Immunosuppressive Drug Choices After Heart Transplant: What Choices Do Patients Have?
The body’s immune system is the enemy of a transplanted heart. To help reduce the impact the immune system has on a new heart, the patient and their doctor must discuss immunosuppressive drug choices after a heart transplant. Patients will take one drug from each of the three different drug groups that make up the foundation of current immunosuppressive therapy after heart transplant. Patients will slowly be weaned off their category three drug, but will take their category one and category two drugs for the rest of their life. If these drugs are stopped completely, the transplanted heart will be rejected by the body so patients must take these drugs everyday as prescribed for the rest of their lives to reduce their chance of experiencing rejection.
Category One Drugs
Category one drugs consist of antimetabolites. These drugs prevent heart transplant rejection by stopping the immune system from producing the T cells and B cells that will result in a transplanted heart being rejected. Imuran is a common antimetabolite medication prescribed to heart transplant patients. This medication can cause side effects, such as bone marrow suppression, nausea, low white blood cell count, and liver abnormalities. Cell Cept is another commonly prescribed antimetabolite. This medication can cause side effects, such as nausea, low white blood cell count, and diarrhea. Rapamycin is another antimetabolite patients may be prescribed. This medication can cause side effects, such as low white blood cell count, low platelets, nausea, and high cholesterol specifically triglycerides.
Category Two Drugs
Category two drugs consist of antiproliferatives. These drugs prevent heart transplant rejection by preventing the cell line expansion that modulates rejection. Neoral is a common antiproliferative medication prescribed to heart transplant patients. This medication can cause side effects, such as kidney problems, tremors, photosensitivity, increased hair growth, headache, high potassium, and thickening of the gums. Prograf is another commonly prescribed antiproliferative medication. This medication can cause side effects, such as kidney problems, seizures, tremor, high potassium, headache, and high blood pressure.
Category Three Drugs
Category three drugs consist of steroids. These drugs prevent heart transplant rejection by nonspecifically preventing the cell line expansion that modulates rejection. Prednisone is a corticosteroid and the most commonly prescribed steroid for heart transplant patients. This medication can cause side effects, such as round face, bone weakening, increased cholesterol, cataracts, diabetes, obesity, muscle weakness, and mood swings.
Dosages
The dosage of these medications are titrated through blood levels. The following are the average dosages for the medications listed above:
- Imuran: Two milligrams a day
- Cell Cept: 1,500 milligrams twice a day
- Rapamycin: No average available
- Neoral: Four to six milligrams twice a day
- Prograf: 0.15 to 0.3 milligrams twice a day
- Prednisone: Up to 50 milligrams a day
Resources
Columbia University Medical Center, Department of Surgery. (2007). Retrieved on July 27, 2010 from Columbia University Medical Center, Department of Surgery: https://www.cumc.columbia.edu/dept/cs/pat/hearttx/medications.html
Medline Plus. (2009). Heart Transplant. Retrieved on July 27, 2010 from Medline Plus: https://www.nlm.nih.gov/medlineplus/ency/article/003003.htm
