Drugs Used to Prevent Transplant Rejection
Drug |
Possible Side Effects* |
Comments |
Corticosteroids (potent anti-inflammatory drugs that suppress the immune system as a whole) |
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Dexamethasone Prednisolone Prednisone |
Excess hair on the face Facial puffiness Fragile skin High blood sugar levels (as occur in diabetes mellitus) Muscle weakness Stomach ulcers Water retention |
Given by vein in high doses at the time of transplantation Gradual reduction of the dose to a maintenance dose taken by mouth, usually indefinitely |
Polyclonal immunoglobulins (antibodies directed toward particular cells of the immune system) |
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Antilymphocyte globulin Antithymocyte globulin |
Severe allergic reactions (anaphylactic reactions) with fever and chills, usually occurring only after the first or second dose Sometimes a reaction to the foreign proteins in the drug, causing fever, rash, and joint pain (serum sickness) Sometimes kidney problems |
Given by vein Used at the time of transplantation with other immunosuppressants so that those drugs can be used in lower, safer doses Also used for rejection episodes |
Monoclonal antibodies (antibodies that target and suppress white blood cells†) |
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Basiliximab |
Severe allergic (anaphylactic) reactions |
Given by vein Used at the time of transplantation or for rejection episodes The only antibody of its type still available |
Calcineurin inhibitors (drugs that inhibit the production and activation of white blood cells†) |
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Cyclosporine |
Excessive hairiness (hirsutism) Gum enlargement High blood pressure Increased levels of cholesterol and other fats Increased risk of lymphoma Kidney damage Liver damage Nerve damage Tremor |
Given by mouth Used at the time of transplantation and for maintenance immunosuppression in people who have received an organ transplant Can be used alone but is usually given with other drugs that help prevent rejection |
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Tacrolimus |
Diabetes Diarrhea Gout Hair loss Headache High blood pressure Increased levels of cholesterol and other fats Increased risk of lymphoma Insomnia Kidney damage Liver damage Nausea Nerve damage Tremor |
Given by mouth Used at the time of transplantation and for maintenance immunosuppression in people who have received an organ transplant Used for rejection episodes |
Rapamycins (drugs that inhibit the production and activity of white blood cells†) |
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Everolimus Sirolimus |
Accumulation of fluid (edema) in the legs Anemia High blood pressure Increased levels of cholesterol and other fats Lung damage Rash Slow healing of wounds |
Given by mouth Used with corticosteroids or cyclosporine for maintenance in people who have received a kidney or liver transplant Everolimus: Used to prevent rejection of a kidney or liver transplant |
Mitotic inhibitors (drugs that suppress cell division and thus the production of white blood cells†) |
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Azathioprine |
Fatigue Fever and rash (hypersensitivity reaction) Hepatitis (rare) Low white blood cell count |
Given by mouth Used at the time of transplantation and for maintenance immunosuppression in people who have received an organ transplant Often used with low doses of calcineurin inhibitors |
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Mycophenolate mofetil |
Diarrhea Increased risk of lymphoma Low white blood cell count Nausea Vomiting |
Given by mouth Used for maintenance immunosuppression in people who have received an organ transplant Used with corticosteroids and cyclosporine or tacrolimus |
OT-cell costimulatory blocker (drug that suppresses activation and proliferation of white blood cells)† |
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Belatacept |
Constipation Dizziness Headache Increased hunger Increased risk of lymphoma Increased urination |
Given by injection Used to prevent rejection of kidney transplants Increases risk of certain viral infections and viral disorders Rarely used in kidney transplant recipients who are at increased risk of kidney damage caused by use of calcineurin inhibitors |
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* All of these drugs increase the risk of infections. Also, they can all cause allergic reactions, but the risk is higher with some of them. |
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† White blood cells help the body recognize and destroy foreign cells. |
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