Anti-rejection medicine
As a transplant patient, you will take anti-rejection (immunosuppressant) medicines for the rest of your life. Each medicine is needed, and they all work in different ways to stop organ rejection.
Your care team will change medicines based on your infection risk, rejection, and side effects.
Azathioprine is an anti-rejection (immunosuppressant) medicine. It may also be called Imuran or Azasan.
Usual dose: Varies
Instructions:
- Take 1 time a day
- Take with or without food, but it must be the same way each day.
- Take it at the same time each day.
- Follow the medicine list your care team gives you.
Special instructions:
- Call the transplant team if you start or stop medicines used for gout.
Side effects:
- Nausea
- Vomiting
- Rash
- Low platelets
- Increased risk of bleeding
- Decreased liver function
- Low white blood cells
- Increased risk of infection
- Increased risk of cancer
50 mg tablet (Imuran)
75 mg tablet (Azasan)
Cyclosporine is an anti-rejection (immunosuppressant) medicine. It may also be called Gengraf.
Usual dose:
- Changes with drug levels.
- Drug levels are checked to decide the dose needed to prevent rejection and lessen side effects.
Instructions:
- Take every 12 hours.
- Take with or without food, but it must be the same way each day.
- Take it at the same time each day.
- Follow the medicine list your care team gives you.
Special instructions:
- Have drug levels checked 12 hours after the last dose of cyclosporine.
- Hold your dose until after blood is drawn on days you have labs.
- Do not eat grapefruit or drink grapefruit juice.
Side effects:
- Headache
- Tremor (hands shake)
- Increased hair growth
- High blood pressure
- Decreased kidney function
- Low magnesium
- High potassium
- Increased risk of infection
- Increased risk of cancer
- Increase risk of diabetes
25 mg capsule
100 mg capsule
Cyclosporine is an anti-rejection (immunosuppressant) medicine. It may also be called Gengraf.
Usual dose:
- Changes with drug levels.
- Drug levels are checked to decide the dose needed to prevent rejection and lessen side effects.
Instructions:
- Take every 12 hours.
- Take with or without food, but it must be the same way each day.
- Take it at the same time each day.
- Shake it well. Use a syringe to measure the dose in milliliters (mL).
Special instructions:
- Have drug levels checked 12 hours after the last dose of cyclosporine.
- Hold your dose until after blood is drawn on days you have labs.
- Do not eat grapefruit or drink grapefruit juice.
Side effects:
- Headache
- Tremor (hands shake)
- Increased hair growth
- High blood pressure
- Decreased kidney function
- Low magnesium
- High potassium
- Increased risk of infection
- Increased risk of cancer
- Increase risk of diabetes
Oral Liquid
1mL = 100 mg
Mycophenolate sodium is an anti-rejection (immunosuppressant) medicine. It may also be called Myfortic.
Usual dose:
- 360 to 720 milligrams (mg).
- Check with a pharmacist before taking antacids or vitamins with aluminum, magnesium, iron, or calcium.
Instructions:
- Take it two times each day without food.
- Take it at the same time each day.
- Do not crush or split tablets.
- Follow the medicine list your care team gives you.
Special instructions:
- It can cause harm to an unborn baby. Do not touch it if you are pregnant or plan to become pregnant.
- Women who are able to get pregnant should be on a specific birth control.
Side effects:
- Nausea
- Vomiting
- Diarrhea
- Stomach pain
- Low platelets
- Increased risk of bleeding
- Low white blood cells
- Increased risk of infection
- Increased risk of cancer
180 mg tablet
360 mg tablet
Mycophenolate mofetil is an anti-rejection (immunosuppressant) medicine. It may also be called Cellcept.
Usual dose:
- 500 to 1,500 milligrams (mg).
- Check with a pharmacist before taking antacids or vitamins with aluminum, magnesium, iron, or calcium.
Instructions:
- Take it two times each day.
- Take it at the same time each day.
- Shake it well. Use a syringe to measure the dose in milliliters (mL).
- Follow the medicine list your care team gives you.
Special instructions:
- It can cause harm to an unborn baby. Do not touch it if you are pregnant or plan to become pregnant.
- Women who are able to get pregnant should be on a specific birth control.
Side effects:
- Nausea
- Vomiting
- Diarrhea
- Stomach pain
- Low platelets
- Increased risk of bleeding
- Low white blood cells
- Increased risk of infection
- Increased risk of cancer
Oral liquid
1 mL = 200 mg
Mycophenolate mofetil is an anti-rejection (immunosuppressant) medicine. It may also be called Cellcept.
Usual dose:
- 500 to 1,500 milligrams (mg).
- Check with a pharmacist before taking antacids or vitamins with aluminum, magnesium, iron, or calcium.
