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This list of drugs does not include everything you might be taking. It includes many drugs commonly given to kidney patients. The inclusion of a drug on the list is not a recommendation that it should be used. Conversely, the omission of a drug from the list does not suggest that your doctor should not be prescribing the drug to you.

Co-trimoxazole

About your medicine
Co-trimoxazole is an antibiotic that you need to take after your kidney transplant or when you are taking cyclophosphamide or rituximab. It is a combination of two medicines called sulfamethoxazole and trimethoprim. It is given at a low dose to prevent you from catching a specific chest infection, a type of pneumonia called pneumocystis, or PCP or CDC. You are more likely to get infections while you are taking a lot of immuno-suppressant drugs for your new kidney. When you are asked to take less immuno-suppressant drugs you will be able to stop taking the co-trimoxazole, normally six months after your transplant or finishing cyclophosphamide or rituximab treatment.

Taking your medicine
Before taking your medicine read the information leaflet inside the pack. It will give you more information about the medicine including a full list of the side effects.

You should swallow the tablets whole with a glass of water. The tablets are usually taken once a day. If you have problems swallowing, a liquid is also available.

Unwanted effects
As with all medicines, co-trimoxazole can cause side effects in some people. The most common side effects include feeling sick, being sick and skin rashes. If the tablets make you feel sick try taking them with food: if you develop a rash, you should report it to your doctor. straightaway. Rarely side effects include changes that will be noticed with your blood tests, eg. changes to your red and white blood cells. This means you may become anaemic, bruise or bleed more easily than usual. Your liver might also be affected and cause you to become jaundiced (yellow).

Unwanted effects often improve after a short while, however, if they are prolonged or troublesome, speak with your doctor or pharmacist.

Storing your medicine
You should store the tablets in their original container in a cool, dry place out of the sight and reach of children.

Do not throw out any expired or unwanted medicine by flushing them down the toilet or throwing them away. Take them to your local pharmacy which will dispose of them for you.

Other Advice

Some drugs may cause a problem when taken with co-trimoxazole.

For instance, co-trimoxazole should never be taken with methotrexate. Always check with your doctor or pharmacist before taking any other medication along with co-trimoxazole including medicines that you can buy without a prescription or any herbal and complementary medicines.

Last reviewed August, 2019

Isoniazid

About your medicine
Isoniazid is a drug which may be taken after a kidney transplant by patients who may come into contact with or have previously had Tuberculosis (TB) – a long term infection which mainly affects the lungs but which can affect any part of the body, or the chest. It is given at a low dose to prevent TB infections.

Taking your medicine
Before taking your medicine read the information leaflet inside the pack. It will give you more information about the medicine including a full list of the side effects.

You should swallow the tablets whole with a glass of water, take them exactly as recommended by the doctor. It is best to take the tablets half an hour before food or two hours after. This is because isoniazid is absorbed better when your stomach is empty.

Unwanted effects
As with all medicines, isoniazid can cause side effects in some people. The most common side effects include feeling sick, being sick. You should tell your doctor if you suffer badly with being sick. It may also damage peripheral nerves which can cause tingling or a loss of feeling in your hands and feet. This can be avoided by taking another tablet called pyridoxine once a day. This is a vitamin which should be taken every day while you are taking isoniazid.

Other side effects can include liver problems. Your doctor will arrange for you to have blood tests while you are taking isoniazid to ensure your liver is working properly.

Unwanted effects often improve after a short while, however, if they are prolonged or troublesome, speak with your doctor or pharmacist.

Storing your medicine
You should store the tablets in their original packet in a cool, dry place out of the sight and reach of children.

Don’t throw out any expired or unwanted medicine by flushing them down the toilet or throwing them away. Take them to your local pharmacy which will dispose of them for you.

Always take your tablets as directed by your doctor and only stop them on the advice of your doctor.

Some drugs may cause a problem when taken with Isoniazid. These include some anti-epileptic drugs and theophylline. This is not a full list so always check with your doctor or pharmacist before taking any other medication along with Isoniazid including medicines that you can buy without a prescription or any herbal and complimentary medicines.

Last reviewed August, 2019

Azathioprine

About your medicine
Azathioprine belongs to a group of medicines called immuno-suppressants. As the word immuno-suppressant suggests, the function of these drugs is to suppress the immune system, which is the body’s natural defence system. The aim is to dampen down the immune system enough to stop it rejecting the transplanted kidney while still keeping it active enough to fight infections. All patients who have a kidney transplant need to take drugs called immuno-suppressants.

Azathioprine is also taken for autoimmune disease, for example, vasculitis. It is used to try and improve kidney function and to dampen down the disease, stopping it from causing any further damage to the body.

Azathioprine is only available from your doctor.

