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IMPORTANT INFORMATION
ABOUT TAKING YOUR
TRANSPLANT DRUGS
After an organ transplant you need to take medication
such as ciclosporin or tacrolimus to help prevent you
from rejecting that organ. How you take your medication
is very important. Below are some key things to
remember.
For further details or if you have any questions, ask
your transplant nurse, doctor or pharmacist.
See also www.esprit.org.uk
The ESPRIT Group is constituted as an independent company limited by guarantee, full name ESPRIT Partnership Ltd., registered in England and Wales no. 06971971. Registered office: 6 Baldwin Crescent, London, SE5 9LQ. Its activities are open to support by educational grants from interested parties. Currently these include Novartis Pharmaceuticals UK Ltd., Astellas Pharma Ltd., Sandoz Ltd.
and Mylan. However, as an independent group, we do not advocate any particular product and our opinions, recommendations 1. What general things do I need to remember about taking
my immunosuppressant?

Take at regular intervals and exactly as instructed by the doctor or pharmacist. This will
normally be every 12 hours (morning and evening), but there is a special ‘prolonged release’
version of tacrolimus which is only taken once a day, usually in the morning. It is very
important that you know exactly which tacrolimus or ciclosporin product you are taking and
when/ how often you should take it.
Avoid pressing the capsules out of their foil strip until you are ready to take your dose.
Do not break open or cut the capsules.
Swallow whole with liquid, preferably water.
Grapefruit or grapefruit juice should be avoided when taking tacrolimus or ciclosporin as
this fruit can affect the levels of medication reached in the blood.
Always take tacrolimus on an empty stomach i.e. at least 1 hour before food or 2-3 hours
after food.
If you miss a dose, take it as soon as you remember, unless it is almost time for your next
dose. Then go on as before.
2. Are there other medicines to be careful of whilst taking
tacrolimus or ciclosporin?

For safety and efficacy, levels of ciclosporin or tacrolimus in the blood must be kept within
a specific range. Many other medications including prescription drugs, over-the-counter
preparations and even herbal remedies can affect their blood levels. It is essential that you
check with your doctor and/or pharmacist before starting, stopping or changing the dose
of any other medication.
There are some medicines which must not be taken with your transplant medications (so
called ‘absolute contra-indications’). There are others which are routinely used in
transplant patients without a problem, but only as long as blood levels and other relevant
parameters are monitored carefully by the transplant team. These drugs may be referred to
as ‘relative contra-indications’.
Key examples are listed below. For full details see the Patient Information Leaflet providedwith your transplant medicine. There is also a complete index of drug interactions in theBritish National Formulary, which is available online at www.bnf.org.uk. See thealphabetical appendix of ‘Drug Interactions’.
Key medicines which must not be taken with ciclosporin
(brand names: Neoral, Capimune or Deximune)

• any immunosuppressants other than those specifically prescribed by your transplant unit • St John’s Wort (Hypericum perforatum) or any other herbal products or supplements, • certain antibiotics, antifungals, epilepsy treatments, antihypertensives and ‘statin’ Other medicines which may be used in transplant patients,
with care and monitoring by the transplant team

Drugs taken regularly
• stomach acid suppressants e.g. omeprazole or lansoprazole • hormone treatments containing oestrogens e.g. the contraceptive pill or danazol • some epilepsy treatments, antihypertensives and ‘statin’ cholesterol-lowering drugs • some analgesic/ anti-inflammatory products – the so-called NSAIDS e.g. ibuprofen Drugs taken occasionally as required
• some antibiotics, antifungals and antivirals Key medicines which must not be taken with tacrolimus
(brand names: Prograf, Advagraf, Modigraf, Adoport,
Capexion, Tacni or Vivadex)

• any immunosuppressants other than those specifically prescribed by your transplant unit • St John’s Wort (Hypericum perforatum) or any other herbal products or supplements, • certain antibiotics, antifungals, epilepsy treatments, antihypertensives and ‘statin’ Other medicines which may be used in transplant patients,
with care and monitoring by the transplant team

Drugs taken regularly
• stomach acid suppressants e.g. omeprazole or lansoprazole • hormone treatments containing oestrogens e.g. the contraceptive pill or danazol • some epilepsy treatments, antihypertensives and ‘statin’ cholesterol-lowering drugs • some analgesic/ anti-inflammatory products – the so-called NSAIDS especially ibuprofen
Drugs taken occasionally as required
• some antibiotics, antifungals and antivirals 3. Are all Tacrolimus and Ciclosporin products the same?
No, taking different brands of tacrolimus or ciclosporin may result in differing levels of drug
circulating in your blood stream i.e. the levels may be too high or too low. This could have
an effect on your overall health and the safety of your transplanted organ(s). It is also
important that all strengths of ciclosporin or tacrolimus you take are of the same brand.
So, it is vital that you know which specific brand of tacrolimus or ciclosporin you are taking
and continue with that brand, unless specifically changed by your transplant unit. In this
case the transplant team will discuss it with you and arrangements will be made to monitor
your blood levels.
In the community you should also check that your GP and community pharmacy record, use
and always provide your correct brand. It is important that you query any apparent change
in your medication before taking it.
For further information, additional resources and latest news, visit the ESPRIT Group
website: www.esprit.org.uk

Source: http://www.esprit.org.uk/download/docs/EspritAddInfo.pdf

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