|
|
|
 |
|
| |
| Liver Transplant |
Medications and After Care
A regular follow up is mandatory after liver transplant. In the first few months after transplant one has to follow up with the team at least twice a week. Blood tests will be conducted to assess the new liver and also the patient will be screened for evidence of liver rejection or new infections. For some this period could be tedious requiring morefrequent visits and admissions. Some patients may require insulin to treat diabetes induced by steroid therapy. Generally no major preparation is required to receive a new patient at home. Clean environment, hygienic food and water and quarantine from people with overt infections (common cold, chicken pox etc) are the basic requirements. A liver biopsy may be required when the liver tests are abnormal. Alcohol is completely prohibited after liver transplant.
The standard medications given after a liver transplant are Cyclosporine, Tacrolimus, Steroids, Azathioprine- which are enumerated here.
Cyclosporine
Other Names: CSA, Samdimmune"
Purpose CSA is an immunosuppressive medication that helps prevent rejection. Because absorption of cyclosporine is variable, blood levels must be monitored to guide the ordering of doses.
Dose (liquid or capsules)
Oral liquid preparation in an olive oil base
100mg in each ml.
Measure dose with a syringe, use a one cc syringe to measure doses less than 100mg. Mix with milk, chocolate milk, or juice. Serve at room temperature, not hot. Stir well and drink at once. Do not allow mixture to stand before drinking. Use a glass container. After you drink your dose add more milk or juice and drink it to be sure that you are getting your entire. Do not use Styrofoam cups. CSA can be taken "straight" followed by a drink of milk, chocolate milk or juice. Carefully follow directions on bottle for storage and precautions. Once the bottle is opened, the contents should be used within two months. Do not mic CSA in a baby bottle- it may change your Childs feeling toward the bottle and if (s)he does not drink all of the liquid, part of the dose will be missed.
Capsules - 100mg and 25mg
Carefully follow directions on box for storage and precautions. Use as soon as possible after removing the capsules from the blister pack.
When to take Cyclosporine
Am dose - in the morning with breakfast
Pm dose - 12 hours after the morning dose.
Missed Dose
If you happen to miss a dose, make up the missed dose as soon as you remember. If it is time for your next scheduled dose, take a double dose to make up a missed dose. If you have forgotten more than a dose, contact the Transplant Center. You need to take all the amount prescribed to prevent rejection. Do not have a CSA level done within 24 hours.
Generic Cyclosprine: Not recommended currently
Precautions
Some medications seriously change the effectiveness of CSA. Never take any medications without telling the transplant center. Blood potassium levels must be monitored and other medications that increase the potassium level should be used with caution. Diarrhea will affect your CSA blood level. Be sure to report any problems with diarrhea to the transplant center. Call your doctor or the transplant center if you have taken an overdose of CSA. If you are on dialysis it does not dialyze off and should be taken on a regular schedule. Check with your transplant doctor before planning a pregnancy.
Side Effects of Cyclosporine
Flushing. A brief period of warmth and / or redness in your face for one to two hours after taking CSA. This feeling disappears within a short time.
Hair Growth Increased hair on your face, arms and body is common but usually not a problem. Special bleach formulations made especially for the face are available if you choose to use a cream hair remover.
Mild tremor of hands. Usually occurs in the month or two and tends to disappear the longer you take CSA or with a decreased dose. If it continues to be a problem for you, please report it.
Gum Swelling and sensitivity to cold or heat. Dental Hygiene is necessary to keep gums in good health. Numbness, tingling, burning sensation, sensitivity to cold and or heat in hands and feet usually noticeable, but not too uncomfortable.
Hypertension or high blood pressure. Appropriate medications will be prescribed to control your blood pressure. It is important to follow other recommendations to help lower your blood pressure such as keeping your weight normal. Eating a low salt diet and exercising. These medications may require constant revision, as the blood pressure may return to normal with reduction in dosage of steroids and CSA.
Elevated serum potassium levels This is more common after you have been on cyclosporine for a few weeks. You might need to restrict the amount of potassium in your food and beverages.
Altered kidney function or nephrotoxicity. Laboratory tests are done to monitor your kidney function. If this side effect develops, your dose will be lowered. The transplant staff may ask you to return to the hospital for evaluation.
Altered liver functions Symptoms include elevated liver enzymes and bilirubin. This occurs rarely. Liver functions tests are done periodically.
Yeast infections in your mouth, esophagus, and stomach. Using an anti fungal medications as prescribed should prevent these infections. If your mouth is sore continously or there is a white coating on your tongue, let your doctor or nurse know.