You should NOT be vaccinated with some vaccines whilst receiving azathioprine. (Vaccines are injections that can be given to help prevent you catching some diseases, for example, polio).
For more information see our Holiday/Travel vaccine Click here

Do not stop taking the drug or start taking it only occasionally, you will lose your kidney or the vasculitis condition may go out of control and your kidneys may fail completely.

Taking your medicine
You should swallow the tablets whole with a glass of water, with meals. Do not chew the tablets. Your recommended daily dose should be taken as a single dose at teatime.

Take the tablets exactly as directed by your doctor. Please read the label carefully.

If you forget to take a dose, take the missed dose as soon as you remember, unless it is nearly time to take the next one. Never take two doses at the same time. Take the remaining doses at the correct times.

Your doctor may want to take regular blood samples while you are taking azathioprine to make sure that dose is ok for you.

Unwanted effects
Azathioprine may cause side effects in some patients. Most side effects are nothing to worry about. Common side effects are feeling sick, being sick, loss of appetite. Taking the tablets with food should reduce this. Other rare, more serious side effects include fever, rashes, decrease in blood cell numbers, liver and kidney problems that are noticed by changes in your blood tests..

You are more likely to develop infections whilst receiving azathioprine and any infections may be worse than normal. You should report any signs of infection to your doctor. You should report any unexpected bruising, bleeding, or rashes to your doctor.

You should avoid sunbathing and use a sunblock in sunny weather. You are recommended to see your doctor about regular skin checks and cervical smears for women, this is because you are more likely to develop skin or cervical cancers which are not serious if noticed early.

All tablets may cause side effects in some people. If you think that you are suffering from a side effect of one of your tablets it is important NOT to stop taking the tablet, but see your doctor who will be able to change that tablet for one which will suit you better.

Storing your tablets
Store all your tablets in their original containers, in a cool dry place out of the sight and reach of children. Only remove them from the bottle/box when it is time to take them.

Always take your tablets as directed by your doctor and only stop them on the advice of your doctor.

Do not throw out any expired or unwanted medicine by flushing them down the toilet or throwing them away. Take them to your local pharmacy which will dispose of them for you.

Last reviewed August, 2019

Prednisolone

About your medicine
Prednisolone is a steroid tablet. It is not the same type of steroid tablet that the body builders take. Prednisolone belongs to a group of medicines called immuno-suppressants. As the word immuno-suppressants suggests, the function of these drugs is to suppress the immune system, which is the body’s natural defence system. The aim is to dampen down the immune system enough to stop it rejecting the transplant kidney whilst still keeping it active enough to fight infections. All patients who have a kidney transplant need to take drugs called immuno-suppressants.

Prednisolone is also taken for auto-immune diseases for example, vasculitis or nephrotic syndrome. It is used to try and improve kidney function and to dampen down the disease, stopping it from causing any further damage to the body.

Whilst you are taking prednisolone you are more likely to become ill due to an infection, especially during periods of stress. It is advisable to report any infection to your doctor.

You should NOT be vaccinated with some vaccines whilst receiving prednisolone (Vaccines are injections that can be given to help prevent you from catching some diseases, for example, polio).
For more information see our Holiday/Travel vaccine Click here

If you or anyone in your family or close friends catches CHICKENPOX it is important to tell your doctor IMMEDIATELY but DO NOT STOP taking your prednisolone. It is also important that you contact your doctor if you catch chickenpox within three months of stopping prednisolone.

Taking your Medicine
You should swallow the tablets whole with a glass of water. They are best taken with food first thing in the morning.

Take the tablets exactly as your doctor explained to you. Do not suddenly stop taking the tablets. Your doctor will tell you when to reduce the dose and when to stop altogether.

If you forget to take a dose, take it as soon as you remember, unless it is nearly time to take the next dose then go on as before.

Unwanted effects
Like most medicines, prednisolone can cause side effects in some people. These include indigestion, weight gain, moon face, diabetes, raised blood pressure, bloated feelings, mood changes, raised cholesterol and tiredness. Some patients may develop facial hair and the face is flushed. Effects that may be seen over a longer period of time include thinning of the bones (osteoporosis) and skin (and bruising on the arms and legs), high blood pressure and mood changes. These side effects are more likely when you are on a high dose, your dose will be lowered by your doctor when it is safe to do so. (For more information about side effects see page 39)

If you suffer from any of these, or other undesirable effects, report them to your doctor. DO NOT stop taking the tablets. Your doctor will have chosen this treatment for you bearing in mind the above risks.

Storing your medicine
Store all your tablets in their original containers, in a cool dry place out of the sight and reach of children. You should only remove them from the bottle/box when it is time to take them.

Do not throw out any expired or unwanted medicines by flushing them down the toilet or throwing them away. Take them to your local pharmacy which will dispose of them for you.

