Immunosuppressant medicines and your transplant

Transcription

1 Immunosuppressant medicines and your transplant

2 ESPRIT stands for Efficacy and Safety of PRescribing In Transplantation. As a multidisciplinary group, comprised of various relevant disciplines including clinicians, pharmacists, and primary care representatives, we share a common commitment to ensure the continued, effective and safe treatment of transplant patients through education of healthcare professionals and patients. The Group was first convened back in 2000, and our activities have been supported by a wide range of professional and patient bodies in the transplant community. Solid-organ transplants are the best possible treatment for most people with organ failure, but the survival of the graft and frequently the patient depends on treatment with immunosuppressive medicines to prevent rejection of the transplanted organ. Whilst the initial focus of the Group was on ciclosporin, attention subsequently turned to a range of other available immunosuppressants and to other areas with the potential to impact the wellbeing of transplant patients, including management of prescribing within the NHS and NICE guidance on immunosuppressant use. The aim of this ESPRIT resource is to give transplant patients the essential information needed to help follow their transplant unit s advice on when and how to take their immunosuppressants. All the ESPRIT materials and associated resources can be accessed via our website For further information, please the ESPRIT Group Secretariat on info@esprit.org.uk.

3 Immunosuppressant medicines and your transplant After an organ transplant, you need to take medicines to stop you from rejecting your new organ. These anti-rejection drugs are called immunosuppressants, because they work by reducing or suppressing your immune system s natural defences and prevent them from attacking your transplant. The aim of this guide is to give you the essential information you need to help you to follow your transplant unit s advice on when and how to take your immunosuppressants. How you take your immunosuppressants is very important, especially now that there are several different versions of some of these medicines. The different versions of these immunosuppressant medications can be divided into the original drug and generics, which are approved copies of the original drug. Some of these generics are called only by the of the chemical (for example, tacrolimus), while others have a brand (for example, Adoport). The original drug and the generics are not always absolutely the same. So it is very important not to switch between them, unless advised by your transplant unit. Important things to remember about your immunosuppressants Take your immunosuppressants every day as advised by your transplant unit. Rejection can happen at any time after your transplant, because your immune system will never forget that your transplant is foreign to you. Always check with your transplant unit before taking any other medicines, which might interfere with your immunosuppressants. Other medicines include herbal or complementary medicines, as well as medicines prescribed by a health professional or bought over the counter. Talk to your transplant unit if you think your immunosuppressants are making you feel unwell. Like other medicines, immunosuppressants can have side effects that may cause problems for some people. Telephone your transplant unit for advice if you are sick after taking your immunosuppressants. Your doctors will need to advise you about your next dose. Never stop taking or change the dose of your immunosuppressants unless advised by your transplant doctor, nurse or pharmacist. Always take the same brand of your immunosuppressants be they an original brand or a generic.

4 Stages of immunosuppression Induction immunosuppression The risk of rejection is especially high during the first few months after your transplant. So at the time of the transplant operation, induction immunosuppression is given as an injection of an antibody drug such as basiliximab (Simulect), alemtuzumab (MabCampath) or antithymocyte immunoglobulin (Thymoglobuline). You also start taking your oral immunosuppression (see below) beginning with high doses that are gradually lowered to become your maintenance immunosuppression. Maintenance immunosuppression Maintenance immunosuppression is taken for the life of your transplant and helps to keep or maintain your transplant for as long as possible. Too little immunosuppression could risk rejection, while too much can increase your risk of infection and side effects. So most people take a combination of medicines that is individually tailored to their needs. There are several drugs, but most people take a combination of: Tacrolimus or ciclosporin Mycophenolate mofetil (MMF) or mycophenolate sodium (MPS) or azathioprine Prednisolone Other immunosuppressants include sirolimus, everolimus and belatacept. These are generally given to people who cannot take the usual combination of immunosuppressants.

5 Tacrolimus Take tacrolimus once or twice daily depending on the brand, and take it at the same time(s) every day: either every 12 hours (twice-daily versions) or every 24 hours (oncedaily versions). Swallow tacrolimus whole with water or juice (but never grapefruit juice or grapefruit). Food can affect the amount of tacrolimus absorbed into your blood. So always take it either an hour before food or two hours after food. Common side effects of tacrolimus include: altered kidney function; shakiness of the hands; upset stomach; headache, hair thinning/loss; high blood pressure; high blood sugar. For more information on side effects, read the leaflet in the tacrolimus pack. Do not take your dose of tacrolimus on transplant clinic days until your blood tests have been done. This is important to give your doctors essential information about the level of tacrolimus in your blood. Tacrolimus is available under several brand s that are not exactly the same. So only change your dose or brand of tacrolimus if advised by your transplant unit. It is especially important to avoid swapping between once-daily and twice-daily versions of tacrolimus unless advised by your transplant unit. If you accidentally take the wrong brand or the wrong dose of tacrolimus, contact your transplant unit urgently for advice. Taken twice a day Prograf 0.5 mg Light yellow hard capsule imprinted in red with 0.5 mg and [f] mg White hard capsule imprinted in red with 1 mg and [f] mg Greyish-red hard capsule imprinted in white with 5 mg and [f] 657 Modigraf 0.2 mg 1 mg White granules, to be dissolved. Taken by mouth Adoport 0.5 mg White and ivory, hard capsule 0.75 mg Light green, hard capsule imprinted with 0.75mg in black 1 mg White and light brown, hard capsule 2 mg Dark green hard capsule imprinted with 2 mg in black 5 mg Opaque, white and orange hard capsule Capexion 0.5 mg Ivory capsule Tacni 0.5 mg Ivory hard capsule 1 mg White hard capsule 5 mg Red hard capsule