Gastrointestinal Symptoms. Nausea, vomiting, diarrhea and decreased apetite are rare, but please report them if they occur.
Rash See your doctor and tell the transplant center if you have a rash.
Neurological Symptoms Headache and feelings that's its harder to remember things. Episodes of black out or seizure are rare and need. Both men and women should immediate medical attention and evaluation.
Lumps in your breast/Chest area examine themselves monthly for lumps and report them to their primary care physician if they occur.
Do not breast feed - cyclosporine can be transmitted to your baby in your breast milk. Allergic reaction very rare.
FK-506 (PROGRAF)
Other Names: Prograf(tm), Tacromilus
Purpose It is an immunosuppressive medication that helps prevent rejection.
Dose: Capsules 1 and 5 milligrams.
Missed Dose
If you miss a dose, try to take it as soon as you remember or check with the Transplant center for further instructions. If you have forgotten more than one dose, contact the transplant center for instruction during hours. It is important to take your entire prescribed dose to prevent rejection.
Side Effects
Fk-506 is similar to cyclosporine. It may use as an alternative to prevent rejection.
Possibe side effects include: Headache, numbness, tingling, Nausea, vomiting, diarrhea and decreased appetite. High blood sugars, Flushing, High Potassium, High blood pressure, High Bun or creatnine levels, Rash.
Special Instructions
When sending blood samples to check for FK506, make sure you use a lab slip that FK506, not cyclosporine.
IMURAN
Other Names: Azathiaprine, AZA
Purpose
Immunosuppressive. This medication is routinely used to prevent rejection in other patients.
Dose
Individual dose is based on your weight and white blood count (WBC). Available only in 50m size tablets. A dose of 25 mg is a half tablet and a dose of 12.5mg is one fourth of a tablet.
When to take
Take the entire daily dose at one time in the evening.
Missed Dose
All of the prescribed amount must be taken to maintain enough immunosuppression to prevent rejection. Make up the missed dose as soon as you remember. If it is already time for your next schedule dose, it is permissible to take a double dose if your white blood count (WBC) is in your normal range. If you have forgotten more than one dose, contact The Transplant Center during regular hours for instructions.
Generic - Azoran
Precautions
Have white blood count (WBC) tests done as instructed.
Report all symptoms of infections immediately.
Take Imuran after dialysis, not before.
Use Allopurinol (Zyloprim) with extreme caution. It should only be taken under close medical supervision. It can cause a serious decrease in your white blood counts, hemoglobin and platelets. It may be serious enough to require hospitalization.
Side Effects
Decreased white blood count.
Liver toxicity. Liver function tests will be done at least twice a year when you take Imuran.
PREDNISONE
Other Names: Deltasone, Wysolone
Purpose It is a steroid immunosuppressive medications that helps prevent rejection.
Dose
Use only the five mg size tablets for adults. Small children can use one mg size tablets as necessary. Using one tablet size is extremely important to prevent mistakes.
When to take
During the first week after transplant or when prednisone is increased to treat rejection - divide your total daily dose into four proportions and take each one at four evenly spaced times during the day. After one week or when predinisone is being tapered - divide your total daily dose and take half in the morning and half in the evening. After three to four months - the total daily dose can be taken once a day. The transplant center will tell you when to switch to one dose a day.
Missed Dose
Take your missed dose as soon as you remember. If it is time for your next scheduled dose, you can take a double dose. If you have forgotten more than one dose, contact The Transplant Center during regular hours for instructions. It is important to take your prescribed prednisone dose to prevent rejection.
Generic - Check the brand of prednisone you are talking, and try to continue taking the same brand when you obtain a new supply. We recommended you use wysolone.
Precautions
Report all illness and fever and be sure to have your blood tests done if you just have the flu. Rejection can be missed until it is too late if you fail to monitor your blood tests during any illness.
Side Effects
Prednisone has many side effects. Those that our transplant recipient most commonly encounter are described here. The side effects are dose related - the higher the dose of prednisone or the more times you have been treated for rejection, the more you experience side effects. As the dose is gradually reduced, the more you experience side effects. As the dose is gradually reduced, the side effects diminish. The prednisone dose will be reduced so that it is will be discounted at a maintenace level by the end of one year.
Sodium retention. When your body retains sodium it also retains fluid, which can cause an increase in your blood pressure. To prevent or treat or treat elevated blood pressures, eat a salt (sodium) restricted diet (see Nutrition section).