Last reviewed August, 2019

Cyclophosphamide

About your medicine
Cyclophosphamide belongs to a group of medicines called immuno-suppressants. It can also be used in bigger doses to treat some cancers. As the word immuno-suppressant suggests, the function of these drugs is to suppress the immune system, which is the body’s natural defence system. Ccyclophosphamide is taken for some auto-immune diseases for example, vasculitis. It is used to try and improve kidney function and to dampen down the disease, stopping it from causing any further damage to the body.

Cyclophosphamide can be taken for myeloma, vasculitis, lupus or membranous nephritis.

Vasculitis causing renal failure can be due to different conditions.

Cyclophosphamide can be given as an injection or in tablet form. Cyclophosphamide can be taken as a larger dose once a week or a smaller dose once a day. Your doctor will decide which is better for you.

Contraception should be used whilst taking cyclophosphamide and for 3 months afterwards because it could be harmful to unborn babies.

You should NOT be vaccinated with some vaccines whilst receiving Cyclophosphamide. Vaccines are injections that can be given to help prevent you from catching some diseases, for example, polio).

Taking your medicine
The tablets should be swallowed whole, not chewed or crushed. Ideally they should be taken with a full glass of water, you should check with your doctor about increasing your fluid intake.

If you are taking high dose cyclophosphamide with another tablet called mesna (see below) the mesna tablets can be broken in half or taken whole to get the dose needed.

Unwanted effects
Like all medicines, cyclophosphamide can cause side effects.

With higher doses, feeling sick is common, but this is reduced by a tablet called ondansetron which is taken one hour before your first dose of cyclophosphamide.

Cyclophosphamide can cause inflammation of the bladder so, with higher doses, you may be given a tablet called mesna, which will protect your bladder.

Hair loss can occur during treatment. It is more likely with the higher dose cyclophosphamide, smaller, daily doses are less likely to cause a problem. Hair growth comes back again after finishing treatment and often comes back whilst remaining on low doses daily.

Cyclophosphamide can also cause a decrease in “white blood cells”, your doctor will check your blood regularly to make sure this does not occur.
A drop in white blood cells can make you more prone to catching infections.
In particular, illnesses like chickenpox can be more severe in this situation - inform your doctor if you come into contact with anyone with chickenpox whilst on cyclophosphamide treatment or if you have had it before.

Cyclophosphamide can also increase the chance of developing a lung infection called “pneumocystis”. You may be prescribed a preventative antibiotic called co-trixazole to reduce this risk.

Contact your doctor if you develop a temperature higher than 38c (100.5Of), or if you feel unwell and develop unexplained bruising or bleeding at any point during treatment with cyclophosphamide.

Cyclophosphamide can cause infertility in some patients (being unable to have a baby). Infertility is usually temporary but in some cases can be permanent. It can occur in both men and women. Your doctor will discuss your options, including sperm banking, before you start treatment.

In women, cyclophosphamide may also cause a temporary or permanent change in your monthly periods, causing them to become irregular or causing them to stop. Women may also experience an earlier menopause.

You are recommended to see your doctor about regular skin checks and, for women, regular cervical smears. This is because you are more likely to develop skin in cervical cancers which are not serious if noticed early.

Storing your medicine
Store the tablets in their original packet in a cool, dry place out of the sight and reach of children. Only remove the tablets from the container when it is time to take them.

Do not throw away any expired or unwanted medicine by flushing them down the toilet or throwing them away. Take them to your local pharmacy which will dispose of them for you.

Last reviewed August, 2019

Ciclosporin

About your medicine
Ciclosporin belongs to a group of medicines called immuno-suppressants. As the word immuno-suppressant suggests, the function of these drugs is to suppress the immune-system, which is the body’s natural defence system. The aim is to dampen down the immune system enough to stop it rejecting the transplant kidney while still keeping it active enough to fight infections. All patients who have a kidney transplant need to take drugs called immuno-suppressants.

Ciclosporin is only available from your doctor.

Ciclosporin is also taken for auto-immune diseases. It is used to try and improve kidney function and to dampen down the disease, stopping it from causing any further damage to the body.

You should NOT be vaccinated with some vaccines whilst receiving ciclosporin. (Vaccines are injections that can be given to help prevent you from catching some diseases, for example, polio).
For more information see our Holiday/Travel vaccine Click here

Ciclosporin is the drug name, there are different brands of ciclosporin available. The best known brand is Neoral® It is also available as Deximune® It is very important that you ALWAYS take the same brand of ciclosporin. Always check that you receive the same brand from your doctor or pharmacy. Different brands can work differently, if you change brands you may damage your new kidney.

You should NEVER stop taking ciclosporin unless told to by your hospital consultant.

Taking your medicine
You should not chew the capsules. Your daily dose should be taken as two divided doses, morning and evening, as directed by your doctor (12 hours apart). Ciclosporin liquid is available if you have problems swallowing.

You should AVOID grapefruit and grapefruit juice for one hour before taking ciclosporin, because it can affect the amount of ciclosporin that gets into your system.

