Your transplant team prescribes anti-rejection medications to keep you healthy and to prevent your immune system from attacking your transplanted organ. They also prescribe medicines that help in other ways. These medicines help protect you from infections, manage side effects from your anti-rejection medicines, and can also help keep your transplant organ healthy. All these medications work together so that you feel well!
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Taking your anti-rejection meds is key—but they’re not the only medications that matter. You may also be on other meds that help keep your body in balance and protect your health after transplant. These can help strengthen your bones, control your blood pressure, keep your electrolytes (like magnesium and potassium) in a healthy range, protect your stomach, and help prevent infections. Your transplant team prescribes these based on what your body needs.
Preventing Infection
Since you have had a transplant, your immune system has been suppressed – or weakened - so your body doesn’t reject the transplanted organ. Because of that, you can catch things—like colds, the flu, or other infections—more easily than most people. It doesn’t mean you’ll always get sick, but you do have to be a bit more careful.
Different germs can cause infections:
- Bacteria (like the kind that cause strep throat)
- Viruses (like the flu, a cold, or COVID)
- Fungi (like certain rashes, and infections in the mouth or lungs)
Paying attention to the early signs of infection—like fever, chills, or just not feeling right—can help you get treated quickly before things get serious. If you have an infection, your treatment may be with one of these types of medications.
- Antibiotics prevent infections caused by bacteria. These infections usually happen in the first few months after your transplant when your immunosuppression levels are high. Many patients take Bactrim™ after transplant to prevent a certain type of pneumonia. This may be prescribed for several months or even years after transplant. And just like anyone, you may also get common bacterial infections, such as a urinary tract infection, a skin infection (cellulitis), or a sinus infection which are treated with antibiotics.
- Antivirals protect you against certain viruses that may occur after transplant, like cytomegalovirus (CMV), herpes, or Epstein-Barr (EBV). If you get one of these viruses you may need to take an antiviral medication such as valganciclovir (Valcyte™), acyclovir (Zovirax™), or letermovir (Plevymis™) for several weeks or longer.
- Antifungals prevent or treat infections from fungus which can be more common in people who have had a transplant. Many patients swish and swallow nystatin (Mycostatin™) a couple times a day to prevent or treat thrush, a fungal infection that can appear on inside of your mouth and on your tongue. This infection can happen right after transplant or when you are being treated for rejection with higher levels of immunosuppression.
Keeping You Healthy: What You Need to Know!
Your transplant team may prescribe some additional medications to help with side effects and keep you feeling healthy. You may also be taking medicines from other doctors – and those are important, too! If you have questions about any medications that are not from your transplant team, be sure to ask the doctor who prescribed them. Also, it is very important that all your doctors know what medicines you are taking – so be sure to keep your med list updated!
- Magnesium is an essential mineral the body uses to keep your bones strong. Magnesium also keeps the nervous system healthy and helps your muscles move. Some anti-rejection medications may lower your magnesium level. Low levels can lead to muscle cramps and weakness, tingling in your hands and feet, and tiredness. Magnesium levels are checked routinely with your labs. If your level is low, your doctor will ask you to take a magnesium supplement (magnesium oxide, magnesium gluconate or magnesium glycinate) and will check to be sure your level improves and is in the normal range.
- Vitamin D is important for bone health and helps your body absorb calcium. Patients who take prednisone (a steroid) for a long time are at risk for their bones becoming weak (osteoporosis). Vitamin D can protect your bones and help them stay strong. Your doctor will check your Vitamin D level about once a year. If your level is low, you will be asked to take Vitamin D2 (ergocalciferol) or Vitamin D3 (cholecalciferol).
- Blood pressure medications: Blood pressure (BP) is the force your blood uses to move through your arteries (vessels that carry oxygen-rich blood away from the heart to tissues and organs in the body). You are probably used to getting your blood pressure taken during clinic or when you were in the hospital and may know what your BP usually is. High BP (hypertension) is common after transplant and is a side effect of some anti-rejection medications like tacrolimus and steroids. It is important that your BP stays within a healthy range. If you have high BP, your doctor will prescribe a medication to lower your pressure. Some of these medicines lower your BP by relaxing blood vessels, making it easier for your heart to pump blood. Some examples of BP medicines are Amlodipine (Norvasc™), Isradapine (DynaCirc™), nifedipine (Procardia™), and clonidine (Catapres™).
- Blood Thinner: To reduce your risk of developing blood clots after transplant, your transplant team may prescribe aspirin for a while after surgery. Aspirin helps prevent clots by “thinning” the blood and making it less likely to develop a clot. It's important to take aspirin as prescribed and follow your doctor’s advice about how long you’ll need it. Always check with your doctor before taking any other medications (including over-the-counter ones), as some can affect how well aspirin works.
- Stomach medications: These medicines may be prescribed to protect your stomach, especially if you're taking prednisone or other drugs that irritate the lining of the stomach. They help reduce the amount of acid in the stomach that can irritate parts of your digestive system (esophagus, stomach, or small intestine). Having less acid in the stomach will help prevent or relieve symptoms from acid reflux and stomach ulcers. Omeprazole (Prilosec™), Pantoprazole (Protonix™), and Lansoprazole (Prevacid™) are the most common stomach medicines.
Be sure to follow your doctor's instructions carefully and take all your medications as prescribed. If you have questions about your medications or notice side effects, contact your transplant team. They are there to help you every step of the way.
For any questions, concerns, or medication changes, always contact your transplant care team.
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