For your body to accept a new organ, the Transplant team will prescribe a combination of immunosuppressant medications. THESE WILL BE TAKEN EVERY DAY FOR AS LONG AS YOU HAVE A WORKING KIDNEY TRANSPLANT. TAKING THESE MEDICATIONS AS DIRECTED IS THE MOST IMPORTANT STEP YOU CAN TAKE TO PREVENT REJECTION. Because these immunosuppressant medications have serious side effects, your doctor will adjust the dosages to protect against rejection without undue risk of complications. The most commonly used immunosuppressants include: Prednisone Tacrolimus (Prograf) Cyclosporine (Neoral) Mycophenolate Mofetil (CellCept) Imuran (Azathioprine) Rapamune (Rapamycin, Sirolimus)

Prednisone is a steroid medication given to prevent and treat rejection after transplant. It will be given in higher doses for the first few months and is tapered to a smaller maintenance dose thereafter. How Prednisone Is Supplied Prednisone is available in liquid as Prelone (15 mg/5 ml) or in 1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, or 50 mg tablets. The tablets can be cut in half if necessary. Special Instructions Never stop prednisone without consulting your kidney doctor. Taking prednisone with food helps to decrease stomach irritation. Possible Side Effects Most side effects of prednisone are dose-related and may decrease or subside as the dose is reduced: Increased appetite and weight gain Salt and water retention, possibly causing swelling of face, hands or ankles Stomach irritation. Antacids may be prescribed if this is a problem. Elevated blood sugar Cushingoid appearance, including a tendency to have rounder cheeks Acne Mood swings Delayed growth Stretch marks Cataracts Glaucoma Bone disease Increased risk for infections

Prograf is a drug that suppresses the immune system and is used to prevent rejection. It is taken every day in the morning and at night. How Prograf Is Supplied Prograf is available as liquid or in 0.5 mg, 1 mg, and 5 mg capsules. Special Instructions It is best to take Prograf at the same times each day under similar conditions (such as before or after eating). Changing conditions can change the amount of medication that is absorbed by your child’s body. On clinic visit days, hold the morning dose of Prograf until after blood work is drawn. The Prograf dose will be adjusted based on the drug’s blood level before that morning dose. Consult your kidney doctor before using any new medications because some drugs may affect the amount of Prograf that is absorbed into the body. Store at room temperature away from sunlight and moisture. Possible Side Effects Most side effects are dose-related and may decrease or subside as the dose is adjusted: Headache Nausea Diarrhea High blood pressure Tremor Hair loss Tingling of hands or feet Trouble sleeping Diabetes (elevated blood sugar) Abnormal kidney function Increased risk for infections

Neoral is a drug that suppresses the immune system and is used to prevent rejection after transplant. It will be taken every day in the morning and at night. How Neoral Is Supplied Neoral is available in liquid form or in 25 mg and 100 mg capsules. Special Instructions Always take Neoral at the same times each day under similar conditions (such as before or after eating). Changing conditions can change the amount of medication that is absorbed into the body. On clinic visit days, you may be asked to hold the morning dose of Neoral until after blood work is drawn. The Neoral dose is adjusted based on the Neoral blood level. Do not give Neoral with grapefruit, pineapple or papaya juice. To improve the taste of liquid Neoral, mix it in a glass cup with milk, chocolate milk, orange juice or apple juice. Do not mix in a plastic, Styrofoam, or wax paper cup, as the liquid will stick to the cup. Store at room temperature away from sunlight and moisture. Consult your kidney doctor before using any new medications as some drugs may affect the amount of Neoral that is absorbed into the body, or how it is broken down in the liver. Schedule regular dental cleanings as Neoral can cause gums to swell and bleed. Possible Side Effects Most side effects are dose-related and may decrease or subside as the dose is adjusted: Headache Nausea Trembling or shaking of hands Excessive hair growth High blood pressure Swollen or bleeding gums Increased risk for infections Abnormal kidney function

CellCept is given along with other immunosuppressant medications to prevent rejection after transplant. It will be taken every day in the morning and at night. How CellCept Is Supplied CellCept is available in liquid or in 250 mg capsules or 500 mg tablets. Special Instructions Swallow the tablets or capsules whole. Do not break, open, crush, or chew them. Do not spill the medicine from inside the capsules or tablets into eyes, nose, mouth or on the skin. If this occurs, wash the skin with soap and water and rinse well. Rinse eyes, nose or mouth with large amounts of plain water. CellCept should not be used by pregnant women unless the possible benefit justifies the potential danger to the unborn baby. Women of childbearing age should use effective contraception before beginning CellCept, during the time they are taking it, and for six weeks after they have stopped taking it. Contact your kidney doctor immediately if there is the possibility of pregnancy. Possible Side Effects Nausea, vomiting and diarrhea. These symptoms, if they occur, usually do so in the initial weeks of therapy and may subside with a reduction in dose. A version of the drug specially coded for protecting the stomach lining may also be used as an alternative if these problems persist or a substitute may be made to Imuran (see below). Reduced white blood cells and / or platelets. You will have regular blood tests to monitor these levels while taking CellCept. Be sure to report any unusual bruising or bleeding to your kidney doctor. Increased observed risk for infections.