6 Taken once a day Advagraf 0.5 mg Hard capsule imprinted in red with 0.5 mg on the light yellow capsule cap and 647 on the orange capsule body 1 mg Hard capsules imprinted in red with 1 mg on the white capsule cap and 677 on the orange capsule body 3 mg Hard capsules imprinted in red with 3 mg on the orange capsule cap and 637 on the orange capsule body 5 mg Hard capsules imprinted in red with 5 mg on the greyish-red capsule cap and 687 on the orange capsule body Envarsus 0.75 mg Oval, white to off-white tablet, with 0.75 on one side and TCS on the other side 1 mg Oval, white to off-white tablet, with 1 on one side and TCS on the other side 4 mg Oval, white to off-white tablet, with 4 on one side and TCS on the other side Note: Envarsus is similar to an original medicine. It contains tacrolimus but has been made in a different way and at different doses to Advagraf Ciclosporin Take ciclosporin twice a day, 12 hours apart, at the same times every day. Swallow your ciclosporin whole with water or juice (but never grapefruit juice or grapefruit). Food can affect the amount of ciclosporin absorbed into your blood, so always take it either with food or without food. Common side effects of ciclosporin include: altered kidney function; shakiness of the hands; upset stomach; headache; increased hair growth; high blood pressure; swollen gums. For more information on side effects, read the leaflet in the ciclosporin pack. Take your ciclosporin on transplant clinic days as advised by your transplant team. This is important to give your doctors essential information about the level of ciclosporin in your blood. Ciclosporin is available under several brand s that are not exactly the same. So only change your dose or brand of ciclosporin if advised by your transplant unit. If you accidentally take the wrong brand or the wrong dose of your ciclosporin contact your transplant unit urgently for advice.

7 Neoral 10 mg Yellow-white, oval soft capsule imprinted NVR 10 in red 25 mg Blue-grey, oval soft capsule, imprinted with NVR 25mg in red Yellow-white, oblong soft capsule, imprinted with NVR 50mg in red 100 mg Blue-grey, oblong soft capsule, imprinted with NVR 100mg in red Sandimmune 25 mg Capimune Capsorin Deximune Vanquoral Pink, oval soft capsule Corn-yellow, oblong soft capsule 100 mg Dusty-rose, oblong soft capsule 25 mg Grey soft capsule White soft capsule 100 mg Grey soft capsule 25 mg Grey soft capsule White soft capsule 100 mg Grey soft capsule 25 mg Grey soft capsule imprinted with DX 25 mg Grey soft capsule imprinted with DX 100 mg Grey soft capsule imprinted with DX 100 mg 10 mg White to off-white soft capsule 25 mg Yellow soft capsule with the IVAX hourglass logo and 25 mg Ochre-yellow soft capsule with the IVAX hourglass logo and 100 mg Brown soft capsule, with the IVAX hourglass logo and 100 mg

8 Mycophenolate mofetil (MMF) Take MMF twice a day. It can be taken with or without food, but aim to take it at the same times every day. Common side effects of MMF include: upset stomach, especially diarrhoea; higher risk of infections. For more information on side effects, read the leaflet in the MMF pack. MMF is available as several brands and generics. It should be possible to switch without problems, but always contact your transplant unit if you are concerned. Unless advised by your transplant unit never switch between MMF and mycophenolate sodium (Myfortic). This is because they are different drugs. CellCept 2 Oblong, blue/brown capsule printed with CellCept 250 on the capsule cap and Roche on the capsule body 500 mg Lavender caplet-shaped tablet, engraved with CellCept 500 on one side and ROCHE on the other 2 Capsule with a caramel body printed with 250 in black, and a light blue cap printed with M in black 500 mg Pale purple, oval tablet, with M500 on one side Myfenax Mycophenolate sodium (MPS) Take MPS twice a day. It can be taken with or without food, but aim to take it at the same times every day. Common side effects of MPS include: upset stomach, especially diarrhoea; higher risk of infections. For more information on side effects, read the leaflet in the MPS pack. Unless advised by your transplant unit, never switch between MPS and mycophenolate mofetil (MMF). This is because they are different drugs. Myfortic 180 mg Lime green round tablet with C on one side 360 mg Pale orange-red oval tablet with CT on one side Ceptava 180 mg Lime green round tablet with C on one side 360 mg Pale orange-red oval tablet with CT on one side