Increased Appetite. There is no way that you can eat enough to make the hunger from prednisone go away. And if you eat more than you need, you will gain weight. Read the nutrition section or talk with a dietitian for information regarding your ideal weight. Food intake, and ways to improve your nutritional status.
Increased fat deposits, especially in the face and abdomen and sometimes on the back of neck.
Increased Acid in your stomach, which can cause ulcers. For this reasons it is important that you follow the antacid guide.
Mood swings or emotional highs and lows.
Thrush (candidi) growth in the mouth. To prevent this use you're anti fungal medications as directed.
Increased sweating especially at night. If you have diabetes be sure to check your blood glucose. Do not just assume you have low blood glucose.
Increased hair growth increased hair on your face, arms, and body is common but usually not a problem. Special bleach formulations made especially for the face are available if you choose top use a cream hair remover.
Acne on the face, back, and chest. Wash your skin two or three times a day. Keep the area as clean and dry as possible.
Bone and muscle problems.
Doing exercises or walking to strngthen these muscles can alleviate muscle weakness, especially in the thigh. Your muscle strength will improve as your prednisone dose is decreased, if you have excercised adeqautely.
Muscle cramps and aching, usually in the lower leg. If you experience muscle cramps and there are troublesome, contact primary care doctor. Quinine, and over the counter medication, may help.
Joint pain may mean you need to see an orthopedic physician. Prednisone affects how calcium absorbed and stored in your body. For this reason it is important that you take care of your bones.
Children may not grow while on high doses of prednisone. If you are under the age of 18, measures your height once a month and report it on a height. Weight chart. Report these measurements to the Transplant Center.
Eye problems Except blurred visison right after transplant, especially while you are taking high doses of prednisone. We recommend you do not change your glasses prescription for at least 6 months after the transplant. If your vision has been improving after an initial deterioration and then you notice an increased blurring or a decrease in your vision again, see your primary care eye doctor (ophthalmologist) Immediately. Other problems may be occurring in your eye.
Increased sugar in blood Many recipients have an increased blood sugar level after surgery. For most people this level returns to normal within a few days after transplant. If you have diabetes, you may notice higher blood glucose level when taking doses of prednisone.
Increased sensitivity to the sun- See the general section for recommendation to prevent skin changes and skin cancer.
Increased time for wounds to heal.
Decrease in the body's ability to fight infection. You is not necessarily going to catch flu's and colds. However, if you get an illness, your body is less able to fight it. Your body has an immune system that fights infection and rejects anything that is foreign. This system is suppressed by anti - rejection medications. It is extremely important that you notify the transplant staff of hay fevers or illness you have.
SIROLIMUS (Rapamune)
New Immunosuppression medication. Usually used along with cyclosporin as an antirejection medication. Occasionally used with Cellcept (MMF) and steroids.
Dose 2 mg/ Day maintenance dose. Upto 5mg/ day has been used. Take the dose recommended by your doctor.
Packing and Administration:
The drug is available in the form of a viscid fluid in a bottle or in sachets of 1ml and 2ml. The required dose for the day should be dispensed in a clear cup and stirred with 60ml of orange juice or water. After consuming, another 120ml of orange juice should be added to the cup, mixed and taken orally.
Side Effects
At higher doses (5mg/ Day)
Anaemia, arthralgia, diarrhoea, hypokalemia and thrombocytopenia.
At 2-5 mg/ day
Hypercholesterolemia, hyperlipemia, hypertension, rash and acne.
Avoid concomitant use of drugs which are nephrotoxic and prokinetic.
Anti Fungal Medications
Examples : Clotrimazole drops, Nilstat (Nystatin Swish and Swallow TM), Mycostain.
Purpose
Kills the fungus or yeast called candida. Different kinds of medications are used to treat fungal or yeast infections of the skin, mouth, throat, or vagina.
Dose
Transplant patients routinely need to take an oral preparations several times a day for six months following transplant or anytime a high dose of steroids (prednisone or solumedrol) is taken. Liquid anti fungal medications shouls be held in the mouth at least five minutes before being swallowed. Use a ear bud or tooth brush to brush the medications around inside of mouth for anyone not able to swish and swallow themselves (eg children or extremely ill adults). Troches should be held in the mouth at least ten minutes, then they may be chewed and swallowed. Don't eat or drink anything for at least 30 minutes after taking the medications. Actual dose varies according to medications and individual needs. Some patients will take both the troches and swish and swallow to prevent or treat Candida infections. Prevention is easier than treating later.
Missed Dose
Take it as soon you remember.
