Taking medicine after a kidney transplant

Medication list

• transplant clinic
• GP
• dentist
• other hospital specialists

If you are admitted to hospital for any reason, you must always take all of your medicines with you.

Medicine supplies – make sure you never run out

Most of your medicines will be prescribed by your GP and dispensed by your community pharmacy. Please ask for prescriptions from your GP surgery at least one week before you need them.

Your transplant team will need to prescribe some specialist medicines that you may need to take. A pharmacy home delivery company or the outpatient pharmacy at the hospital will provide you with these specialist medicines prescribed by the transplant team.

You must always have at least one-month’s supply of these medicines at home.

You always need to know how much of each specialist medicine you have at home. So keep track and ask the doctor you see in your transplant clinic to write a prescription when you need one.

Immunosuppression (anti-rejection) medicines

Immunosuppressant medicines reduce the effects of your body’s immune system. This protects the kidney that has been transplanted from attack and lowers the chance of rejection. You will need to take immunosuppression medicines for the rest of your life. You will also need regular blood tests by the transplant team to check you are on the right level of immunosuppression to help your kidney and stop your body rejecting it.

Possible side effects of immunosuppressants / anti-rejection medicines
Skin cancer:
Though immunosuppressants are essential to keep your kidney transplant working, they can increase your risk of developing certain cancers. The most common is skin cancer, so you must:

• avoid sunbathing
• protect your skin from the sun
• wear a high factor sun cream when outside all year round
• You should always tell the transplant team or your GP if you notice any changes in your skin.

Increased risk of infection:
Immunosuppressants can put you at increased risk of infection. If you think you are developing any kind of infection you should always let the transplant team or your GP know.

Ways to avoid infection include:

• avoid visiting friends and family if they have an infection such as COVID or flu or have diarrhoea and vomiting
• avoid eating out or having a takeaway in the first six to eight weeks after the transplant
• avoid salad bars and buffets as these have an increased risk of contamination
• check out the food hygiene rating of the restaurant you are eating out at, to ensure that it has good standards, preferably five stars. See ratings and get food hygiene advice at the Food Standards Agency

Commonly prescribed immunosuppressants
The immunosuppressants we prescribe most often are: tacrolimus, mycophenolate and prednisolone

• tacrolimus (Adoport, Prograf, Advagraf, Dailiport, Envarsus)
  You will need to take tacrolimus once or twice a day. Side effects include tremor, hair loss, headache, sleep disturbance, diabetes and impaired kidney function. The blood level of tacrolimus will be monitored carefully to avoid as many side effects as possible.
• mycophenolate
  Some patients are prescribed mycophenolate. If you need to take mycophenolate the doctors will explain why to you. You will need to take it twice a day. Side effects include diarrhoea and nausea. It can also affect your blood counts, especially the number of white cells in your blood. The blood level of mycophenolate will be monitored carefully to avoid as many side effects as possible.
• prednisolone
  Most patients take prednisolone for one week only after the transplant. If you have to take it for longer than one week the doctors will explain this to you. Side effects include indigestion, increased appetite, weight gain, high blood pressure, high blood sugars and mood changes.
  
  

Stopping infections by virus, bacteria and fungus

You will also need to take:

• valganciclovir to prevent cytomegalovirus (CMV) for three months after the transplant.
• co-trimoxazole to prevent urinary tract infection and chest infection for six months after the transplant.
• nystatin mouth solution to prevent fungal infection for six weeks after the transplant.
• Some patients take isoniazid and pyridoxine to prevent tuberculosis (TB) for one year after the transplant.

Protecting your stomach from irritation

You will be given medicines to protect your stomach from the irritation that can sometimes be caused by the anti-rejection and blood thinning medicines.

Blood thinners

You will have an injection to thin your blood every day for about four weeks. You will then take a low dose aspirin tablet once every day.

Blood pressure
You may need to take medicines to lower your blood pressure.

Cholesterol
Most patients are given medicines to keep their cholesterol low. (Cholesterol is a fatty substance in your blood).

Fluid balance
You may need to take medicines to stop you losing too much water from your body (getting dehydrated) or to stop you getting overloaded with fluid.

Diabetes
You may need medicines to lower your blood sugar levels, especially if you had diabetes before the transplant. If you managed your diabetes with tablets before your transplant, you may need to start insulin. If you managed your diabetes with diet and lifestyle changes before your transplant, you may need to start tablets or insulin.

Painkillers
Paracetamol is an effective painkiller and is safe for transplant patients.

Non-steroidal anti-inflammatory drugs (NSAIDS), like ibuprofen and diclofenac, can damage the kidneys. They are not safe for transplant patients and should not be used. This includes gels and creams.

If you have a pain and paracetamol is not working for you, your GP or transplant team can prescribe something stronger that is safe for your kidney.

Over-the-counter medicines
Please do not use any of the following products, which can be bought over the counter, without a prescription:

• herbal medicine
• homeopathic medicine
• Ayurvedic medicine
• Chinese medicine
• natural medicine
• supplements, like vitamins and minerals
• cough and cold remedies
• non-steroidal anti-inflammatory drugs (NSAIDs) like ibubrofen and diclofenac

You can use:
sugar free simple linctus

Food that can affect your medicine
You will need to avoid the following fruits and juices as they can affect the levels of some of your medicines:

• grapefruit
• pomello
• pomegranate
• seville orange (used to make marmalade. Other oranges are OK.)

Help and support with your medicines

You will be given lots of help with your medicines from the doctors, nurses and pharmacy team. They want to make sure that any medicines you take are as effective as possible and reduce the chances of causing any complications or side effects. Every transplant clinic has a pharmacist who can give help and advice with your medicines.

You will be given a pill box to go home with after the transplant to help you take your medicines more easily at home.

You can also download a variety of apps on your phone that help you to manage your medication and remind you when you are due to take a dose.

You can find lots of other medicines information at:

• The NHS Blood and Transplant (NHSBT) website
• Kidney Care UK website
• Kidney Research UK
• National Kidney Federation

You can watch a video about life after your transplant, including your medicines.

Prescription charges
Transplant patients must pay prescription charges unless you do not need to pay for another reason.

A prescription prepayment certificate is the most affordable way to pay. They cost £30.25 for three months or £108.10 for one year and will pay for an unlimited number of prescriptions in that time.

To buy an NHS prescription prepayment certificate:

1. ask for a paper application form at your high street pharmacy/chemist
2. go to the NHS Business Services Authority website and follow the instructions

Disposing of unwanted or out-of-date medicines
Take medicines that you no longer need or that are out-of-date to your local pharmacy and they will be happy to destroy them safely for you. Do not throw medicines away in the rubbish or flush them down the toilet.

Vaccinations after a kidney transplant
We recommend you have the following vaccinations:

• seasonal flu vaccine every year
• pneumococcal vaccine every five years
• COVID vaccine according to national guidance
• non-live Shingles vaccine if you are over 70 years old. You can only have the non-live vaccine, called Shingrix®.

Your GP can give you all of these vaccines. You must not have live vaccines. These include:

• BCG (Bacillus Calmette-Guerin) vaccine
• live shingles vaccine
• live chickenpox (varicella zoster) vaccine
• nasal spray flu vaccine
• rotavirus vaccine
• oral typhoid vaccine, taken as capsules
• oral polio vaccine
• yellow fever vaccine
• MMR (measles, mumps and rubella) vaccine

Make sure any vaccine is safe by telling your travel clinic, GP, transplant clinic or pharmacist about your transplant medications.