You will take a combination of medicines after surgery to help your body accept the new kidney. Every patient is on a customized medication schedule. All immunosuppressive drugs increase the risk of infection and cancer. Ongoing research exists to better the outcome of transplants.
The medications are very expensive. You will meet with the transplant social workers during your evaluation and after the transplant to discuss your plan for paying for the medications.
Listed below are the most common medications currently being used:
- Prograf/Astagraf XL(tacrolimus) – acts to suppress the body’s immune system. This drug is a small capsule. Side effects include tremors, possible toxicity to your kidney, high blood pressure, and increased stomach upset and diarrhea. (You may be taking either Prograf or Cyclosporine but not both medications.) The approximate cost per month for this drug is about $1350.
- Cellcept / Myfortic (mycophenylate) – acts to suppress your body’s ability to fight the new kidney. This drug is available in both tablet and capsule. Side effects of this medication may include decreased white cell count (WBC) increased risk for infection and increased stomach upset and diarrhea. (You may be taking either Cellcept / Myfortis or Imuran but not both medications.) The approximate cost per month for this drug is $625.
- Rapamune (sirolimus) – acts to depress the body’s immune system. This drug comes in both liquid and tablet form. Side effects may include increased cholesterol level and decreased platelet count. (You may be taking this medication along with Neoral, Prograf, CellCept and Prednisone.) The approximate cost per month for this drug is $550.
- Zortress (everolimus) – acts to suppress the body’s immune system. This drug is used in the prevention of kidney transplant rejection in patient’s at a low to moderate immunologic risk. Also fights cancer by reducing cell growth. The approximate cost of this drug per month is $1274.
- Prednisone or prednisolone – reduces your body’s chance of attacking your transplanted kidney. This drug is a tablet. The dose is high at the time of transplant but is tapered quickly to a lower maintenance dose. Some of the more common side effects are: fluid retention, weight gain, night sweats, joint pain, mood swings, increased risk of bleeding ulcer, changes in eyesight, weakness of bones, and increases in blood sugar. Many of these side effects will decrease as the dose of the medication is lowered. The approximate cost per month for this drug is $10.
- Sandimmune/Neoral (cyclosporine) – acts to suppress the body’s immune system. This drug is a gel capsule or liquid. Side effects may include excessive hair growth, increase in gum tissue, tremors, possible toxicity to your kidney or liver, and high blood pressure. (You may be taking either Cyclosporine or Prograf but not both medications.) The approximate cost per month for this drug is $750.
- Imuran (azathioprine) – acts to suppress your body’s ability to fight the new kidney. This drug is a tablet. Side effects may include decreased white cell count (WBC), and increased risk of liver abnormalities and hair loss. (You may be taking either Imuran or Cellcept but not both medications.) The approximate cost per month for this drug is $45.
You may receive additional medications to prevent complications or to treat a current problem:
- Insulin – increased blood sugar seen with steroid medication may require insulin treatment.
- Antacids – coats the stomach to prevent stomach ulcers while you are on higher doses of steroids. Antacids can cause either constipation or diarrhea, which can be controlled by changing the dosage.
- Mycostatin mouthwash (nystatin) or Mycelex Troches (clotrimazole) – helps prevent a fungal infection called thrush. Usually this medication is discontinued when steroid doses are reduced. Side effects may include nausea.
- Valcyte – helps to prevent or treat cytomegalovirus (CMV) infections. Some patients may need this, while others may not. Usually this medication is taken from three to six months. The approximate cost per month of this drug is $4000.
- Blood pressure medicine
- Medicine to increase your urine output.
- You may be prescribed an antibiotic as a preventative measure while you are taking immunosuppressant medications.
Although many insurance plans cover medications, be prepared to spend several hundred dollars on medication when you leave the hospital.
PLEASE REMEMBER – IT WILL BE NECESSARY FOR YOU TO TAKE YOUR IMMUNOSUPPRESSIVE MEDICINES AS LONG AS YOU HAVE YOUR TRANSPLANTED KIDNEY. If you stop taking your immunosuppressive medicines – you will lose your kidney.