When to Take
Troches need to be taken five times a day after each meal in the middle of the after noon, and before going to bed.
Precautions
Anti fungal medications is only effective when it is in contact with the tissues. If you eat or drink right after taking it, you wash away the medications and its effect.
Be sure to brush teeth 30 to 60 minutes after taking Swish and Swallow to prevent teeth from decaying. This is especially important after the dose you take before going to bed. Other anti fungal medications such as Ketoconazole, Fluconazole or Itraconaazole should never be started without consulting the transplant center. These medications will affect your cyclosporine dose. If you wear dentures, remove them before taking this medications.
SIROLIMUS (Rapamune)
New Immunosuppression medication. Usually used along with cyclosporin as an antirejection medication. Occasionally used with Cellcept (MMF) and steroids.
Dose 2 mg/ Day maintenance dose. Upto 5mg/ day has been used. Take the dose recommended by your doctor.
Packing and Administration:
The drug is available in the form of a viscid fluid in a bottle or in sachets of 1ml and 2ml. The required dose for the day should be dispensed in a clear cup and stirred with 60ml of orange juice or water. After consuming, another 120ml of orange juice should be added to the cup, mixed and taken orally.
Side Effects
At higher doses (5mg/ Day)
Anaemia, arthralgia, diarrhoea, hypokalemia and thrombocytopenia.
At 2-5 mg/ day
Hypercholesterolemia, hyperlipemia, hypertension, rash and acne.
Avoid concomitant use of drugs which are nephrotoxic and prokinetic.
ANTACIDS
Purpose
Antacids help to buffer the acid in your stomach. The prednisone you take causes increased acid in your stomach, which can lead to stomach ulcers.
Dose
Adult: 5 to 10 ml (1 to 2 teaspoons)
Child: 1 to 5 ml according to doctors order.
Shake well before each use.
We recommend using liquid antacids, as they are effective than tablets. People who cannot liquid antacids can take the tablets form. Chew the tablet completely and drink a full glass of water after wards to help the antacid dissolve and disperse. Swallowing the tablets whole will not be effective.
When to take Antacids
When you are eating food normally, take an antacid about one hour after each meal and just before going to bed. When you are taking high doses of prednisone (right after transplant and during rejection treatment), take an antacid if you happen to wake up during the night. However, do not set your alarmclock. When you are not eating, take an antacid every two hours. After 6 months when your prednisone is stopped or minimal then take one dose of antacid per day - just before you go to bed.
Magnesium and Aluminum Combinations Antacids.
Recommended Kinds:
Maalox
MylantaII - contains Simethicone
Riopan - low in sodium but not as concentrated.
Side Effects
Diarrhoea
Aluminium Antacids
Some Examples:
Aluminum Antacids, Magnesium Antacids, Calcium Antacids, Sucralfate
Side effects of aluminium antacids
Constipation
Low phosphorus level.
Calcium Antacids
Calcium - containing antacids are less effective than magnesium and aluminium antacids in preventing stomach ulcers. Also, they should be used under the close supervision of your physician because frequent, chronic use can increase the calcium level in the blood too much.
Precautions Regarding All Antacids
When kidney function is decreased, do not take an antacid containing magnesium - your kidney will not be bale to clear it. Check with your primary care doctor to determine which antacid is appropriate for you. Do not take an antacid at the same time you take any of the following medications. Most often you should take these medicines at least one hour before you take your antacid. If you take these medicines with an antacid, the following medications are less effective or break down too soon-
Bisacodyl(Dulcolax)
Naproxen
Cyclosporine
Phenytoin (Dilantin)
Digitalis, Digoxin
Quinidine
Indocin (Indomethacin)
Tetracycline antibiotics (take at least three hours before or after antacid)
Iron preparations.
TMP SULFA / BACTRIM
Purpose
An antibiotic used to treat urinary infections and to prevent certain types of pneumonia that can be serious for transplant patients.
Dose
Adult: one single strength tablet once a day, If you are only able to get double strength tablets, you will need to take only half a tablet. If you are using liquid from, 10cc equals one strength tablet.
When to take
Take it in morning.
Missed Dose
Take it as soon as you remember it even if it is time for your net scheduled dose. Never take more than doses at one time. Then resume your regular schedule.
Precautions
If you do not have a spleen: do not stop taking TMP Sulfa unless you are given an alternative antibiotic such as pencillin or erythromycin.
