This is Part 3 of a series on transplant medications. Here we look at all the Non Anti Rejection Medications after a heart / lung transplant. These medications are often prophylactic to prevent infections, and side effects from anti-rejection drugs post transplant.
What Medications Are Needed After A Heart Lung Transplant
This is Part 3 of a three part series on medications you will need after a heart / lung transplant.
Part 1, Practical Tips explores general and practical information about taking medications after a transplant.
Part 2, rejection Meds looks more closely at Anti Rejection Medications prescribed after a heart / lung transplant. These anti rejection medications are vital as they prevent fatal organ rejection.
Part 3, unpacks all the Non Anti Rejection Medications needed after a heart / lung transplant. These medications are prescribed to prevent infections, and side effects from anti-rejection drugs post transplant.
What Prophylactic Medications Are Used After A Heart / Lung Transplant
Prophylactic Medications are prescribed after a heart / lung transplant as well as rejection medications. Prophylactic medicines are designed to prevent infections, and other side effects from your anti-rejection drugs. After an organ transplant you will have a lowered immune system due to the anti rejection medications.
This in turn exposes you to increased risk of illness, infections and complications. To counteract this risk, you will be taking many more medications to prevent and treat possible complications. Prophylactic medicines are designed to prevent infections, and other side effects from your anti-rejection drugs.
Post Heart / Lung Transplant Antibiotics
Antibiotics containing Sulfamethoxazole and Trimethoprim are commonly used after a heart / lung transplant. Bactrim is the common brand name. Bactrim and its derivatives are broad spectrum antibiotics. They can be used to prevent and or treat bacterial infections which may lead to urinary tract, middle ear, lung or skin infections. Broad spectrum prophylactic antibiotics are important after a transplant to prevent serious types of pneumonia.
I take Resprim™ twice a week on Monday and Friday.
Antibiotics And Dental Care
It is important to take care of your dental health after a transplant. Ask the Transplant Team, your GP or your Dentist about taking a dose of antibiotics before having your teeth cleaned or any type of dental work or surgery.
Usually you may be asked to take 4 antibiotic tablets within 1 hour of your dentist appointment. This is to prevent any bacteria from the mouth spreading and causing an infection elsewhere in your body, particularly your blood or heart.
Transplant Australia has a PDF resource: What Every Transplant Patient Needs to Know About Dental Care. You can download here or visit Transplant Australia Bone And Dental Health.
Antiviral Medications Needed After A Heart / Lung Transplant
Ganciclovir is an IV antiviral used to treat or prevent cytomegalovirus (CMV). Valganciclovir is an oral antiviral to prevent CMV. Heart / Lung Transplant recipients will usually take oral antivirals for up to 6 months after transplant to prevent viral infections.
Anti-Fungal Medications Needed After A Heart / Lung Transplant
For the prevention of fungal infections, medications like Nebulized Amphotericin, Itraconazole, and Nystatin may be prescribed. Anti Fungal medications have many possible side effects and drug interactions you need to know about. I have a copy of a fact sheet on APO-ITRACONAZOLE you can download using the button below.
Blood Pressure Medications After A Heart / Lung Transplant
After a heart or lung transplant patients are on anti rejection medications which can cause high blood pressure. As Tacrolimus or Ciclosporin may increase your blood pressure, some transplant patients may also be prescribed antihypertensive medications. You can read the post about home health monitoring to learn more about home testing after transplant.
Common blood pressure medications include: Diltiazem, Irbesartan, and Hydralazine. Diltiazem is a class of drugs called Calcium Channel Blockers (CCB) which help treat angina (chest pain), hypertension (high blood pressure) and some arrhythmias (abnormal heart rhythm).
Cholesterol Levels After A Heart / Lung Transplant
Anti Rejection medications can increase your cholesterol levels. Pravastatin is prescribed to lower cholesterol in transplant patients as a preventative measure. It is important to avoid too much cholesterol in your blood.
High cholesterol increases your risk of a blood clot forming in your blood vessels and causing a blockage. Blood vessels that become blocked can lead to further heart disease, angina or stroke.
Bone Health After Transplant
Anti rejection medications are known to cause Osteoporosis and bone density issues over time. Heart / lung transplant recipients will be prescribed Vitamin D, Calcium and Magnesium supplements to prevent Osteoporosis.
