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Transplant Meds
Solid Organ Transplant
Drug | Class/MOA | Major ADR | Premdicate | Place in Therapy | D/I | Other |
---|---|---|---|---|---|---|
Tacrolimus | CNI | Nephrotoxicity Hepatotoxicity Neurotoxicity Tremor Alopecia Hyperglycemia | No. | Maintenance. Cornerstone to immunosuppression regimen | CYP3A4 | Highly lipophilic; does not require bile for absorption Monitor trough levels (CNI): African Americans typically require larger doses; redistributes to erythrocytes |
Sirolimus | mTOR-I | Angioedema, proteinuria, oral ulcers, micoryctic anemia, impaired wound healing, graft thrombus: (greatest risk in first 30 days of transplant) Heart Transplant: delay initiation until 3-6 months’ post-transplant | No. | Maintenance Can replace CNI or Anti-metabolite Nephrotoxicity Cancer Intolerance to another agent | CYP3A4 | No IV formulation Nephrotoxicity when used in combo with CNI, so need to lower CNI target troughs when combine CNI with mTOR inhibitor |
Everolimus | mTOR-I | Angioedema, proteinuria, oral ulcers, micoryctic anemia, impaired wound healing, graft thrombus: (greatest risk in first 30 days of transplant) Heart Transplant: delay initiation until 3-6 months’ post-transplant | No. | Maintenance Can replace CNI or Anti-metabolite Nephrotoxicity Cancer Intolerance to another agent | CYP3A4 | No IV formulation Cannot crush tablets |
Azathioprine | Antimetabolite | Bone marrow suppression, pancreatitis, alopecia, photosensitivity, monitor WBC | No. | Maintenance. Commonly used with CNI | llopurinol (decrease azathioprine to 1/4th original dose); Febuxostat | IV:PO conversion: 1 mg IV: 1 mg PO |
Belatacept | Co-Stimulation Blocker | PTLD, C/I in EBV, PML, CNS infection | No | . Maintenance Commonly used with CNI | N/A | N/A |
Mycophenolate | Anitmetabolite | Bone marrow suppression N/D Teratogenic- REMS | No. | Maintenance Commonly used with CNI | Bile Acid Resins | Cellcept 500 mg = Myfortic 360 mg; cannot crush |
Anti-thymocyte globulin | Antibody depleting T and B cells | Low lymphocytes Cytokine release syndrome | Yes. Acetaminophen, Diphenhydramine, Steroids | Induction | None | IV infusion, held for low cell counts, use a filter, central IV line, round the dose to vial size |
Alemtuzumab | Antibody (against CD52) depleting T and B cells , Steroids | hemolytic anemia, hyperthyroidism | Yes. Acetaminophen, Diphenhydramine | Induction | None | Single Dose IV |
Basiliximab | IL2RA | Hypersensitivity | No. | Induction | None | None |
Corticosteroids | Corticosteroids | Hyperglycemia, Osteoporosis, Buffalo hump, moon face etc. | No. | Induction/ Maintenance/ Rejection | None | May give pre- or intra-operative Kidney/pancreas transplant: may withdraw steroids after pre-op dose; Other organs: typically withdraw steroids months/years after transplant |
Cyclosporine | CNI | Nephrotoxicity Hepatotoxicity Tremor Hirsutism, Gingival hyperplasia Hypertension Hyperlipidemia | No. | Maintenance. Cornerstone to immunosuppression regimen | CYP3A4 and P-GP Avoid ACE-I and ARBs | Sandimmune is NOT interchangeable with Neoral or Gengraf (Neoral, Gengraf preferred) Monitor: Trough concentrations |