Medication

There are three types of medications you'll need:

It's important to know which medications can cause drug interactions so if you're ever in an emergency, you and your care partner know which drugs aren't safe. If you have been prescribed new medication in a clinic, please let the transplant team know before starting so we can check whether there are interactions.

There are certain medications you should never take. This includes certain antibiotics like:

• Clarithomycin (Klacid®)
• Erythromycin
• Fluconazole (Diflucan®)

You also need to avoid all NSAIDs. NSAIDs (nonsteroidal anti-inflammatory drugs) are medications that reduce pain, fever and inflammation. If you're not sure whether a pain medication is an NSAID, ask your pharmacist first. Common NSAIDs include:

• Ibuprofen (Advil®, Nurofen®)
• Diclofenac (Difene®, Voltaren®)
• Naproxen (Aleve®, Naprosyn®)
• Mefanamic Acid (Ponstan®)
• Disprin (Voltaren®)
• Celecoxib (Celebrex®)

You will be given a pocket card with this information on it. Show it to anyone that is prescribing or providing medication to you.

Anti-fungal medications

Some anti-fungal medications have interactions with your immunosuppressants. If you are starting or stopping an anti-fungal medication, please ring the clinic so we can make changes to your immunosuppressant dose, if needed.

Alternative medicines

Sometimes patients try to treat specific symptoms with alternative medicines like food supplements, patches, topical creams, herbal remedies, or green teas. These may seem harmless but since the ingredients are highly concentrated, they can interact with your medications. You can use normal quantities of herbs and spices for cooking, but don't try any high concentrations. This includes:

• St. John's Wort
• echinacea
• ginkgo biloba
• ginseng
• goldenseal
• kava
• milk thistle
• turmeric or curcumin
• ginger
• garlic supplements

If you have any questions about whether something is safe to consume or if you’re looking for a way to treat a specific symptom, don’t hesitate to ask the transplant team for advice.

Safety tips

• Always read the leaflet of any new medication. If you have any questions or concerns, ask the prescribing doctor and the transplant team.
• Vomiting, diarrhoea and constipation can affect whether your body properly absorbs medication, which could put you more at risk for rejection. If you’re experiencing any of these, seek medical advice. If you are vomiting your tablets and not able to keep them in your stomach, go to your local emergency department.
• Do not eat grapefruit, pomelo, pomegranate, or fresh ginger, as these can interact with your medications. For a full list of foods to avoid, go to High risk foods and their alternatives.
• Never order medications or treatments online. Only get your medications from your local pharmacist.
• Always use your medication within the expiry date.
• Do not use blister packs for your medication. The tablets are sensitive to light and are best kept in their original packaging until you are ready to take them. Storing them outside their foil wrapping may affect their quality and how well they work for you.

You will experience side effects with your medications. Some will be minor and temporary, but others may be more serious, like high blood pressure, diabetes or osteoporosis. Your healthcare team will talk you through possible side effects, but it’s also your responsibility to keep informed by reading all the material in your medication packs.

If you’re experiencing any uncomfortable side effects, let the team know. They may be able to alter the dose or find a better fit for you.

You may also have extra medications to take throughout the day. They need to be taken at the same time each day to give your body the right level of protection 24 hours a day. Missing this by even an hour can have an effect. Being consistent with your medications will also give the transplant team a more accurate reading during blood tests, so they can make adjustments to your doses as needed.

How to organise your medications

Use a big, roomy plastic container to store your medication. It should include:

• All of your medication, in its original packaging. The medication is less effective when exposed to light or air so they need to stay in their original packaging.
• Your medication journal and a pen
• A clean cup or bowl

You need to know your medications. Take the immunosuppression medication out of its original packaging every time you have to take them. This is very important as your prescriptions, doses and instructions may change regularly. If a medication is ever stopped, remove it from the box and return it to your pharmacy for disposal.

If you're having trouble managing your medications or you find you're relying too much on your care partner to help you, please talk to the post transplant nurses for advice.

Post transplant journal

You’ll be given a post transplant journal before you are discharged from hospital. This journal includes a section for keeping track of your medication, the dosage and times they were taken. It will help you to stick to your daily routine and make note of any concerns.

Recommended routine

Set an alarm on your phone for 10am and 10pm.

• Go to a quiet place so you can concentrate.
• Write down the medications you need to take in your medication journal.
• Take all the medications you are going to use out of the container.
• With the first medication, take out the correct number of tablets and put them into a cup. Tick it off the list in your transplant journal.
• Repeat the above step for each medication, one at a time, until all the tablets you need to take are in the cup.
• Take all of the tablets.
• Put each medication back into its original packaging, and into the storage container.

If you have a medical card, this will cover the cost of your medications. However, the particular medications covered may change over time, so it’s best to speak to your local pharmacist.

Every resident in Ireland is entitled to the Drugs Payment Scheme, which caps the amount you pay each month for all necessary drugs. For more information, visit Drugs Payment Scheme - HSE.

Not all vaccines are safe for people who have had a transplant. This is because a vaccine may include a live virus, which can be tough on your weakened immune system.

For more information, go to Lifelong care.

Immunosuppressives

Steroids

Antibiotics

Anti-viral medications

Antiviral medication may only be needed for a few months after transplant to reduce the risk of viral infection. The transplant team will tell you when you can stop taking them.

Anti-fungal medications

Other medications