Immunosuppressant (anti-rejection) medicines

What are immunosuppressant (anti-rejection) medicines?

Your immune system is your body's way to protect you from "invaders", or things like germs, viruses and harmful substances. When this system finds something that it thinks shouldn't be there, it defends against it. After a kidney transplant, your immune system might see your new kidney as something that doesn't belong and may try to attack it. Immunosuppressants, or anti-rejection medicines, help prevent this by lowering your immune system's response, allowing your new kidney to stay healthy and keep working.

Common immunosuppressant medicines

Your transplant team will choose a combination of medicines that are right for you based on your medical history and how well your kidney is working. This medicine can increase your chances of success and have been proven to help stop the immune system from rejecting the transplanted kidney. Common immunosuppressant medicines include:

• Tacrolimus
• Mycophenolate mofetil
• Mycophenolic acid
• Prednisone
• Cyclosporine
• Sirolimus
• Everolimus
• Basiliximab
• Anti-thymocyte globulin 

Talk to your transplant team if you have any questions. They will work with you to adjust any medicines based on monitoring labs to help protect your kidney and support your overall health.

Anti-rejection drugs and kidney damage

Anti-rejection (immunosuppressants) medicines may have side effects that can be managed by adjusting the dose. If the level of medicine in your body is too high, it can affect your kidney and cause damage. However, if there is not enough of a level of medicine, you will be at risk of rejection. This does not mean the medicine is bad for you. Your transplant team will monitor your lab results regularly and adjust your medicine if needed to help protect your overall health and keep your transplanted kidney working.

Why do I need to take immunosuppressant medicines?

Immunosuppressants keep your new kidney healthy and working. There are usually no symptoms when your body starts to reject the kidney and lab work can help determine if the doses are correct.   Stopping them or missing doses is likely to cause rejection. 

Keep taking your medicines as prescribed, no matter how good you feel!

What are the side effects of immunosuppressant medicines?

Many people experience side effects, especially in the first weeks and months after the transplant. Side effects can vary based on the type of medicine, your dose and your overall health. Some are temporary and get better as your body adjusts. Everyone responds differently to immunosuppressant medicines. Some people have mild or short-term effects, while others may face longer-term health risks.

Common short-term side effects

In the first few days after transplant, some side effects are common, including:

• Upset stomach or nausea
• Tremors (shaky hands)
• Trouble sleeping
• Headaches
• Hair loss (alopecia)

Other effects to be aware of

Some side effects of immunosuppressant medicines, such as increased risk of infections, can begin shortly after your transplant. If not managed well, the side effects may last longer. These side effects are common and treatable, but it is important to know what to watch for and when to contact your doctor.

Infections

Immunosuppressant medicines lower your immune system's strength, so your body doesn't attack your new kidney. This also means your body may have a harder time fighting off infections. You will be prescribed prophylaxis or preventative medicines for the first 3-6 months immediately after transplant. Other common infections can be prevented with hand washing and wearing a mask.

Common infections include:

• Colds and flu: cough, runny nose, body aches, fever
• Urinary tract infections (UTIs): burning when you urinate (pee), needing to go more often, cloudy or strong-smelling urine
• Respiratory infections: sore throat, shortness of breath, chest tightness
• Skin infections: redness, swelling, warmth, or pus around a wound or scratch

Weight gain

It's common to gain weight after a transplant. This may be from changes in your medicine, your appetite, or your ability to eat foods you avoided during dialysis.

Too much weight gain can increase your risk of diabetes or heart disease, so your transplant team will help you stay on track with meal planning and low-impact physical activity, such as walking or swimming. They can help you create a meal plan and recommend ways to be active. Learn more about post-transplant eating and healthy living.

Long-term risks and side effects

Some immunosuppressants can affect your kidneys over time, depending on the dose and type of medicine. These medicines can also cause other health problems, including:

• High blood pressure
• New-onset diabetes after transplant (NODAT), also known as post-transplant diabetes
• Gout
• Skin cancer (especially in sun-exposed areas)
• Liver problems
• Chronic kidney disease (CKD)

When to call your doctor

Let your transplant team know right away if you:

• Notice signs of infection (fever, chills, cough, or unusually tired)
• Have swelling, weight gain, or changes in how often you urinate
• Experience side effects that affect your daily life or don't get better

Managing side effects

Many side effects can be managed by changing your dose or switching to a different medicine. Don't hesitate to speak about how you're feeling. It's important to communicate clearly and honestly with your transplant team so they can help you feel your best. The sooner you share any concerns, the sooner your team can make adjustments to improve your quality of life and your kidney health.

Managing side effects early helps protect both your quality of life and your new kidney.

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

Taking your immunosuppressants every day, as prescribed, is very important. Missing even one dose can increase the risk of your body rejecting your new kidney. Most people need to take these medicines for the rest of their lives to keep their transplant working. Always take your medicines exactly as your doctor prescribes.

Missing a dose

Even one missed dose can raise your risk of rejection. If you forget a dose or run out of medicine, call your transplant team right away. They can tell you what to do and may help you get a short-term supply. If you are running low on your medicine and think you may not be able to afford a refill, notify your doctor and social worker immediately.

Are there other medicines that I need to take?

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

• Antibiotics (medicines that kill bacteria) to prevent infection
• Antiviral medicine to prevent infection from viruses
• Other medicines to prevent or treat other health conditions you may have, such as:
  • Statins to lower blood cholesterol levels
  • Medications to lower high blood pressure
  • Insulin to control diabetes

Some medicines, foods and supplements can affect how your body processes immunosuppressants. They can increase side effects or make the medicines less effective. It's important to avoid anything that can change the level of these medicines in your blood. This includes avoiding:

• Grapefruit and grapefruit juice
• St. John's Wort (herbal supplement)
• Erythromycin (an antibiotic)
• Certain blood pressure medicines like diltiazem or verapamil
• NSAIDs (like ibuprofen) unless your doctor approves them
• Over-the-counter supplements, especially those containing potassium or magnesium

Before taking any new medicine, over-the-counter drug, or supplement, always talk to your transplant team. They can help you understand what's safe and what could interfere with your treatment.

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

Immunosuppressant medicines can be expensive. In January 2023, Medicare began covering immunosuppressant medicines for people under 65 who may not have other insurance.

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

Medicare

• Under 65: If you had Medicare at the time of your transplant at a Medicare-approved facility, Medicare may cover your medicines for 3 years.
• 65 and older: Medicare may cover your medicines for as long as your transplant lasts.

Medicaid

• May cover your medicines for as long as you stay enrolled and eligible.
• Eligibility and drug coverage vary by state.
• Visit healthcare.gov or medicaid.gov to check if you qualify.

Private Insurance

• If you had private insurance at the time of transplant and keep the same plan, your medicines may be covered if you maintain that coverage.
• Plans differ: costs, drug lists, and coverage details may change yearly.
• During open enrollment, check if your medicines are still covered.

Drug Assistance Programs

• Many drug manufacturers and nonprofit programs offer discounts or free medicines.
• Members of your transplant team, like your social worker or financial counselor can help you apply.

Insurance and drug coverage rules can change, so it's a good idea to review your options regularly and ask your transplant team or social worker for the most up-to-date information.