioscience Austin, TX USA Transplantliving.org BWH: A Guide To The Care of Lung Transplant Recipients At BWH