You should take the capsules exactly as recommended by your doctor. You will need to have regular blood samples taken to check that you are receiving the correct dose of ciclosporin, too much can be bad for your kidney. When you come to have a blood test you should not take your morning dose until after you have had your blood taken.

If you forget to take a dose, take it as soon as you remember, unless it is nearly time for your next dose, then go on as before.

Always take ciclosporin as directed by your doctor and only stop it on the advice of your doctor.

You will lose your new kidney if you stop taking ciclosporin.

Unwanted effects
Ciclosporin can cause side effects in some people, the most common side effects include gum swelling, hair growth (especially facial hair), tremor, feeling sick and diarrhoea, the more rare side effects include rashes, weight increase, kidney damage and muscle weakness.

It is important that you visit your dentist regularly and tell them that you are taking Ciclosporin and clean your teeth regularly. It is recommended to use a medicated mouthwash such as Corsodyl® to help the gums not to swell.

You are more likely to develop infections whilst receiving immuno-suppressant therapy and any infections may be worse than normal, you should report any signs of infection to your doctor. You should also report any unexpected bruising, bleeding or rashes to your doctor.

Some drugs may cause problems with ciclosporin; these include erythromycin, rifampicin and phenytoin. Some herbal remedies may also cause problems, including St. John’s Wort.– this is not a full list so always check with your doctor or pharmacist before taking any other medicines with ciclosporin.

It is best to AVOID sunbathing and to use a sunblock in sunny weather. You are recommended to see your doctor about regular skin checks and cervical smears for women. This is because you are more likely to develop skin or cervical cancers, though these are not serious if noticed early.

Storing your medicine
Store the tablets in their original packet in a cool, dry place out of the sight and reach of children. Only remove the tablets from the container when it is time to take them.

Do not throw away any expired or unwanted medicine by flushing them down the toilet or throwing them away. Take them to your local pharmacy which will dispose of them for you.

Last reviewed August, 2019

Mycophenolate

About your medicine
Mycophenolate belongs to a group of medicines called immuno-suppressants. As the word immuno-suppressant suggests, the function of these drugs is to suppress the immune system enough to stop it rejecting the transplant kidney while still keeping it active enough to fight infections. All patients who have a kidney transplant need to take drugs called immuno-suppressants.

Mycophenolate is also taken for auto-immune diseases for example, systemic lupus erythematosus (SLE). It is used to try and improve kidney function and to dampen down the disease, stopping it from causing any further damage to the body.

Mycophenolate is only available from your doctor.

There are several mycophenolate products which include mycopheolate mofetil (Cellcept) and mycophenolate sodium (Myfortic or Ceptava). Your transplant doctors will advise which you are to take. You must not switch between the two preparations of the drug unless your transplant doctor advises you to do so. However, you may change between different brands of mycophenolate mofetil - ask your pharmacist for advice.

You should NOT be vaccinated with some vaccines whilst receiving mycophenolate. (Vaccines are injections that can be given to help prevent you from catching some diseases, for example, polio).
For more information see our Holiday/Travel vaccine Click here

Taking your medicine
Your recommended daily dose should be divided and taken as equal doses in the morning and evening (12 hours apart).

Take the capsules/tablets exactly as your doctor asked you, never change the dose yourself. If you accidentally take an extra dose, tell your doctor immediately, if you forget to take a dose, take it as soon as you remember unless it is nearly time for the next dose, then go on as before.

If you stop taking mycophenolate you will lose your new kidney or cause your disease to get worse.

You will need to have regular blood samples taken and your medication may need to be adjusted according to your blood test.

Unwanted effects
Mycophenolate may cause side effects in some people. The most common side effects include diarrhoea, feeling sick, trembling, headaches and dizziness. Other side effects include problems with the blood. As with any immuno-suppressant drug you are more likely to develop infections and any infections may be worse than normal, you should report any signs of infection to your doctor.

Some other drugs may cause problems with mycophenolate, these include indigestion remedies, aciclovir, probenecid and cholestyramine. Some herbal remedies may also cause problems including St. John’s Wort. This is not a full list so always check with your doctor or pharmacist before taking any other medication along with mycophenolate.

It is best to AVOID sunbathing and to use a sunblock in sunny weather. You are recommended to see your doctor about regular skin checks and cervical smears for women. This is because you are more likely to develop skin or cervical cancers, though these are not serious if noticed early.

Always take mycophenolate as directed by your doctor and only stop them on the advice of your doctor.

All tablets may cause side effects in some people. If you think that you are suffering from a side effect of one of your tablets it is important NOT to stop taking the tablet, but see your doctor who may be able to change that tablet for one which will suit you better.

Mycophenolate products can cause birth defects in the unborn baby of mothers who are, or have recently been, taking mycophenolate. It is for this reason women are advised not to become pregnant whilst taking mycophenolate and for 6 weeks after stopping it.

