Step 10: Medications for life
Following your liver transplant, you will take a lot of new medicines. These are vital to the success of the transplant and will become an important part of your life. It is important that you have a good understanding of your medicines including how to take them properly and what side effects to expect.
Anti-rejection medicines
The most important group of medicines following a liver transplant are those that suppress your immune system; otherwise known as ‘immunosuppressant’ or ‘anti- rejection’ medicines. Without these you would reject your liver within a few days.
Our immune system protects the body against infection. It does this by recognising foreign material such as bacteria or viruses which cause infection and releasing a variety of chemicals and white blood cells to destroy them. However, following a liver transplant your immune system will recognise your new liver as being foreign and will respond to destroy it; this is called ‘rejection’.
We use anti-rejection medicines to prevent your body rejecting your new liver.
It is important that you never stop taking your anti-rejection medicines, even for a short time
You will be at risk of losing your liver due to rejection or shortening the life of it. If, for any reason you cannot take your anti-rejection medicine for example, you are vomiting or you have left your medicine at home or run out of tablets, contact the transplant unit or your clinic area as soon as possible.
Questions you may have
What medications do I need to take after transplant?
You will be taking a combination of anti-rejection medicines. The most commonly used anti-rejection medicines are:
- Tacrolimus (Prograf®) regular release or Tacrolimus (Advograf®) controlled release or Cyclosporin (Neoral®)
- Azathioprine or Mycophenolate
- Prednisolone
Other anti-rejection medicine which may be used include:
- Everolimus
In addition to these immunosuppressive medications, you may also need medications to prevent infections. These include antibiotics to prevent bacterial infections, antivirals to prevent viral infections and antifungals to prevent fungal infections.
How long do I take the medications for, and what happens if I forget a dose?
Having a liver transplant means you will need to take medications life-long. Following your transplant, the pharmacist will provide you with a dosette box, which allows you to set your medications out for the week. This process helps you with managing and remembering to take your medications every day.
The success of your liver transplant relies on you taking your medication at the same time each day, exactly as it is prescribed.
Do not double up on dose
If you forget to take a dose, take it as soon as you remember unless it is time for your next dose.
If you have missed a dose you must inform your clinic nurse or doctor as this may affect your blood levels.
If you regularly forget to take your medication or alter your prescribed medicines without discussing with your transplant team, you are at a very high risk of damaging your liver transplant. Sometimes the damage can be irreversible and your life will be at risk.
If you are experiencing discomfort or side effects from medication, we encourage you to discuss these with your liver transplant team. Good communication is vital between you and the team.
What are the main side effects of the medications?
The anti-rejection medications can cause a variety of side effects that the team will work to minimise. It is really important to alert the doctors of any side effects you are experiencing as altering your dosage might be possible.
Possible side effects can include:
- Diabetes
- High blood pressure
- High cholesterol
- Tremor, tingling of the fingers and toes, burning sensation
- Headache, blurred vision
- Nausea, vomiting, diarrhoea
- Hair loss or hair growth
- Impaired kidney function
- Vomiting or diarrhoea
- Low white cell count
- Low haemoglobin
- Low platelet count are cells that help blood to clot
- Abdominal pain
- Mood swings
- Nervousness, restlessness, trouble sleeping
- Increased appetite, which can lead to weight gain
- Acne or other skin problems
- Facial or body hair
- Slower healing of wounds
- Thin skin and easy bruising
- Osteoporosis or weak bones - you will be on medication to limit this
- Cataracts - you should report any changes in vision
- Loss of potassium
- Fluid retention
- Increase in blood pressure
- Upset stomach or gut irritation
- Increase in blood sugar levels - you may need to start additional medication to control this
What if I want to take other medications, over-the-counter vitamins, other supplements or herbal medications after my transplant?
Many medicines, including over-the-counter medicines, herbal and complimentary medicines have the possibility to damage your new liver or interact with your transplant medicines. Taking these could lead to rejection of your liver or increase the chance of side effects from your transplant medicines.
Tell every treating doctor, dentist or pharmacist about your medicines
It is important that any doctor, pharmacist or dentist who is treating you knows that you have had a liver transplant and which medicines you are on.
Please make a habit of always letting them know.
All livers are precious, but donor livers are more sensitive to injury than healthy, non-transplanted livers. The advice from the Queensland Liver Transplant Service is that you should check with your doctors before taking absolutely anything that’s not prescribed. It is a good idea to bring into the clinic a sample of what you wish to take to discuss its safety before starting therapy.
Do not eat grapefruit nor drink grapefruit juice
This increases the absorption of Tacrolimus and Cyclosporin and increases the risk of side effects. All other citrus drinks are fine.
How much do the medications cost, and where do I obtain them from?
Normal Pharmaceutical Benefits Scheme (PBS) prices apply for all items prescribed following a liver transplant. More information on fees and patient contributions can be found at the PBS website.
Before you are discharged from the ward, you will spend time with a pharmacist who will discuss a lot of information, including where you can get access to ongoing supplies of your medications. Most of your scripts for your transplant medications will be provided by your hospital specialist. Over time as your tables become more stable, your general practitioner will be able to prescribe your regular medicines allowing you to access them from your local community pharmacy.
Drug trials
Progress in our understanding and use of medications following liver transplant has been thanks to previous patients’ participation in approved clinical trials.
You may be offered the opportunity to take part in a clinical trial whilst under the care of the Liver Transplant Team. Participation is entirely optional, and individuals will be asked to consent to being included only after all the details of the clinical trial are explained.
Your participation or otherwise will in no way affect your treatment as a liver transplant patient as it is purely a personal choice.