7. MEDICATION TO BE TAKEN BY THE TRANSPLANTED PATIENT

7. MEDICATION TO BE TAKEN BY THE TRANSPLANTED PATIENT

From the transplant you must take medications called IMMUNOSUPRESORES. The taking of medication is obligatory to diminish the reaction of the organism in front of the organ transplanted, is what is known as rejection. Immunosuppressants are taken from the first day of transplantation and should continue to be taken throughout life. They are IMPRESCINDIBLE for the patient and under no circumstances MUST LEAVE TO TAKE OR MODIFY THE DOSES BY OWN ACCOUNT. Failure to take them can mean transplant failure.

Taking this medication decreases the body's defenses and causes an increased risk of infections, which can sometimes be very serious. NEVER FORGET THESE TWO RISKS: INFECTION AND REJECTION

The doctor is the one who indicates the doses of the medicines and when it is necessary to modify the dose. In order to ensure that the doses taken by the patient are correct, blood tests are performed periodically. Thus we determine the concentration of the drugs in blood and we know if the dose is correct, or it is necessary to modify it. The trend is as time goes by, decreasing the dose of these medications.

7.1 TREATMENT KEYS WELL DONE

It is vital that the patient perform the treatment correctly, for which we advise:

1. Try to learn the name of the medicines and their purpose.
2. Memorize, if possible, the doses, hours and days in which you must take them.
3. Do not rely on your memory and check the doses, hours and days to take them
4. Take the medication as it has been prescribed, do not make modifications on your own.
5. Keep medication stored, tidy, clean and dry, away from points of light, heat or moisture.
6. Dispose of depleted or expired bottles or boxes.
7. Never change medicine boxes, or put them in another box, is a source of mistakes.
8. Record the unintended effects of the medication and report it to your doctor: vomiting, hives, headache, stomach pain or any other.
9. If you make a mistake in one dose, do not try to correct it in the next one. Write it down for comment.
10. In case of forgetfulness, if more than 4 hours have elapsed take the next dose, but, take the one that corresponds.
11. Do not take any other medications without first telling them.
12. Immunosuppressive treatment YOU MUST ALWAYS TAKE IT.
13. In the case of vomiting and believing that you have vomited part of the medication, you should take at least half the dose. If you have vomited everything, you must take it again.
14. When medical tests are to be performed, you should try to adjust the time taken to take the medication.
7.2 IMMUNOSUPPRESSORS EMPLOYED AT THE CURRENT MOMENT

The most commonly used immunosuppressants at the present time are:

 CYCLOSPORINE

Ciclosporin is the active ingredient. The commercial name by which the patient will know it is SANDIMUN NEORAL ®. Its use in organ transplantation begins in the year 1980. It is the first of the immunosuppressants so we have more information. The effects of this medication are frequent and are usually avoided by modifying the doses of this medicine, although in some cases it is necessary to replace it with another.

Taking SANDIMUN NEORAL causes a number of side effects, including the occurrence of hypertension in patients who were not hypertensive, deterioration of kidney function, excessive hair growth, headache, redness of The face, the appearance of a tremor in hands and fingers, nasal congestion, enlargement of the gums, diarrhea and the possibility of appearance of nodules in the breasts.

If the patient has some of the side effects described, you should ALWAYS consult your doctor, but you should NEVER discontinue or modify the dose on your own.

The presentation of SANDIMUN NEORAL is in tablets of 100, 50 and 25 milligrams. Its use allows reducing the dose of corticosteroids and in some cases their suppression. The patient will take it twice a day, every 12 hours.

TACROLIMUS or FK-506

The onset of this medication is after Cystosporine (SANDIMUN NEORAL®). In the pharmacy the patient will find it with the name PROGRAF ®.

As with SANDIMUN NEORAL®, PROGRAF also has a number of side effects such as hand and finger tremor, headache, diarrhea and nausea, and causes elevations of blood glucose levels that can force the patient into Weeks after transplant to need to inject insulin.

The presentation of this drug is in tablets of 0.5, 1 and 5 milligrams. Its administration is also orally, twice a day. It is very important that you take it on an empty stomach and with some liquid, preferably water (never take with grapefruit juice). You should not eat food one hour before or one hour after taking PROGRAF, as this may interfere with the absorption of the medicine. The patient should always take this medication for a few hours or so fixed and take into account the diet of not ingesting food.

It is very important that if the patient is going to take any new medication, check with your doctor beforehand, as any medication may interfere with PROGRAF.

MICOFENOLATO

These immunosuppressants have the advantage over the aforementioned ones, which do not affect the function of the kidney. The trade name is CELL-CELPT ® and MYFORTIC ®. Usually they are used in association with SANDIMUN NEORAL or PROGRAF. They can also cause side effects, which in these cases will be primarily of gastrointestinal origin such as diarrhea, nausea, abdominal discomfort and vomiting.

At the beginning of treatment with these medicines, the doctor will perform tests to know the status of white blood cells and platelets.
Its administration is also orally. They are usually taken 2 or 3 times a day.

Azathioprine

Commercially known as IMUREL ®. As a side effect can cause vomiting and hair loss. As its action is at the level of the marrow preventing the normal manufacture of lymphocytes, and causing leukocyte decline, it is necessary to perform control analytics.

It is usually taken once or twice a day, usually at bedtime. At present it is hardly used. It comes in 50 mg tablets, is given orally.

PREDNISONE

This drug belongs to the family of CORTICOIDS , it can have a great variety of side effects. It highlights its potent immunosuppressive and anti-inflammatory effects. The usual thing is that after transplantation is started with high doses of this drug and gradually reduce the dose gradually, until reaching a dose minina and complete suppression thereof.

Among the most striking side effects highlights the full moon face (rounded), increased appetite and body hair, the appearance of facial acne. It is quite frequent that occasions mood swings. One of the most important alterations is the increase of blood glucose, which forces the patient to perform a diet, moderate physical exercise and medication if necessary. As with other medicines, side effects will go away as the dose decreases.

Some patients cause increased sweating, joint pain, dry skin, salt retention, blurred vision. These alterations are usually as frequent as the full moon face, they may appear in the course of time.
In general, all these side effects tend to disappear once the administration of Prednisone is suspended.

It is very important that the patient NEVER CHANGE THE DOSE OR STOP TAKING THE MEDICATION. If, for any reason, the patient erroneously decides to abandon the medication and stop taking Prednisone suddenly, it disappears from the blood and since the adrenal glands have not been working for some time, they are slow to start again, leading to a dangerous situation. Lack of corticosteroids in the body.

The doctor is in charge of reducing progressively, weekly, in order that gradually the adrenal glands begin to function.

Although there are many side effects described by the drugs that must be taken to avoid rejection, not all of them occur and in most cases they are usually reversible, disappearing as we decrease the dose.