Do not adjust your dose of TMP Sulfa. Follow directions from the Transplant Center. Only use single strength tablets. Switch your child to tablets as soon as dose can be easily obtained from a tablet and your child is bale to swallow a tablet. Drink at least eight glasses of liquid every day. You do not specifically have to drink a full glass of water when you take the pill - just be sure you have adequate fluid intake through out the day. If you choose take a generic form of this medications, be sure you always take the generic form - do not switch back and forth. Some people have allergic reactions to generic TMP Sulfa but may be able to take the non generic form.
Side Effects
Liver Toxicity.
Lowered white blood count.
Allergic reaction with itching, rash, fever.
Sensitivity to sun which will cause you to sunburn easliy
Nausea, vomiting, diarrhea.
ACYCLOVIR
Purpose
Anti viral medications used to treat cold sores and genital herpes (herpes simplex virus infections); and to treat chicken pox and shinghle (varicella - zoster virus infections). It also helps prevent cytomegalovirus(CMV infections).
Dose
Each capsule contains 200mg
Tablets contain 800mg.
When to take
May be given for the first three months after transplant to prevent CMV or to treat infection.
Missed Dose
Take as soon as you remember, unless it is time for your next scheduled dose, and then just take the dose that is due. Do not take a double dose.
Side Effects
May affect the white blood cell (WBC) count.
May affect BUN creatinine levels.
ACETAMINOPHEN
Other Names: Anacin 3, Tylenol, Calpol, Crocin
Purpose
Decrease pain from any cause, including arthritis.
Decrease temperature or fever.
Begins to work in ten minutes to one hour after it is taken and continues to work up to eight hours.
Dose
Follow label instructions for an adult and child doses or consult your privacy care doctor.
When to take
Take only when absolutely necessary for pain or headache. Be sure to report pain and amount of medications you have taken.
Precautions
These medications can reduce a fever and may cause you to delay seeking important medical care. Report fevers of greater than 101 degrees Fahrenheit to your primary care physician or the Transplant Center before taking Tylenol TM.
ASPIRIN
Other Names: Acetylsalicyclic Acid, ASA
Rule of Thumb: Do not take aspirin or any medicine that contains aspirin unless prescribed by your primary care doctor. Check all non-prescription medications with your pharmacist before buying to be sure they don't contain aspirin.
Purpose
Decrease pain from any cause, including arthritis.
Decrease temperature or fever.
Decrease the ability for platelets to stick together and therefore, helps prevent blood from clotting.
When to take
Aspirin is sometimes prescribed for heart, liver and pancreas transplant patients to prevent blood clots. Always take aspirin with a full glass of water.
Missed Dose
Take the missed dose as soon as you remember, but not if it is the time of your next dose. Do not take a double dose.
Precautions
Report bruising or blood in your urine or sputum immediately.
Do not take aspirin if you are taken Coumadin Tm or another blood thinner.
Side Effects of Aspirin
Ringing in ears, difficulty hearing, dizziness, stomach upset. These symptoms usually occur only at high doses.
Stomach pain, burning or ulcers with bleeding.
Non Steroidal Anti Inflammatory Medications:
Examples of Non Steroidal Anti Inflammatory Medications:
Ibuprofen / Sumo / Voveron
Purpose
Relive pain, inflammation, swelling and joint pain caused by arthritis.
Dose
Varies with each medications. Always use the smallest dose that brings relief. You will use these medications for a short time only.
Use with Caution. Do not take medications unless your creatinine is monitored frequently. Check with Transplant Center before taking first dose for more information.
When to take
Take with food or milk to prevent stomach upset.
Side Effects
Stomach irritation with symptoms of nausea, vomiting, heartburn, upset stomach. Take with food, or decrease or stop medications if these occur.
Allergy with skin rash and hives.
Ringing in the ears, dizziness, headache.
Increased creatinine.
Laxatives
It is better to prevent constipation than to try and to treat it. Many different laxatives are available in your local drug store, but some are safer than others for frequent use.
Warning: If you have pains in your stomach, Don't use a laxative without talking to your primary care doctor.
The following laxatives are considered safe for chronic use by transplant patients, keep us informed of the laxatives you use regularly.
Bisacodyl (Dulcolax): A mild luxative available in tablets or as a rectal suppository.
Docusate Sodium or DSS: A stool softener that works by drawing more fluid into the stool to make it softer. Drinking plenty if water is necessary for this laxative to be effective.
Docusate Sodium: This laxative has a stool softener.
Milk of Magnesia: A good laxative to use to treat mild constipation. Take one or two tablespoons as needed. |
| |
|
|
