What medications are used for liver transplant?The first 3 months after transplantation is when the patient requires the most medication. After that time, some medicines can be stopped or their dosages decreased. Some of the medication is dosed according to the patient's weight. It is important for the patient to be familiar with the medications. It is also important to note their side effects and to understand that they may not occur with everyone. The side effects may lessen or disappear as the doses of medicine are lowered over
time. Not every patient having a liver transplant takes the same medications.
Liver transplant recipients are generally prescribed two types of medications: immunosuppressive medications to prevent rejection and antibiotics to prevent infections. Most patients will be maintained on a primary immunosuppressive agent, either Tacrolimus (Prograf) or Cyclosporine (Neoral). One of these agents is generally taken for life following a transplant. Cyclosporine A (Neoral/Sandimmune) helps prevent rejection. It comes in pill and liquid form. If the liquid is given, it is important to mix the liquid in apple juice, orange juice, white milk, or chocolate milk. The patient can "shoot" it directly into the mouth and then follow it with any liquid. Cyclosporine should not be mixed in a paper or Styrofoam cup because they absorb the drug. It should only be mixed in a glass container directly before taking the drug. Tacrolimus (Prograf) helps prevent and treat rejection and works in a similar way to cyclosporine. Certain medications and substances, including alcohol, antibiotics, antifungal medicines, and calcium channel blockers (high blood pressure medications), may elevate levels of tacrolimus and cyclosporine. Other medications, including antiseizure medicines (phenytoin and barbiturates) and other antibiotics, may decrease tacrolimus and cyclosporine levels. Patients usually require a higher dose of these agents immediately following their transplant because rejection more commonly occurs in the first three months. In time, the dose is lowered, but lifelong therapy is necessary.
Some patients may be on additional immunosuppressive agents, such as rapamycin (Rapamune), mycophenolate (Cellcept) or prednisone. Most of the additional agents are given for only short periods of time (two to six months). Each of these agents has its own side effects. Prednisone (Deltasone, Meticorten), a steroid, acts as an immunosuppressant to decrease the inflammatory response. Initially, prednisone is given intravenously. Later, prednisone is given in pill form. Azathioprine (Imuran) is an immunosuppressant that acts on the bone marrow by decreasing the amount of cells that would attack the new liver. The dose is based on the person's weight and white blood cell count. Muromonab-CD3 (Orthoclone OKT3) is an immunosuppressant used for people who are rejecting the transplant, for those in whom prednisone is not working well enough, and for those who cannot take tacrolimus or cyclosporine. Sirolimus (Rapamune) is an antibiotic used as an immunosuppressant. Sulfamethoxazole-trimethoprim (Bactrim, Septra), an antibiotic, acts to prevent Pneumocystis carinii pneumonia, which occurs more often in people who are immunosuppressed. Acyclovir/ganciclovir (Zovirax/Cytovene) acts to prevent viral infections in people who are immunosuppressed. These drugs work particularly against cytomegalovirus (a type of herpes virus) infection.