Instructions:
- Take it two times each day.
- Take it at the same time each day.
- Do not crush or split tablets.
- Follow the medicine list your care team gives you.
Special instructions:
- It can cause harm to an unborn baby. Do not touch it if you are pregnant or plan to become pregnant.
- Women who are able to get pregnant should be on a specific birth control.
Side effects:
- Nausea
- Vomiting
- Diarrhea
- Stomach pain
- Low platelets
- Increased risk of bleeding
- Low white blood cells
- Increased risk of infection
- Increased risk of cancer
250 mg capsule
500 mg tablet
Prednisone is an anti-rejection (immunosuppressant) medicine. It may also be called Deltasone.
Usual dose:
- Changes with time.
- Slow decreases.
Instructions:
- Take it one or two times each day with food.
- Do not stop taking it suddenly.
- Follow the medicine list your care team gives you.
Special instructions:
- It can cause an upset stomach. You may need medicine to protect your stomach.
- It can cause bone loss, so calcium and vitamin D supplements may be added.
- It will make you more sensitive to the sun. Use sunscreen to prevent sunburn.
Side effects:
- Increased appetite
- Weight gain
- Puffy face
- Upset stomach
- Fluid retention
- Mood changes (irritability)
- Insomnia (not able to sleep)
- Skin rash (acne)
- Muscle weakness
- High blood pressure
- High blood sugars
- Increased risk of infection
- Increased risk of cancer
5 mg tablet
10 mg tablet
Sirolimus is an anti-rejection (immunosuppressant) medicine. It may also be called Rapamune.
Usual dose:
- Changes with drug levels.
- Drug levels are checked to decide the dose needed to prevent rejection and decrease side effects.
Instructions:
- Take it once each day in the morning.
- Take it with or without food, but it must be the same way each day.
- Take it at the same time each day.
- Shake it well. Use a syringe to measure the dose in milliliters (mL).
- Follow the medicine list your care team gives you.
Special instructions:
- Have drug levels checked 24 hours after the last dose.
- Hold your dose until after blood is drawn on days you have labs.
- Do not eat grapefruit or drink grapefruit juice.
- Call the transplant team if you need to have a surgery or procedure.
Side effects:
- Mouth sores
- Skin rash (acne)
- Leg swelling
- Weight gain
- Poor wound healing
- High cholesterol and triglycerides
- Low platelets
- Increased risk of bleeding
- Low white blood cells
- Increased risk of infection
Oral Liquid
1mL = 1 mg
Sirolimus is an anti-rejection (immunosuppressant) medicine. It may also be called Rapamune.
Usual dose:
- Changes with drug levels.
- Drug levels are checked to decide the dose needed to prevent rejection and decrease side effects.
Instructions:
- Take it once each day in the morning.
- Take it with or without food, but it must be the same way each day.
- Take it at the same time each day.
- Follow the medicine list your care team gives you.
Special instructions:
- Have drug levels checked 24 hours after the last dose.
- Hold your dose until after blood is drawn on days you have labs.
- Do not eat grapefruit or drink grapefruit juice.
- Call the transplant team if you need to have a surgery or procedure.
Side effects:
- Mouth sores
- Skin rash (acne)
- Leg swelling
- Weight gain
- Poor wound healing
- High cholesterol and triglycerides
- Low platelets
- Increased risk of bleeding
- Low white blood cells
- Increased risk of infection
0.5 mg tablet
1 mg tablet
2 mg tablet
Tacrolimus is an anti-rejection (immunosuppressant) medicine. It may also be called Prograf.
Usual dose:
- Changes with drug levels.
- Drug levels are checked to decide the dose needed to prevent rejection and decrease side effects.
Instructions:
- Take it every 12 hours.
- Take it with or without food, but it must be the same way each day.
- Take it at the same time each day.
- Follow the medicine list your care team gives you.
Special instructions:
- Have drug levels checked 12 hours after the last dose.
- Hold your dose until after blood is drawn on days you have labs.
- Do not eat grapefruit or drink grapefruit juice.
Side effects:
- Headache
- Tremors (hands shaking)
- Tingling (nerve pain)
- Decreased kidney function
- Low magnesium
- High potassium
- High blood pressure
- Increased risk of diabetes
- Increased risk of cancer
- Increased risk of infection
0.5 mg capsule
1 mg capsule
5 mg capsule
Tacrolimus is an anti-rejection (immunosuppressant) medicine. It may also be called Prograf.
Usual dose:
- Changes with drug levels.
- Drug levels are checked to decide the dose needed to prevent rejection and decrease side effects.
Instructions:
- Take it every 12 hours.
- Take it with or without food, but it must be the same way each day.
- Take it at the same time each day.