9 Azathioprine Take azathioprine once daily at the same time every day. Azathioprine can upset your stomach, so take it with or after food. Common side effects of azathioprine include: higher risk of infections; upset stomach, especially feeling sick; hair thinning/loss. For more information on side effects, read the leaflet in the azathioprine pack. Azathioprine can cause allergic reactions. Contact your transplant unit immediately if you develop a skin rash, bone or muscle pain. Azathioprine can cause liver problems. Contact your transplant unit immediately if you notice yellowing of your skin or whites of your eyes, stomach pains or itching. Azathioprine is available as branded and unbranded generics. It should be possible to switch without problems, but always contact your transplant unit if you are concerned. Imuran 25 mg Orange round tablets marked with GL EL5 Yellow, round, scored tablets marked with GX CHI Azapress Pale yellow table scored on one side and marked with A10 Prednisolone Take prednisolone once daily with or after food at the same time every day. It is best to take prednisolone in the morning, as it can disturb your sleep. Do not take antacids at the same time as you take prednisolone. Common side effects of prednisolone include: upset stomach and indigestion; fluid retention (for example, swollen ankles); acne; weight gain; mood changes; high blood sugar; high blood pressure; muscle weakness; thinning of the bones; eye problems. For more information on side effects, read the leaflet in the prednisolone pack. Never stop taking prednisolone without advice from your doctor. Your doctor, nurse or pharmacist should give you a steroid card. Carry the card with you at all times and show it to anyone treating you, such as another doctor or a dentist. Prednisolone is available as a plain, white 5 mg generic tablet. Do not take the red gastroresistant tablets. This may lead to lower levels of prednisolone in your blood and increase the risk of rejection.

10 Sirolimus Take sirolimus once daily at the same time every day. Swallow your sirolimus whole with water or juice (but never grapefruit juice or grapefruit). Food can affect the amount of sirolimus absorbed into your blood, so always take it either with food or without food. The 0.5 mg sirolimus tablets are not chemically the same as the 1 mg and 2 mg tablets. So do not take two or four 0.5 mg tablets if your dose is 1 mg or 2 mg. Common side effects of sirolimus include: swollen ankles, hands and feet; upset stomach; mouth ulcers; nosebleeds; acne; high cholesterol. For more information on side effects, read the leaflet in the sirolimus pack. Rapamune 0.5 mg Tan triangular tablet marked RAPAMUNE 0.5 mg on one side. 1 mg White triangular tablet marked RAPAMUNE 1 mg on one side 2 mg Yellow to beige triangular tablet marked RAPAMUNE 2 mg on one side Everolimus Take everolimus twice daily at the same times every day. Swallow your everolimus whole with water or juice (but never grapefruit juice or grapefruit). Food can affect the amount of everolimus absorbed into your blood, so always take it either with food or without food. Common side effects of everolimus include: swollen ankles, hands and feet; upset stomach; mouth ulcers; nosebleeds; acne; high cholesterol. For more information on side effects, read the leaflet in the everolimus pack. Certican 0.25 mg Round, flat, white to yellowish marbled tablet with C on one side and NVR on the other 0.5 mg Round, flat, white to yellowish marbled tablet with CH on one side and NVR on the other 0.75 mg Round, flat, white to yellowish marbled tablet with CL on one side and NVR on the other

11 Belatacept Belatacept is given every four weeks by an infusion into a vein. The infusion takes about 30 minutes and is given in hospital. You may not be able to receive belatacept if: you have not been exposed to Epstein Barr virus (EBV) before your transplant; you are infected with cytomegalovirus (CMV); or you have received treatment for acute rejection. This is because belatacept may increase your risk of a type of cancer called post-transplant lymphoproliferative disorder (PTLD). Belatacept can cause tiredness and/or sickness that may affect your ability to drive or operate machines. Other common side effects of belatacept include: shortness of breath; changes in blood pressure; pain in the joints; headache; upset stomach; high cholesterol; high blood sugar. For more information on side effects, talk to your transplant doctor, nurse or pharmacist. Nulojix White to off-white powder to be mixed with sterile water, saline solution, or glucose solution

12 The ESPRIT Group is constituted as an independent company limited by guarantee, full ESPRIT Partnership Ltd., registered in England and Wales no Registered office: 6 Baldwin Crescent, London, SE5 9LQ. Its activities are open to support by educational grants from interested parties. These have included Novartis Pharmaceuticals UK Ltd., Astellas Pharma Ltd., Sandoz Ltd., Mylan and Chiesi Ltd. However, as an independent group, we do not advocate any particular product and our opinions, recommendations and activities are all our own. Date of preparation: September 2017