Imuran is a medication given to prevent rejection and taken once a day. It is an “older relative” of CellCept and sometimes used in its place. How Imuran Is Supplied Imuran comes as a 50 mg tablet that can be broken up. Some pharmacies, including the outpatient pharmacy can also prepare a liquid version of Imuran for patients who have trouble taking the tablet. Possible Side Effects Most side effects of Imuran are not noticed by patients taking this medication but are instead picked up during routine blood tests during clinic visits: Decreased blood cell counts Liver damage Inflammation of the pancreas Vomiting or diarrhea Muscle aches Fever Rash

Rapamycin is a rather new medicine used to prevent rejection. Small children usually need to take rapamycin twice a day, while older patients just need one dose a day. How Rapamycin Is Supplied Rapamune comes in 1 mg and 2 mg tablets or as solution containing 1 mg/1 ml. Special Instructions On clinic visit days you will be asked to hold your dose of rapamycin until after blood work is drawn. Your dose will be adjusted based on your rapamycin blood level. Please make sure this medicine is always taken with or without food, not sometimes with food and on an empty stomach at other times. Take the rapamycin solution with some water or orange juice, but not with grapefruit juice. Possible Side Effects Rapamycin can cause several side effects, and regular monitoring during clinic visits, including measurements of rapamycin blood levels, is required. Some of the side effects may require treatment, for example, adding medicines to lower cholesterol or blood pressure. Decreased blood cell counts Swelling High blood pressure High blood cholesterol and other blood fats Nausea, vomiting, diarrhea, constipation or tummy aches Headache Joint pain Fever Delayed wound healing Rash Trembling Mouth sores Decrease in sex hormone levels Rapamune delays wound healing. If you are having surgery or dental work, call as soon as it is scheduled to taper Rapamune and resume Prograf. After your child has healed from surgery, he will be converted back to Rapamune.

Capsule and time release tablets should be swallowed whole and never crushed, chewed or opened – otherwise, a large dose can be absorbed too quickly. Immunosuppressive medications should never be taken with grapefruit juice. In addition to avoiding grapefruit juice, do not eat whole grapefruit or drink fruit juice blends or sodas that contain grapefruit juice. Some medications need to be refrigerated, especially liquid antibiotics. Check the directions on the bottle. Always check with your transplant team before taking any new medicines, even the ones you buy over the counter, including vitamins and herbal remedies. Wear a Medic Alert® (or similar brand) bracelet or pendant that states you are a transplant recipient and you take steroids (if you do), in case you are ever in an accident and someone finds you unconscious. If any medicine changes odor or color, if it gets wet, or if it is soft, sticky, hard or cracked (and it shouldn’t be), it could have lost its effectiveness and should be replaced. Talk to your pharmacist about any changes in your medicines. If your insurance company does not require you to use a particular pharmacy, shop around. Prices can vary. Let your insurance company and transplant team know if you are having trouble paying for your medicines. Carry a list of your medicines and their doses in your wallet or purse. Share this list with your other doctors. Try to buy all your medicines from the same pharmacy. Many pharmacies keep a profile on their customers so that they can track whether or not a new drug will cause problems if taken with the patient’s other medications. Unwanted hair growth, caused by some medications, can be removed with shaving, waxing or hair removal (depilatory) products. Limit your sun exposure and always wear sunscreen (minimum SPF 30).

Always keep extra doses of your medicine with you when you travel in case you are delayed or miss a plane, train or bus. Keep your pharmacy’s phone number with you. Never pack your medications in your luggage; always carry them with you or they may get lost or be exposed to temperatures that are too cold or too hot. Mail-order pharmacies can ship your medicines if you are away from home for an extended period of time. Carry a letter (or prescription) from your doctor about your medicines in case you have any problems with customs when traveling overseas. You may be able to fill your prescription in a pharmacy at your travel destination. Prevent infection. Wash your hands often and thoroughly, especially before eating. This is even more important the first few months after your transplant, when you are taking higher doses of anti-rejection medication.

Valganciclovir is an antiviral. It is used to treat infections caused by viruses. This medicine is also used to prevent CMV disease in patients who have received an organ transplant (eg, heart, kidney, or kidney-pancreas transplant).

Generic name: tacrolimus [ ta-KROE-li-mus ] Drug class: Calcineurin inhibitors Oral route(Tablet, Extended Release) Increased risk for developing serious infections and malignancies with tacrolimus extended-release tablets.

Generic name: azathioprine [ ay-za-THYE-oh-preen ] Brand names: Azasan, Imuran Dosage form: oral tablet (100 mg; 50 mg; 75 mg) Azathioprine weakens your body’s immune system, to help keep it from “rejecting” a transplanted organ such as a kidney.

Generic name: basiliximab [ bass-il-IX-im-ab ] Brand name: Simulect Dosage form: intravenous powder for injection (10 mg; 20 mg) Drug class: Interleukin inhibitors

cyclophosphamide [ sye-kloe-FOSS-fa-mide ] Brand names: Cytoxan, Neosar, Cytoxan Lyophilized Cyclophosphamide is used to treat several types of cancer.