- Shake it well. Use a syringe to measure the dose in milliliters (mL).
- Follow the medicine list your care team gives you.
Special instructions:
- Have drug levels checked 12 hours after the last dose.
- Hold your dose until after blood is drawn on days you have labs.
Side effects:
- Headache
- Tremors (hands shaking)
- Tingling (nerve pain)
- Decreased kidney function
- Low magnesium
- High potassium
- High blood pressure
- Increased risk of diabetes
- Increased risk of cancer
- Increased risk of infection
1mL = 0.5 mg
Infection prophylaxis medicine
As a transplant patient, you are at a higher risk of infection and will take medicines to lower your risk of infection.
Anti-rejection medicines lower your ability to fight infections, so these medicines are important because they help protect you from harmful infections.
These medicines lower your risk of:
- Viral infections
- Cytomegalovirus (CMV): Risk depends on you and your donor's exposure to the virus
- Herpes simplex virus (HSV)
- Fungal infections
- Thrush: The highest risk of this infection is while taking high doses of prednisone
- Lung infections
- Pneumocystis pneumonia (PCP): You are at higher risk due to anti-rejection medicines
Your care team will change medicines based on your infection risk.
Vaccines (immunizations) are also very important to protect you from infection. Follow these guidelines to help lower your risk.
- Stay up to date on recommended vaccines.
- Get an influenza (flu) and COVID-19 vaccine each year.
- Do not get live vaccines.
- The transplant team will tell you when it is safe to get vaccines after your transplant.
Acyclovir prevents or treats a viral infection called herpes simplex virus (HSV). It may also be called Zovirax.
Usual dose:
- Varies
Instructions:
- Take it two to four times each day.
- Take it with or without food, but it must be the same way each day.
- Take it at the same time each day. Do not miss a dose.
- Follow the medicine list your care team gives you.
Side effects:
- Headache
- Nausea
- Vomiting
- Diarrhea
200 mg capsule
400 mg tablet
800 mg tablet
Atovaquone prevents a lung infection called pneumocystis pneumonia (PCP). It may also be called Mepron.
Usual dose:
- 10 mL (1,500 mg)
Instructions:
- Take it once each day with food.
- Shake it well. Use a syringe to measure the dose in milliliters (mL).
- Follow the medicine list your care team gives you.
Side effects:
- Headache
- Nausea
- Vomiting
- Diarrhea
Oral liquid
1 mL = 150 mg
Sulfamethoxazole/Trimethoprim prevents toxoplasmosis and a lung infection called pneumocystis pneumonia (PCP). It may also be called Bactrim.
Usual dose:
- 10 mL (400-80 mg) or 20 mL (800-160mg)
Instructions:
- Take it once each day or three times a week.
- Take it with a full glass of water.
- Shake it well. Use a syringe to measure the dose in milliliters (mL).
- Follow the medicine list your care team gives you.
Special instructions:
- Take it with food or milk if it upsets your stomach.
- Use sunscreen when you are outside to prevent sunburn.
Side effects:
- Headache
- Nausea
- Vomiting
- Diarrhea
- Stomach pain
- Skin rash
- Low white blood cells
- High potassium
- Sun sensitivity
Oral liquid
1 mL = 400-80 mg
Sulfamethoxazole/Trimethoprim prevents toxoplasmosis and a lung infection called pneumocystis pneumonia (PCP). It may also be called Bactrim.
Usual dose:
- Single strength tablet (400-80 mg) or double strength tablet (800-160 mg)
Instructions:
- Take it once each day or three times each week.
- Take it with a full glass of water.
- Follow the medicine list your care team gives you.
Special instructions:
- Take it with food or milk if it upsets your stomach.
- Use sunscreen when you are outside to prevent sunburn.
Side effects:
- Headache
- Nausea
- Vomiting
- Diarrhea
- Stomach pain
- Skin rash
- Low white blood cells
- High potassium
- Sun sensitivity
400-80 mg single strength (SS) tablet
800-160 mg double strength (DS) tablet
Clotrimazole prevents or treats a fungal infection in the mouth called thrush. It may also be called Mycelex.
Usual dose:
- 10 milligrams (mg)
Instructions:
- Take it three to four times each day.
- Let it dissolve in your mouth. Do not chew or swallow the lozenges.
- Take it at the same time each day. Do not miss doses.
- Follow the medicine list your care team gives you.
Special instructions:
- Do not eat or drink for 30 minutes after each dose.
- It changes anti-rejection drug levels. You will need close monitoring and dose changes.
Side effects:
- Nausea
- Vomiting
- Unusual taste in mouth
10 mg troche/lozenge
Isavuconazonium sulfate prevents or treats fungal infections, including thrush (a fungal infection in the mouth). It may also be called Cresemba.