As discussed there is an interaction between calcium/magnesium and anti rejection medications. Therefore, it is vital you continue to take the specific supplement brand you are prescribed. Maintaining the correct dosage and scheduled timing for these supplements is central to avoiding negative interactions and possible rejection.
Anti Reflux Medications After A Heart / Lung Transplant
Many medications prescribed after transplant may cause reflux and digestive issues. Prednisone is a known contributor to reflux issues after a heart or lung transplant. Anti-reflux and anti-ulcer medications work by suppressing the production of stomach acid and so may prevent reflux, and the development of stomach ulcers. These may include Ranitidine, Pantoprazole and Rabeprazole.
While Antacids containing calcium carbonate or calcium products are safe to take, they may alter the absorption of Mycophenolate (Myfortic). For this reason avoid taking any form of calcium or magnesium within 2 hours before or after taking Mycophenolate.
Drug Interaction Between Calcium/Magnesium And Mycophenolate.
I continue to suffer from terribly painful reflux after the transplant. I am still using Pantoprazole but this is giving me little relief. Recently I started taking Rennie ™ tablets which is an antacid based on calcium carbonate & magnesium carbonate. Not long after beginning to take Rennie™, I found I was in mild rejection.
I had completely forgotten the interaction between calcium/magnesium and Mycophenolate. I had been taking the Myfortic at 9pm then going to bed, feeling symptomatic of reflux and taking Rennie tablets. This mishap may explain my current rejection. I have replaced Rennie with LifeSaver ™ Fruit Tingles near my Myfortic doses.
Fruit Tingles, yes the nostalgic lolly called Fruit Tingles are made from Sodium Bicarbonate (bicarb soda) and can assist relieve reflux symptoms. Fruit Tingles are available again and now sold under the trademark LifeSavers ™ Fruit Tingles. However, be careful of your sugar intake as Prednisone can cause Diabetes. It is always a balancing act.
While in hospital, I started using an anti reflux / anti nausea medication called Metoclopramide Apo. This is usually taken an hour before food. This didn’t stop the reflux completely but it did allow me at least enough relief to enable me to eat and drink small amounts. While I found Metoclopramide effective you can only use it short term.
Grapefruit Interactions With Anti Rejection Medications
Many immunosuppressants, including Cyclosporine, Tacrolimus, Sirolimus, and Everolimus, are known to interact with grapefruit so you will need to avoid all foods and drinks containing grapefruit juice.
What Medications Should Be Avoided After Transplant?
Over-The-Counter Medications
Over-the-counter medications like cold and flu medicines, vitamins, and herbal remedies can interact with anti rejection medications so always check with your Transplant Consultant before taking alternative medicines.
Specifically avoid:
Generic Brands of your medications, never swap or interchange brands of prescribed transplant medications.
Cough and cold syrups,
Oral medications for blocked sinuses e.g., Sudafed®
Anti-inflammatory painkillers e.g. Ibuprofen (Nurofen®, Brufen®), diclofenac (Voltaren®), indomethacin (Indocid®), celecoxib (Celebrex®) 44
Herbal medications, such as St. John’s Wort and Echinacea.
Heart Transplant Patient Treatment Record
You will find that your medication types and levels will change often. The transplant team will provide you with a Heart Transplant Patient Treatment Record Booklet to assist you in keeping track of all your medications as they fluctuate.
While post transplant medications are certainly life-saving and necessary they can also have side effects. It’s important to work closely with your transplant team to monitor and manage any side effects you may experience. They may be able to adjust your medication or provide additional support to help you cope.
You may consider asking the pharmacist for an information sheet on each medication you are prescribed. I always get a print out for each medication and read it thoroughly.
You could also do your own research. I usually use webmd. I simply type in the medication name and select the drug. You will see navigation tabs along the top which help you find specific information you might need.
Keep An Updated Medications List
I keep a list of medications in a note in my phone (Samsung Notes) for medical appointments or in case I am admitted to a hospital other than my transplant hospital. I try to keep this updated every time my medications are altered. This is then shared with my husband.
Please check out the other 2 posts I have on taking transplant medications: Practical Tips On Taking Medications and Anti Rejection Medications.
You might like to read the post What You Need To Know About A Heart Transplant as I reveal all the things I was not aware of before having my heart transplant.
I would love to hear from you about any tips and tricks you have learnt about taking transplant medications. As always, take care and be kind to yourself.
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