  • Information for women who could become pregnant
    Do not stop taking mycophenolate without speaking to a member of the transplant/renal team if you think you have become pregnant
  • We now know that approximately one in four children born to women who are taking mycophenolate will have a birth defect. Up to half of pregnant women taking mycophenolate will have a miscarriage. Both of these figures are much higher with mycophenolate compared with women who take other anti-rejection medicines or in those who do not take mycophenolate
  • Before you start mycophenolate you will be asked to do 2 pregnancy tests 8-10 days apart. Where possible treatment will only be started if these are negative
    □ Date of pregnancy test 1
    □ Date of pregnancy test 2 (8-10 days later)
  • While taking mycophenolate (and for at least 6 weeks after stopping) you should use two reliable forms of contraception.
  • Reliable methods of contraception include :
    □ Barrier methods (condoms, diaphram) when supplemented with
    spermacide
    □ Tubal ligation (sterilisation)
    □ Hormonal implants
    □ Oral or injected combined hormonal contraceptives (the pill)
    □ Certain intrauterine devices (the coil - check with family planning
    clinics)
    □ Male sterilisation
  • Do not donate blood during or for 6 weeks after stopping treatment.

Information for men whose partner could become pregnant

  • Do not stop taking mycophenolate without speaking to a member of your transplant/renal team even if you think that your partner has become pregnant
  • For sexually active men (including those who have had a vasectomy) condoms should be used during treatment and for 90 days (13 weeks) after your last dose of mycophenolate to avoid mycophenolate being passed to your female partner.
  • Female partners of male patients treated with mycophenolate should use reliable contraception during treatment and for 90 days (13 weeks) after your last dose of mycophenolate
  • Do not donate blood during or for 6 weeks after stopping treatment

If I am taking mycophenolate and want to try for a baby, what are my options ?
It is important that you talk to your consultant or a member of the transplant/renal team before trying for a baby. If you are a man or a woman taking mycophenolate, it may be possible for you to change to an alternative medicine.

In transplantation, we recommend that both male and female patients who are taking mycophenolate wait one or two years after your transplant before considering a switch of anti-rejection medicines in order to try for a baby. This helps to ensure that :

  • any risk of rejection with medicine switch is minimal
  • you are on the lowest doses of anti-rejection medicine possible
  • your transplant function is stable
    For people taking mycophenolate for an auto-immune disease, we recommend that you have a discussion with your consultant in clinic before trying for a baby. Your consultant will assess how active your disease is as it is important that you only try for a baby if your disease is well controlled. Your consultant will discuss the possibility of switching to an alternative treatment to mycophenolate.

Storing your medicine
Store the capsules in their original container in a cool, dry place, away from children. Only remove the capsules from the blister pack when it is time to take them.

Do not throw out any expired or unwanted medicine by flushing them down the toilet or throwing them away. Take them to your local pharmacy which will dispose of them for you.

Last reviewed August, 2019

Sirolimus

About your medicine
Sirolimus belongs to a group of medicines called immuno-suppressants. As the word immuno-suppressant suggests, the function of these drugs is to suppress the immune-system, which is the body’s natural defence system. The aim is to dampen down the immune system enough to stop it rejecting the transplant kidney while still keeping it active enough to fight infections. All patients who have a kidney transplant need to take drugs called immuno-suppressants.

Sirolimus is only available from your doctor.

You should NOT be vaccinated with some vaccines whilst receiving sirolimus.
For more information see our Holiday/Travel vaccine Click here

Taking your medicine
The tablets should be taken consistently with food or on an empty stomach at the same time each day.
You should AVOID grapefruit and grapefruit juice for one hour before taking sirolimus because it will affect the amount of sirolimus on your body.
Take the tablets as your doctor recommended, never change the dose yourself. If you do not take the sirolimus you will lose your new kidney.

If you forget to take your dose, or accidentally take an extra dose, tell your doctor. You will need to have regular blood samples taken to check that the dose of sirolimus is right for you. When you come to have a blood test do not take your morning dose until after you have had your blood taken.

Sirolimus is available in tablet form and also as a liquid. The liquid must be kept in the fridge. If you are taking the tablets, the different strengths are NOT interchangeable i.e. a 1mg tablet is not the same as 2x0.5mg tablets.

Unwanted effects
Sirolimus can cause side effects on some people. The most common side effects with sirolimus include headaches, feeling sick, rash, high cholesterol, anaemia and taking longer to heal wounds.

You should inform your doctor if you suffer from any of these. Sirolimus can also cause anaemia. You are more likely to develop infections whilst receiving immuno-suppressant therapy and any infections may be worse than normal, so you should report any signs of infection to your doctor.

Some other drugs may cause problems with sirolimus, these include erythromycin, clarithromycin, fluconazole, rifampicin and miconazole. Some herbal remedies may also cause problems for example, St. John’s Wort. This is not a full list so be sure to check with your doctor or pharmacist before taking any other medication along with sirolimus.