Usual dose:
- 372 mg (two capsules)
Instructions:
- Take it once each day.
- Take it with or without food. Take it the same way each day.
- Take it at the same time each day. Do not miss doses.
- Follow the medicine list your care team gives you.
Special instructions:
- It changes anti-rejection drug levels. You will need close monitoring and dose changes.
Side effects:
- Nausea
- Vomiting
- Constipation or diarrhea
- Rash
- Headache
- Decreased liver function
172 milligram (mg) capsule
Dapsone prevents a lung infection called pneumocystis pneumonia (PCP). It may also be called Avlosulfon.
Usual dose:
- 100 milligrams (mg)
Instructions:
- Take it once each day.
- Take it with or without food. Take it the same way each day.
- Take it with food or milk if it upsets your stomach.
- Follow the medicine list your care team gives you.
Side effects:
- Nerve pain
- Low red blood cell count (anemia)
100 mg tablet
Fluconazole prevents or treats fungal infections, including thrush (a fungal infection in the mouth). It may also be called Diflucan.
Usual dose:
- 100 to 400 milligrams (mg)
Instructions:
- Take it once each day.
- Take it with or without food. Take it the same way each day.
- Take it at the same time each day. Do not miss doses.
- Follow the medicine list your care team gives you.
Special instructions:
- It changes anti-rejection drug levels. You will need close monitoring and dose changes.
Side effects:
- Headache
- Nausea
- Vomiting
- Diarrhea
- Rash
- Decreased liver function
100 mg tablet
200 mg tablet
Nystatin prevents or treats a fungal infection in the mouth called thrush. It may also be called Bio-Statin.
Usual dose:
- 5 mL
Instructions:
- Take it four times each day, after meals and before bed.
- Swish and swallow it.
- Shake it well. Use a syringe to measure the dose in milliliters (mL).
- Follow the medicine list your care team gives you.
Special instructions:
- Do not eat or drink for 30 minutes after each dose.
Side effects:
- Unusual taste in mouth
- Nausea
Oral liquid
1 mL = 100,000 units
Pentamidine prevents a lung infection called pneumocystis pneumonia (PCP). It may also be called Nebupent.
Usual dose:
- 300 milligrams (mg)
Instructions:
- Take it once every four weeks.
- It is inhaled using a nebulizer.
- A nebulizer will turn the medicine into a mist for you to inhale (breathe in).
- This has to be given at a health care facility.
- Follow the medicine list your care team gives you.
Special instructions:
- Use an albuterol inhaler before the treatment to prevent shortness of breath.
Side effects:
- Unusual taste in mouth
- Shortness of breath
- Cough
300 mg solution
Nebulizer
Valganciclovir prevents or treats viral infections called cytomegalovirus (CMV) and herpes simplex virus (HSV). It may also be called Valcyte.
Usual dose:
- 9 mL (450 mg) or 18 mL (900 mg)
Instructions:
- Take it two times each day (9 mL) or once each day (18 mL)
- Shake it well. Use a syringe to measure the dose in milliliters (mL).
- Follow the medicine list your care team gives you.
Special instructions:
- The dose may change based on kidney function.
- Drink plenty of water while you are taking this medicine.
Side effects:
- Headache
- Nausea
- Vomiting
- Diarrhea
- Stomach pain
- Low platelets
- Increased risk of bleeding
- Low white blood cells
Oral liquid
1 mL = 50 mg
Valganciclovir prevents or treats viral infections called cytomegalovirus (CMV) and herpes simplex virus (HSV). It may also be called Valcyte.
Usual dose:
- 450 milligrams (mg) or 900 mg
Instructions:
- Take it two times each day (450 mg) or once each day (900 mg).
- Follow the medicine list your care team gives you.
Special instructions:
- The dose may change based on kidney function.
- Drink plenty of water while you are taking this medicine.
Side effects:
- Headache
- Nausea
- Vomiting
- Diarrhea
- Stomach pain
- Low platelets
- Increased risk of bleeding
- Low white blood cells
450 mg tablet
Voriconazole prevents or treats fungal infections, including thrush (a fungal infection in the mouth). It may also be called Vfend.
Usual dose:
- 200 milligrams (mg)
Instructions:
- Take it two times each day.
- Take on an empty stomach (one hour before or one hour after meals).
- Take it at the same time each day. Do not miss doses.
- Follow the medicine list your care team gives you.
Special instructions:
- It changes anti-rejection drug levels. You will need close monitoring and dose changes.
- Women of child-bearing age should handle this medicine with gloves.
Side effects:
- Headache
- Nausea
- Vomiting
- Diarrhea
- Rash
- Decreased liver function
- Visual disturbances
200 mg tablet