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Lung Transplantation

Medications for Lung Transplant Patients

After a lung transplant, patents are generally given drugs that will suppress the body's natural immune system. This is to prevent the body from rejecting the new lungs. A strict medication regimen needs to be followed after lung transplantation to ensure the survival of the transplanted lungs and the health of the patient.

Types of Medications

Immunosuppressant Drugs - these drugs suppress the immune system. They need to be administered to prevent organ rejections.

Anti-infective Drugs - these drugs need to be administered to prevent infection caused by a lowered immune system.

Anti-hypertensive Drugs - these drugs may need to be taken because hypertension may be a side effect of immunosuppressive treatment.

Supplements - these may be recommended by your transplant physician.

Some Do's and Don'ts of Medication

DO:

DON'T:

Immunosuppressant Drugs

Cyclosporine - Cyclosporine is taken to prevent rejection of the lungs and has greatly increased the survival of all transplant patients. It is best not to miss a dose of this medication. Do not stop taking cyclosporine for any reason without the approval of your transplant physician. Some side effects may include headaches and tremors. Cyclosporine may also cause increase hair growth.

Tacrolimus - Tacrolimus is an alternative drug that may be used to prevent rejection. As with Cyclosporine, you should do your best to not miss a dosage. The side effects are else headaches and tremors. Tacrolimus can also cause high potassium levels.

Azathioprine - It is used in conjunction with your other anti-rejection medications. Azathioprine has relatively few side effects. In rare cases it may cause liver and pancreas abnormalities.

Mycophenolic Acid - Mycophenolic acid may be used instead of azathioprine in conjunction with other drugs.

Prednisone - Prednisone is a steroid similar to what the adrenal gland normally produces. Prednisone should not be skipped. Prednisone, an appetite stimulant, can lead to overeating and cause cosmetic changes. The most serious of these is weight gain occurring mostly in the trunk. The face may become rounded (moon face) and a fat pad may develop between the shoulder blades. You may develop acne on the face or back; treat with over-the-counter acne medications. Your skin may become oily and hair growth more prominent. Women who are concerned about this may use over the counter bleaching agents. Over time your skin may become thin and bruise easily.

Prednisone causes salt and water retention which may result in swollen ankles and increased blood pressure. You may notice a weakness in your leg muscles. It is important to maintain good muscle tone by exercising daily.

Symptoms will decrease as the drug's dose is decreased over time. Over time prednisone frequently causes bone thinning and your bones may become more brittle. You may be advised to take medications to prevent osteoporosis. Some patients taking prednisone for a prolonged period of time develop cataracts; schedule periodic eye exams. Prednisone may aggravate pre-existing diabetes or unmask latent diabetes.

Sirolimus - Sirolimus is an immunosuppressive agent, although its use is much less than the others listed above.

Anti-infective Drugs

Co-Trimoxazole - This is a combination drug that prevents infections involving the lung and urinary tract. Tell your physician if you are allergic to sulfa drugs because other drugs can be used.

Valcyte - Valcyte is an antiviral medication given to prevent cytomegalovirus (CMV). Your complete blood count and kidney function tests will be closely monitored while you are on this medication. The most frequent side effect of the drug being lowering of white blood count and platelet count.

Ganciclovir - Ganciclovir is an antiviral medication given to prevent and treat cytomegalovirus (CMV). It is administered intravenously the first three months to after lung transplants. An oral formulation may be given after the IV course.

Acyclovir - Acyclovir is used to prevent and treat herpes infections. It is used to treat skin, lip, and genital herpes infections as well as shingles.

Itraconazole - Itraconazole is prescribed for the prevention and treatment of certain fungal infections.

Voriconazole - Voriconazole is used like itraconazole to prevent and treat certain fungal infections.

Nystatin - Nystatin is used to prevent and treat yeast and fungal infections involving the mouth, throat, and esophagus and to treat skin, nail, and vaginal fungal infections. Take the ordered dose and swish it inside the mouth for several minutes before swallowing.

Clotrimazole - Clotrimazole is prescribed for candida infections of the mouth (thrush). Either nystatin or clotrimazole usually is prescribed for approximately one month after transplant. It also will be used if the patient develops thrush at some later date.

Anti-hypertensive Drugs

There is a large range of drugs here. It may be more useful to look at this as a concept rather than list of drugs.

Beta and Alpha Blockers - Beta blockers and alpha blockers (clonidine) are additional classes which are typically used in transplant patients as well.

Calcium Channel Blockers - Some of the calcium channel blockers interact with cyclosporine, therefore it is important that only your transplant physician change the dose of these medicines.

Diuretics - Diuretics must be used only under supervision. Diuretics are prescribed to help reduce fluid buildup. They cause the kidneys to eliminate excess water and salt from the body into the urine and are used to treat swelling water retention as well as high blood pressure.

Supplements

Calcium - Calcium may be taken by transplant patients because some transplant medications such as prednisone, cyclosporine, and diuretics lead to calcium loss and cause osteoporosis and bone loss.

Magnesium - A magnesium supplement may be ordered due to therapy depleting it. A low magnesium level can cause irritability, muscle weakness, cramps, tingling and irregular heartbeats. Take it with meals; taken on an empty stomach magnesium may cause diarrhea.

This information originally appeared in the University Hospitals Lung Transplantation Patient Handbook, and was adapted for use on NetWellness with permission, 2007.

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Last Reviewed: Aug 27, 2013

Robert  Schilz, DO, PhD Robert Schilz, DO, PhD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University