You should avoid sunbathing and use a sunblock in sunny weather. You are recommended to see your doctor about regular skin checks and cervical cancers which may not be serious if noticed early.

Storing your medicine
Store tablets in their original packet in a cool, dry place, away from children. Only remove the capsules from the blister immediately before taking.

All tablets may cause side effects in some people. If you think that you are suffering from a side effect of one of your tablets it is important NOT to stop taking the tablet, but see your doctor who will be able to change that tablet for one which will suit you better.

Always take your tablets as directed by your doctor and only stop them on the advice of your doctor.

Do not throw out any expired or unwanted medicine by flushing them down the toilet or throwing them away. Take them to your local pharmacy which will dispose of them for you.

Last reviewed August, 2019

Tacrolimus


About your medicine
Tacrolimus belongs to a group of medicines called immuno-suppressants. As the word immuno-suppressant suggests, the function of these drugs is to suppress the immune system, the body’s natural defence system. The aim is to dampen down the immune system enough to stop it rejecting the transplant kidney while still keeping it active enough to fight infections. All patients who have a kidney transplant need to take drugs called immuno-suppressants.

Tacrolimus is also taken for auto-immune diseases for example, minimal change disease. It is used to try and improve kidney function and to dampen down the disease, stopping it from causing any further damage to the body,

Tacrolimus is only available from your doctor.

There are several different brands of tacrolimus. Prograf® was the first to be introduced, there are now several others, for example Adoport® , Adragraf® and Envarus®. You should not switch between brands without the advice of the transplant or renal unit, and a check is needed to make sure that the blood levels of the drug are kept at the right level for you.

You should NOT be vaccinated with some vaccines whilst receiving tacrolimus. (Vaccines are injections that can be given to help prevent you from catching some diseases, for example, polio)
For more information see our Holiday/Travel vaccine Click here

Taking your medicine
The capsules should be removed from the blister immediately before taking and swallowed whole with water. The capsules are best taken one hour before a meal or two hours afterwards, ie. on an empty stomach.

The total daily dose that you are asked to take should be divided and taken in two doses, 12 hours apart (Prograf® and Adoport®) or once daily (Adragraf ®)

You should AVOID grapefruit and grapefruit juice for one hour before taking tacrolimus because it will affect the amount of tacrolimus in your body.

Take the capsules as your doctor recommended, never change the dose yourself. If you do not take the tacrolimus you will lose your new kidney or cause a flare up of your disease.

If you forget to take a dose, or accidentally take an extra dose, tell your doctor. You will need to have regular blood samples taken to check that the dose of tacrolimus is right for you, too much can be harmful to your kidney. When you come to have a blood test do not take your morning dose until after you have had your blood taken.

Unwanted effects
Tacrolimus can cause side effects in some people. The most common side effect with tacrolimus include trembling, headaches, feeling sick and pins and needles in your arms and legs. You should inform your doctor if you suffer from any of these. Tacrolimus can also damage your kidneys if your blood levels are too high.

You are more likely to develop infections whilst receiving immuno-suppressant therapy and any infections may be worse than normal, so you should report any signs of infection to your doctor.

Some other drugs may cause problems with tacrolimus, these include erythromycin, clarithromycin, fluconazole, rifamicin and miconazole. Some herbal remedies may also cause problems, including St. John’s Wort. This is not a full list so be sure to check with your doctor or pharmacist before taking any other medication along with tacrolimus.

You should avoid sunbathing and use a sunblock in sunny weather. You are recommended to see your doctor about regular skin checks and cervical smears for women. This is because you are more likely to develop skin or cervical cancers which may not be serious if noticed early.

Storing your medicine
Store the capsules in their original packet in a cool, dry place away from children. Capsules should not be taken if they have been out of the aluminium outer wrapper for longer than twelve months. Only remove the capsules from the blister immediately before taking.

You should NOT eat the sachet of silica gel contained within the aluminium wrapper.

All medicines may cause side effects in some people. If you think that you are suffering from a side effect of one of your medicines, it is important NOT to stop taking the medicine but see your doctor, who will be able to change that medicine for one which will suit you better.

Always take your medicines as directed by your doctor and only stop them on the advice of your doctor.

Do not throw out any expired or unwanted medicine by flushing them down the toilet or throwing them away. Take them to your local pharmacy which will dispose of them for you.

Last reviewed August, 2019

Other antibiotics used after transplantation
Nystatin solution - rinse round the mouth four times a day (prevents fungal infection)

Valganciclovir- taken once a day (prevents cytomegalovirus or CMV) side effects include a reduction in the number of white blood cells, your bloods will be monitored regularly. Doses may be reduced depending on how well the kidney is working.

