One of the main questions I get asked as a mentor is related to the medications you have to take after receiving an organ transplant.
Without getting into very scientific detail, I will tell you the most common transplant medications you may be prescribed, as well as what their general purpose is for your transplant.
Transplant maintenance medications are comprised of two groups. The first group is immunosuppression medications that are used to help prevent rejection, and the second group are medications to prevent infection. The second group of medications is needed due to having to take the immunosuppression medications. And you may find that most post-transplant medications you may be prescribed are due to the side effects of your immunosuppression medications. However frustrating as it may seem, your IMMUNOSUPPRESSION MEDICATION IS VITAL!! With a lung transplant, you will need to expect to be on these medications the rest of your life.
First, lets get to the easiest and cheapest drug in the immunosuppression category.
PREDNISONE (Deltasone): used to reduce inflammation 'signals'. These 'signals' are what your body 'sends out' to get your immune system to respond to something 'bad.' Inflammation is the result of your body trying to take care of the 'bad' thing and make you better. Prednisone reduces this signal to keep your body from trying to 'fix the problem', which in a lung transplant is your donor lungs.
The next two medications are in the immunosuppresant group as well:
Azathioprine (Imuran), OR Cellcept (Mycophenolate Mofetil) & Cyclosporine (Gengraf, Neoral) OR Tacrolimus (Prograf). These medications are used for two different things. The first two drugs available, Imuran and Cellecpt don't allow T-cells to multiply. T-cells belong to a group of white blood cells called lymphocytes. The last two drugs listed, Cyclosporine and Prograf work to keep T-cells from being activated, the trigger to activating the immune systems response. (A great illustration and webpage detailing our immuse system can be found here:The Immune System)
Another available medication called Sirolimus (Rapamune) is available if the patient is having difficulty with the other available immunosuppression drugs or rejection. This drug cannot be used in combination with cyclosporine or prograf!!! It also is not used within the the first 3-6 months of transplant. This medication works to inhibit the growth of white blood cells.
The second group, medications to prevent infection can be very diverse in what is prescribed, as well as diverse as far as what is available and who makes them and what they cost.
Acyclovir (Zovirax), Valganciclovir (Valcyte), Ganciclovir (Cytovene) are all medications used to prevent and treat infections, but vary in which infections they treat.
Sufamethoxazole/Trimethoprim (Bactrim), Atovaquone (Mepron), Pentamidine (NebuPent) are used to prevent or treat pneumocystis pneumonia.
Nystatin, Fluconazole (Diflucan), Itraconazole (Sporanox), Voriconazole (V-Fend) are used to prevent or treat fungal infections (aspergillus or candida).
Different medications are used to prevent rejection. And each persons dosage of the above maintenace medications may be different. Regular blood labs are drawn to maintain a steady amount of the immunosuppression medication in your body.
MOST IMPORTANTLY.......It is VITAL for your survival after a transplant to NEVER SKIP YOUR MEDICINE!!!
The above information was provided by a pharmacist that is a part of the Barnes Jewish Lung Transplant Team.
Pharmacies are NOT required to notify patients of a change in manufacturers when dispensing medications.
Switching between generic and name brand drugs requires careful monitoring of the drug levels in the patient as well as titration of the drug to get to the level the patient needs.
Small differences in dosing can result in the drug not working as it is intended and/or serious side effects.
Information About Generic Medication:
Must contain the identical active ingredient.
Must contain same strength.
Must contain same dose form.
Must contain same route of administration (oral, IV, etc.)
Must be prescribed for the same indication (uses).
Can differ in color and shape.
Can differ in inactive ingredients.
Can differ in packaging.
For all these reasons, please consult with your doctor or clinical pharmacist about the risks and implications of using generic or switching from brand name to generic medications!!!
Cellcept 250mg capsules (30): $142.28
Cellcept 500 mg tablets+ (100): $865.60
Prograf .5mg capsules (100): $214.06
Prograg 1mg capsules (100): $409.94
Myfortic 360mg tablets+ (120): $801.36
Mycophenolate Mofetil 250mg capsules (30): $35.99
Mycophenolate Mofetil 500mg tablets (100): $129.99
Tacrolimus .5mg capsules (100): $150.17
Tacrolimus 1mg capsules (100): $297.33
*without prescription coverage or copay assistance. Information provided by Angela Wills, PharmD; as of December 2010.
+no generic is available for these medications at this time.
I am often asked what medications I take and how many pills. Here is a look at just my transplant related per diem medications:
Cellcept 500mg X 2 a day=2
Prograf .5mg X 1 a day=1
Prograf 1mg X 2 X 2 a day=4
Acyclovir 200mg X 2 a day=2
Sulfamethoxazole 800mg X 1 a day=1
A total maximum of 10 in a day. The last drug (Septra) is only on Monday, Wednesday, and Fridays and only in the morning. A max of 6 in the morning, and 4 in the evenings.
Everyone's dosing is different and each drug can come in many different size of doses to make changing doses easier. For example, I could take 4 of the .5mg Prograf to keep my co-pay for the drug down to one prescription, but I choose to take fewer capsules. Plus, I have the co-pay assistance card and get my drugs for free ($80 worth of co-pays).
Roche, now a part of Genentech, the drug company that makes Cellcept (MYCOPHENOLATE MOFETIL), is offering co-pay assistance through their coupon card program. With this coupon card, you can receive up to $100 of your out of pocket costs covered. With this program it can help to keep you on the name brand drug, versus the generic that is now available. See the company website for more information on coupon details and duration. Click the link below to get to their website to get your coupon card.
Astellas, the drug company that makes Prograf (Tacrolimus) is offering co-pay assistance that will cover us $200 of your out of pocket cost of your prescription. Follow the link below to get to their web page and learn more about the program and get your own co-pay assistance card. Gary and I both use it and we save over $120 each month thanks to this program!
Novartis offers free 30 day trial for Myfortic if it is your first time using the medication, as well as a co-pay assistance card. The co-pay card helps by covering up to $100 of your out of pocket costs for up to a year. Click the link below for more information, however this card isn't a web ready card you can print. You need to call 1-866-myfortic (1-866-693-6784) in order to get enrolled. Your doctor may also have cards available, it never hurts to ask.