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Monica Amin, PharmD
Monica Amin joined the Marley Drug team in 2022, prior to which she held various roles in the pharmaceutical industry as a pharmacist. Monica holds a PharmD and is actively pursuing an MBA.
Feb 3, 2023
Immunosuppressants

Immunosuppression for Transplants

Transplants and Immunosuppressants

Transplantation is a complex surgical procedure consisting of transferring an organ or tissue from one person to another. Preventing rejection is the primary objective of transplant medications as well as reducing adverse effects.

Rejection develops when your body mounts an immunological reaction against the transplanted organ; this might result in transplant failure and necessitate the removal of the transplanted organ right away to avoid death.

What are Immunosuppressants?

Immunosuppressive medications prevent your immune system from harming healthy tissues and cells.

Immunosuppressants may be administered:

  • chronically (long-term) after transplant (maintenance immunosuppression),
  • shortly before transplant (induction immunosuppression),
  • and in the case of acute rejection, which can develop during the first 3 months after transplant.

What are Immunosuppressants used for?

An autoimmune disorder

Your immune system frequently attacks the healthy cells and tissues in your body as a result of these conditions

  • Lupus
  • Rheumatoid arthritis
  • Psoriasis
  • Multiple sclerosis
  • Inflammatory bowel disease (IBD), such as ulcerative colitis and Crohn’s disease
Organ transplant
  • Kidney
  • Liver
  • Pancreas
  • Heart
  • Lungs
Stem cell or bone marrow transplant

What are examples of Immunosuppressants?

As previously mentioned, induction immunosuppressants are administered before or at the time of transplant to provide a higher level of immunosuppression and prevent acute rejection during the early post-transplant period.

Induction immunosuppresant

Interleukin-2 (IL-2) receptor antagonist (monoclonal antibody):
Basiliximab (Simulect): administered via IV (intravenous) injection

Side effects:

  • Fever
  • Upset stomach
  • Nausea
  • Vomiting
  • Cramping
  • Painful urination
  • Shortness of breath

Maintenance immunosuppressants

Steroids:
Prednisone 2.5–5 mg (taken by mouth) daily

Side effects

  • Upset stomach
  • Emotional instability, including mood swings and/or irritability
  • Insomnia
  • Increased appetite and/or weight gain
  • Increased blood pressure
  • Impaired wound healing
  • Acne
  • Impaired growth in children

Antiproliferative agents:

Mycophenolate Mofetil (CellCept): 1–1.5 grams (administered via IV or by mouth) twice a day
Mycophenolate acid (Myfortic): 360–720 mg (by mouth) twice a day
Azathioprine (Azasan, Imuran): 1–3 mg/kg (taken by mouth) daily

Side effects

  • Upset stomach
  • Nausea
  • Vomiting
  • Diarrhea
  • Signs of an infection

Calcineurin inhibitors

Tacrolimus (Prograf): 0.1–0.2 mg/kg/day (taken by mouth)

Side effects

  • Increased blood pressure
  • Kidney toxicity
  • Increased blood sugar levels
  • Increased potassium levels
  • Rash
  • Stomach pain
  • Nausea
  • Urinary tract infection
  • Anemia
  • Abnormally high levels of fats/lipids in your blood
Cyclosporine (Gengraf, Neoral, Sandimmune)

Side effects

  • Increased blood pressure
  • High potassium levels in your blood
  • Low magnesium levels in your blood
  • High blood sugar levels
  • Hirsutism (abnormal facial hair growth)

mTOR kinase inhibitors

Sirolimus (Rapamune): 1–5 mg daily
Everolimus (Zortress): 0.75–1 mg (taken by mouth) twice a day

Side effects

  • Increased blood pressure
  • Headache
  • Rash
  • Insomnia
  • Acne
  • Abdominal pain
  • Diarrhea or constipation
  • Nausea
  • Anemia

Some of these medications listed are administered intravenously (IV) and are therefore not made available through our MarleyDrug website.

What are the risk factors and side effects of Immunosuppressants?

Because they reduce your immune system's ability to fight off infections and because the dosage of immunosuppressive medications is higher during these times, immunosuppressive medications carry a high risk of infection.

The most common side effects are:

  • Upset stomach, nausea, and/or vomiting
  • Acne
  • Diabetes
  • Increased hair loss or growth
  • Weight gain
  • Mouth sores
  • Fever
  • Chills
  • Dizziness
  • Headache

The immunosuppression is typically reduced about 6–12 months following a transplant, therefore, the risk of adverse effects should be minimal.

Ensure you speak with your doctor if you encounter:

  • High temperature (fever greater than 100ºF)
  • Drainage from surgical scars
  • Urination that induces burning
  • Persistent signs and symptoms