Last reviewed August, 2019

Controlling Anaemia : increasing your Blood Count

Ferrous Sulphate

Ferrous Sulphate is an iron tablet which can be used to treat anaemia. It is often taken three times a day. If you are taking phosphate binders or some antibiotics (check with the pharmacist) you should try and split the doses by one hour. Side effects can include constipation, diarrhoea or feeling sick – If this happens try taking the tablets with food. You may notice your stools or urine becoming a darker colour; this is normal and nothing to worry about. If your stools suddenly become very black, tell your doctor.

Intravenous Iron

About your medicine
People with kidney failure suffer from anaemia which makes you breathless and tired.

There are ways of treating this:- taking oral iron tablets eg. ferrous sulphate and erythropoiesis stimulating agent (ESA) injections (see ESA page 28).

Intravenous Iron can be used for people who are anaemic and either cannot take iron tablets or they do not work as well due to poor ability to absorb iron due to your kidney disease or other tablets you are taking or who need a significant boost in their blood irons (often prior to starting treatment with ESA) .

How do you receive Intravenous Iron ?
People with kidney failure suffer from anaemia which makes you breathless and tired.

There are ways of treating this:- taking oral iron tablets eg. ferrous sulphate and erythropoiesis stimulating agent (ESA) injections (see ESA page 28).

Intravenous Iron can be used for people who are anaemic and either cannot take iron tablets or they do not work as well due to poor ability to absorb iron due to your kidney disease or other tablets you are taking or who need a significant boost in their blood irons (often prior to starting treatment with ESA) .

Unwanted Effects
You should not receive any intravenous iron if you have a history of anaphylactic reactions to iron or if you have an infection which you are either about to get antibiotics for, or are on antibiotics for.

For some types of intravenous iron, your first dose will be given very slowly and gradually increased if you have no reaction to it. This is because there is a small possibility of an allergic reaction.

Other side effects include headache, nausea, metallic taste, fever and skin flushing.

Whilst you are receiving iron injections, you SHOULD NOT take iron tablets so you should stop taking any ferrous sulphate, ferrous fumarate, pregaday or sytron liquid.

Erythropoiesis Stimulating Agents (ESA)

About your medicine

Many patients with kidney failure have a condition called anaemia. This means that they have a lack of red blood cells in their body.

Blood is made up of a liquid part and small particles called cells. These cells can be red or white. Red cells carry oxygen around the body. Measuring the level of something called haemoglobin in the blood gives a guide as to the number of red cells and whether a person is anaemic.

One of the jobs the kidneys do is to manage the production of red blood cells in the body. To do this they make a substance called erythropoietin (EPO). When someone’s kidneys do not work the kidneys produce less EPO and so the person becomes anaemic.

If you are anaemic then you may :

  • Feel tired
  • Be short of breath
  • Feel the cold more
  • Have a reduced ability to do everyday tasks
  • Not be able to concentrate

Erythropiesis stimulating agents (ESA) are medications similar to erythropoietin. They are artificial versions of this hormone which increase the number of red blood cells in the body. More than half the people on dialysis, and nearly half of the people who are being followed up by renal doctors, but are not on dialysis, take this drug.

There are several different makes of the drug, these include :

  • Eprex
  • Neo-Recormon
  • Retacrit
  • Aranesp
  • Mircera

It does not matter which make you receive though you should not switch between brands without careful supervision. Each of the makes is available as different preparations for example, pre-filled pens or syringes. Your doctor, specialist nurse or pharmacist can help you to decide which sort suits you best.

Taking your medicine
ESA needs to be given by injection through the skin. You will be taught how to inject yourself with ESA.

The dose varies from person to person and depends on whether or not you are on dialysis. The anaemia team or your doctors will use the level of haemoglobin in the blood to decide which dose to use. It is usual to inject a dose once, twice or three times a week. Once stable, you may find you only need to inject every two weeks or every month if you are not on dialysis or on peritoneal dialysis.

It will take a few weeks for them to work as we need to make sure your haemoglobin does not increase too quickly as that can make side effects, like high blood pressure, worse. You will need to have your blood pressure and haemoglobin monitored regularly.

If you forget to take a dose contact your renal team and they will advise you when to take your next dose.

Unwanted effects
As with all medicines, some people may suffer side effects. ESA may cause your blood pressure to rise, especially at the beginning of treatment. It is important that your blood pressure is monitored.

Other side effects are injection site pain or redness around the injection site, these can be reduced by changing the site you inject your ESA.

Storing your medicine
Keep your medicines away from children. ESA needs to be kept in the fridge in its original container until it is time to be injected.

You should take the dose as recommended by your anaemia team or doctor. You will need regular blood tests to make sure that you are prescribed the correct dose.

Do not throw out any expired or unwanted medicine by flushing them down the toilet or throwing them away. Take them to your local pharmacist which will dispose of them for you.

