Immunosuppressant (anti-rejection) medicines

What are immunosuppressant (anti-rejection) medicines?

Immunosuppressant, or anti-rejection, medicines prevent your body from rejecting (fighting) the new kidney. This can happen if your body's immune system realizes that the kidney is from someone else. Immunosuppressant medicines lower (suppress) your immune system to weaken its response to fight your new kidney.

There are three types of immunosuppressant medicines:

• Induction immunosuppressants: Strong medicines used before or right after transplant surgery to prevent your body from rejecting your new kidney right away
• Maintenance immunosuppressants: Medicines you will take daily for the rest of your life (or for as long as your new kidney lasts) to prevent your body from rejecting your kidney long-term
• Rejection immunosuppressants: Medicines used if your body starts rejecting your new kidney

Why do I need to take immunosuppressant medicines?

Immunosuppressant medicines keep your new kidney healthy and working. There are usually no symptoms when your body starts to reject the kidney. Keep taking your medicines as prescribed, no matter how good you feel! Stopping them is likely to cause rejection.

What are the side effects of immunosuppressant medicines?

Infection

The most common side effect of immunosuppressants is infection. You have a higher chance of getting infections because immunosuppressants lower the strength of your immune system.

Weight gain

It is common to gain weight after a transplant as a side effect of the medicines you need to take and because you can eat foods you could not eat when you were on a strict dialysis meal plan.

If you gain too much weight, it can raise your chance of getting heart disease or diabetes.

Your transplant team will work with you to keep a healthy weight. They can help you create a meal plan and recommend ways to be active. Learn more about post-transplant eating and healthy living here.

Other common early side effects include:

• Upset stomach
• Tremors (shaky hands)
• Problems sleeping
• Hair loss
• Headaches

Taking immunosuppressant medicines can also give you a higher chance of other health problems, such as gout, skin cancer and high blood pressure. If you have side effects, talk to your doctor about changing your dose or type of medicines.

How often and how long do I have to take immunosuppressant medicines?

Taking your immunosuppressants is critical. If you miss taking your medicine even one time, your body could reject your new kidney. You will have to take immunosuppressants every day for as long as your transplant lasts. Take your medicines exactly as your doctor prescribed.

If you ever miss taking your medicine, call your doctor right away.

If you are close to running out of your medicine and think you will not be able to afford a refill, let your doctor and social worker know right away.

How much do immunosuppressant medicines cost and will insurance help pay for them?

Immunosuppressant medicines can be expensive.

Here are possible options to get help paying for your immunosuppressant medicines:

• If you are under age 65, are eligible for Medicare because of your kidney failure (end-stage renal disease, or ESRD) status and had Medicare at the time of your transplant in a Medicare-approved facility: Medicare will cover your medicines for three years after the date of your transplant surgery. After three years, you will need to have another way to pay for your medicines, such as other insurance. Many people living with a transplant find jobs after their surgery and can get health insurance through their employer. Other people sign up for a qualified health plan (QHP) through their state's Affordable Care Act Health Insurance Marketplaces or Exchanges.

However, in December 2020, Congress expanded immunosuppressant medicine coverage for people under age 65. Starting in January 2023, Medicare will cover the cost of your immunosuppressant medicines if you do not have any other type of coverage.

• If you are 65 or older and have Medicare: Medicare will cover the cost of your medicines for as long as your transplanted kidney lasts.  
• If you had private health insurance at the time of your kidney transplant and kept the same insurance: Your existing insurance will cover your immunosuppressant medicines for as long as you keep your insurance plan. Your private insurance plan will have its own premium, deductible, copays and coinsurance. These costs usually change year-to-year. Additionally, your formulary, which is a list of approved drugs, can change year to year. It is important to read about the changes in your health insurance policy during every open-enrollment period. The Affordable Care Act eliminated pre-existing conditions in private insurance, so a different plan must still provide immunosuppressant drug coverage, but they may have a different "preferred" immunosuppressant medicine drug on their formulary.
• If you have Medicaid: Medicaid may cover your immunosuppressant drugs for as long as you qualify for and stay enrolled in Medicaid. People qualify for Medicaid based on income, specific health conditions and being in a certain group, like children or pregnant women. Each state runs its own Medicaid program, so eligibility, covered benefits and the lists of approved immunosuppressant drugs will differ from state to state. You can see if you qualify for Medicaid by going to healthcare.gov or Medicaid.gov and answering the questions.

Talk to the social worker or financial counselor at your transplant center to figure out the costs of your medicines and how to pay any costs that insurance does not cover. They may help you find programs that can help pay for your medicines.

The American Kidney Fund may also be able to help. Recent transplant recipients who demonstrate financial need may apply for assistance through our grant programs. Learn more about financial assistance here.

What if I need help paying for my medicines?    

Programs from drug companies or other organizations can help people who qualify to pay for their medicines, such as:

• The Partnership for Prescription Assistance
• RxAssist Patient Assistance Program Center
• Needy Meds
• Drug company programs
• State programs

Are there other medicines that I need to take?

In addition to immunosuppressant medicines, your transplant team may also have you take:

• Antibiotics to prevent infection from bacteria
• Antivirals to prevent infection from viruses
• Medicines to prevent or treat other health conditions you may have, such as:
  • Statins to lower blood cholesterol levels
  • ACE (angiotensin converting enzyme) inhibitors or ARBs (angiotensin receptor blockers) to lower high blood pressure
  • Insulin to control diabetes

You will need to avoid some medicines, foods and supplements that can change the levels of immunosuppressants in your blood. This includes avoiding:

• Grapefruit and grapefruit juice
• St. John's Wort
• Erythromycin (an antibiotic)
• Some common blood pressure medicines, like diltiazem

Before taking any medicines or supplements, ask your doctor if they are safe for you.