Anti-rejection drugs

 

Anti-rejection drugs (also called immunosuppressants) protect the transplanted liver against rejection by lowering your child’s immune response. Most commonly used anti-rejection drugs include Prograf® (tacrolimus, FK506),  Prednisone® and Prednisolone® (steroid derived from cortisone) and Cellcept® (mycophenolate mofetil). Other drugs are used more rarely such a Certican® (everolimus), Sandimmun Neoral® (cyclosporine) and Rapamune® (sirolimus). At present, we think that your child will have to take one or several of these anti-rejection drugs for life. Certain side effects may occur with every one of these drugs. Immunosuppressive drugs are all associated with an increased risk of infection and an increased incidence of cancer. The most common and the most serious side effects are listed below.

 

PROGRAF®, (TACROLIMUS FK 506)

The side effects of Prograf® include in particular:

  • tremor
  • diabetes mellitus
  • hypertension
  • digestive disorders, diarrhoea
  • hyperkalaemia (elevated level of potassium in the blood)
  • hypomagnesaemia (low level of magnesium in the blood)
  • photosensitivity
  • decrease in renal function.

Your child takes Prograf® or other immunosuppressive drug. It is available as syrup or capsules and is taken twice daily. Depending on the age and autonomy, you will be proposed one of the two preparations.

The retard formulation of tacrolimus, Advagraf®, which is taken once daily and is only available as capsules, is proposed at some time after the transplant.

This medicine should be taken under the following conditions:

Do not eat for one hour before taking Prograf® and also wait for half an hour afterwards before eating. Drinking water during this time is permitted. Do not take any other medication for one hour before taking Prograf® and also wait for half an hour afterwards before doing so.Taking food and other medicines simultaneously with Prograf® reduces its absorption. It must be administered at set hours in order to avoid fluctuations of its level in the blood and to thus attenuate its side effects.

The change in the time schedule for administration of tacrolimus is made by mere adjustment to the new schedule, without any gradual scheme. This rule applies irrespective of the interval lapsing between the former schedule and the new one.

For example:

Upon the seasonal time change, give the medicine to your child according to the new time.

08:00 a.m. wintertime      ->           08:00 a.m. summer time

Travelling between time zones

08:00 a.m. Geneva time    ->           08:00 a.m. New York time

 

While your child is taking this drug, he must avoid all grapefruit-based products due to its interference with the metabolism of tacrolimus. Grapefruit juice may very significantly increase the level of tacrolimus in the blood. When your child eats grapefruit or drinks the juice of this fruit by mistake, please inform the transplant team immediately! You must also avoid exposing your child directly to sunlight, by putting sunscreen on his skin or by dressing him to completely cover his skin. Your child’s blood status will be followed up closely as long as he takes this drug. It is also important to encourage him to drink more in order to avoid damage to the kidneys.

Due to the toxic effect of Prograf® on the kidneys, urine specimens will be taken during the follow-up examinations.

Several drugs interact with the metabolism of tacrolimus; this is why we recommend you always inform a caregiver who is going to prescribe a treatment for your child.

The list of drug interactions is available on this site.

 

PREDNISONE®

Prednisone® is a steroid derived from cortisone. Its side effects include in particular:

  • digestive disorders
  • abdominal pain
  • changes of mood
  • increase in weight
  • bone loss
  • disturbed vision
  • development of cataracts
  • water retention
  • acne and tendency to bruise easily
  • Difficulty in controlling the blood sugar (diabetes)

Except for the increase in weight, these side effects occur rarely in children. Prednisone® is given in decreasing doses during the first three months after the graft and is discontinued subsequently. It is, however, possible that we must reintroduce Prednisone® for two reasons:

  • In case of rejection.
  • When an infection or great stress (operation) occurs shortly after the discontinuation of Prednisone®, a so-called ‘stress’ dose is recommended to cover a possible transitory deficit of the adrenal glands.

 

CELLCEPT® (MYCOPHENOLATE MOFETIL)

The side effects of Cellcept® include in particular:

  • diarrhoea
  • digestive disorders, vomiting
  • reduced white blood count.

This drug can be administered in case of need to prevent rejection. It has been shown that mycophenolate mofetil may cause severe birth defects. Therefore, it must not be given to pregnant women. Moreover, sexually active men and women must take contraceptive precautions (such as the pill or preservatives) during and at least up to 90 days after the treatment. Inhalation or direct contact with the powder inside the capsule or the suspension must be avoided.

NOTE: Most patients who have undergone a graft take at least two anti-rejection drugs.  Prograf® (tacrolimus) and Prednisone® are the drugs that are used most commonly.