Helping teens understand their medications is a key part of building safe and effective self-management skills as they transition to adult providers. When AYAs know the purpose of each medication, how and when to take it, and what to watch for side effects, they are more likely to take ownership of their routine and have better adherence. This knowledge also supports better communication with providers and helps teens recognize when something isn’t right. Taking time to engage them in age-appropriate education can improve confidence, reduce errors, promote transparency, and lay the groundwork for a smooth transition to adult care
Post-Transplant Medications
Maintenance immunosuppression, usually with a calcineurin inhibitor, is used to prevent graft rejection. Tacrolimus, sirolimus, or cyclosporin are most commonly prescribed. These medications are usually taken every 12 hours to maintain a therapeutic level. The level may be affected by some foods (grapefruit, starfruit, pomegranate) and other medications (fluconazole, erythromycin). Some patients are also prescribed prednisone, particularly early on after transplant or during treatment for rejection. Additional agents include azathioprine, mycophenolate mofetil or sirolimus. The dose of the medication is adjusted based on graft function, trough levels, and concomitant rejection or infection.
Infection prophylaxis is used to prevent transplant-related infections, particularly in the early post-transplant period or during treatment for rejection. These agents include antiviral medications (valganciclovir), antifungal medications (nystatin, fluconazole), and antibiotics (trimethoprim-sulfamethoxazole, Pen VK). Antibiotics for prophylaxis against urinary tract infection may be indicated for some patients.
Most immunosuppressive medications are prescribed every 12 hours. Remind AYAs that labs should be done prior to taking their antirejection medications to ensure that an accurate 12-hour trough level is obtained for tacrolimus, sirolimus, cyclosporin, and/or mycophenolate.
Discuss how to adjust administration times if a dose is missed. Teens are usually advised to take the missed dose as soon as they remember. If it is near the time for the next dose (about two hours), that dose will be missed and they will resume the regular dosing schedule. Teens should be strongly encouraged to call their transplant coordinator or pharmacist if they are missing doses for advice on how to get back on track. They should be aware that immunosuppression levels may need to be monitored more frequently until stable.
Remind teens that ibuprofen (Motrin®) and other nonsteroidal anti-inflammatories (NSAIDs) can be nephrotoxic and should be avoided. Acetaminophen (Tylenol®) is usually recommended for discomfort, pain, or fever.
Encourage the AYA to avoid herbal products and remedies since these products have not been tested for effectiveness, side effects, and drug interactions by the FDA. Some herbal remedies may interact with prescribed medications and affect immunosuppression levels or graft function.
Providers should review common medication side effects with teens in a developmentally appropriate manner. In addition, they should be aware of the most common drug interactions as listed below. Teens should be reminded to always contact their transplant team if they have questions about their medications or if another provider is starting a new medication.
It is essential that AYAs develop a clear understanding of their medications, including purpose, dosing, timing, and potential side effects, as this knowledge directly supports adherence and long-term graft health. Ongoing teaching and reinforcement by the transplant team help teens build confidence, independence, and accountability as they transition toward managing their own care. The transplant pharmacist plays a critical role in this process—providing detailed education, identifying potential interactions, addressing barriers, and helping tailor regimens to fit the teen’s daily routine. Consistent, team-based messaging ensures that medication education is not a one-time task, but a continuous, supportive effort.
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