Merck Manual

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Drugs Used to Prevent Transplant Rejection

Drugs Used to Prevent Transplant Rejection

Drug

Possible Side Effects*

Comments

Corticosteroids (potent anti-inflammatory drugs that suppress the immune system as a whole)

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)

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†)

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†)

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

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†)

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†)

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

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)†

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

* 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.

† White blood cells help the body recognize and destroy foreign cells.