Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to email@example.com
This is a conclusion of last week’s discussion about the medication used to prevent your body rejecting the new kidneys. Last week I discussed Neoral®, Prograf® and Deltacortil®, this week I discuss Rapamune® and Cellcept. Anti-rejection medication must be taken long term. While I specifically deal with kidney transplants this week, much of the advice I give is true for any type of transplant (eg) Heart, lung, liver.
Sirolimus may be combined with other immunosuppressive medications to prevent organ rejection. If you forget a dose of Sirolimus, take your missed dose as soon as possible and get back on schedule with the next dose. Never double up a dose.
Side Effects of sirolimus can include:
Headaches; swelling; tremor; insomnia; diarrhoea, nausea, vomiting; constipation and bloating; low platelet count or anaemia; high or low potassium levels; diabetes; back or abdominal pain; cough; skin rashes; acne and high cholesterol
You blood counts (white blood cells, platelets, haemoglobin) need to be monitored while on Sirolimus. It can cause anaemia (low red blood cells), if it does, the Sirolimus dose will be lowered or held for a while and you may be prescribed Erthropoietin (Aranesp®). Erythropoietin is a naturally occurring hormone produced in the kidneys to produce red blood cells. Neupogen® may be prescribed if neutrophils (a type of white blood cell) are low as Sirolimus can cause neutropenia (low levels of neutrophils).
Mycophenolate Mofetil (Cellcept®)
Mycophenolate Mofetil (Cellcept®) may be combined with other immunosuppressive medications to prevent organ rejection. It is usually taken two to four times a day and the usual total daily dose is 1000-2000mg.
Side Effects of Cellcept® can include:
Nausea and vomiting; diarrhoea or constipation; stomach pains and cramps; low white blood cell count; anaemia; high or low potassium levels; tremor; headaches; diabetes and insomnia. Blood counts (white blood count and haemoglobin) must be monitored regularly while taking Cellcept®. If blood counts are less than the normal range, Cellcept® may be lowered or held. Neupogen® will need to prescribed to increase white cell count or Erythropoietin (Aranesp®) will need to prescribed to increase red cell count.
Interactions with transplant drugs
Some medications interfere with the immunosuppressive medications used to prevent transplant rejection. Antibiotics to avoid include clarithromycin (Klacid®), erythromycin and azithromycin (Zithromax®). Other drugs to avoid include the antifungal fluconazole (Diflucan®) and the heart rhythm drug diltiazem (Dilzem®).
AVOID grapefruit or grapefruit juice when prescribed immunosuppressants like Neoral®, Prograf® or Rapamune® as grapefruit changes the metabolism of these medications. Avoid antacids such as Rennies®, Maalox® or Gaviscon® within 2 hours of taking your medications as they may reduce absorption of many anti-rejection drugs. Herbs can cause serious interactions with kidney transplant drugs. Some herbs reduce the effectiveness of transplant rejection medication or cause other kidney problems. To be safe, transplant patients should avoid herbal preparations.
Organ Donor Awareness Week
Next week is Organ Donor awareness week (April 1st to 8th) so if you have not got an organ donor card get one from now from your local pharmacy. You can also request a donor card from the Irish Kidney Association in one of the following ways:
- email: firstname.lastname@example.org
- freetext DONOR to 50050
- lo call 1890 543639
- By post to: Freepost, Donor House, Irish Kidney Association, Park West, Dublin 12
Give the gift of life by getting an organ donor card from the Irish Kidney Association on LoCall 1890 543639 or www.ika.ie