Last reviewed August, 2019

Lowering Blood Pressure : Antihypertensives

Blood Pressure tablets
There are many tablets available to bring your blood pressure down. Different people respond better to the different sorts. Your doctor will have chosen the tablet most suitable for you. A combination of a few tablets is often needed to have the effect wanted.

You may not feel unwell with high blood pressure but it can cause other health problems and cause damage to your kidneys so it is important to continue taking your tablets. If you experience side effects then you should speak to your doctor. The tablets listed below are ones most commonly used. If you are taking a tablet not listed and would like more information then you can speak to your doctor or pharmacist.

Calcium channel blockers

Amlodipine is usually taken once a day in the morning. Side effects can include headache, dizziness, and ankle swelling.

Nifedipine can be taken once or twice a day. You should avoid grapefruit and grapefruit juice for one hour before taking the tablets. Side effects can include headache, flushing and ankle swelling.

Nifedipine comes as different forms of tablets, or capsules. Please follow the directions for the type given to you and always stick to the same brand.
Other types of calcium channel blockers include felodipine and lercanidipine

Beta blockers

Atenolol is usually taken once a day in the morning. Side effects can include tiredness and cold hands and feet. It is usually taken once a day.
Other types of beta blockers include bisoprolol and metoprolol.

Alpha blockers

Doxazosin (Cardura) is taken once or twice a day. Side effects can include dizziness, headache, feeling sick – try taking with food. The long acting preparation (CarduraXL) is only taken once daily.
Other types of alpha blockers include indoramin and prazosin.

Ace Inhibiters
Enalapril (Innovace) is usually taken once or twice a day. Side effects can include fatigue, feeling sick – try taking with food. Sometimes you may get a dry cough; if this occurs, tell your doctor who may be able to consider an alternative for you.

Lisinopril, Perindopril (Coversyl) and Ramipril (Tritace) are usually taken once a day in the evening. Side effects can include tiredness and feeling sick – try taking with food. Sometimes you may get a dry cough, if this occurs tell your doctor who may be able to consider an alternative for you.

Angiotensin antagonists

Losartan is usually taken once daily. It can be used with an ACE inhibitor if you have protein in your urine. It is also used as an alternative if you cannot take ACE inhibitors. Side effects are usually mild but can include tiredness, dizziness and stomach upsets.
Other types of angiotensin antagonists include valsartan, irbesartan and candesartan.

Rarely, some people can get allergic reactions to angiotensin antagonists. This may include itching, a rash or swelling of the lips and face. If this happens you should stop taking your tablets and speak to your doctor.

Other blood pressure tablets

Hydralazine is sometimes used when your blood pressure is still high after a combination of other tables. Side effects can include a build up of fluid in your system (fluid retention).

Aliskerin is a new drug that is sometimes used instead of ACE inhibitors or angiotensin antagonists. Side effects can include an upset stomach and rash.

Moxonidine is sometimes used when your blood pressure is still high after a combination of other tablets. Side effects can include tiredness, headache and dry mouth.

Storing your medicine
You should store the tablets in their original packet in a cool, dry place out of the sight and reach of children.

Do not throw out any expired or unwanted medicine by flushing them down the toilet or throwing them away. Take them to your local pharmacy which will dispose of them for you.

Blood Pressure Medications and Dialysis

Sometimes blood pressure medications can cause your blood pressure to fall too low during dialysis, causing problems. If this happens the type of blood pressure medication you take may be changed or you may be advised to wait and take your medication after you have finished your dialysis session.

Last reviewed August, 2019

Phosphate Binders

About your medicine
Phosphate is a mineral that affects the health of bones. When someone has kidney failure they tend to have high phosphate levels. This puts them at risk of bone problems. Too much phosphate in your body can also make you itchy. Long term, high levels can also affect the health of blood vessels and the heart.

Treatment includes eating a diet low in phosphate and taking phosphate binders. Dialysis treatment also helps to remove some phosphate.

There are several types of phosphate binders available. Your doctor and dietician will help to decide which one is best for you to take depending on blood results and how easy you find it to take your tablets.

  • Alucaps (aluminium hydroxide) is a phosphate binder which contains aluminium. It is very effective at binding phosphate, but if taken over a long period of time, aluminium can build up in the body, possibly causing memory problems. Your doctor will measure your aluminium levels if you take Alucaps. Side effects include constipation. Alucaps should be swallowed whole 10-15 minutes before meals.
  • Calcichew is a phosphate binders which contain calcium. Side effects include a chalky taste in the mouth, or sometimes the level of calcium in your blood can rise. Calcichew should be swallowed whole, 10-15 minutes before meals.
  • Phosex/Renacet (calcium acetate) are phosphate binders which contain calcium. They should be swallowed whole and taken 10-15 mins before meals
  • Renagel/Renvela (selelamar) are phosphate binders which do not contain calcium or aluminion. The tablets should be swallowed whole with meals. Renvela is also available as a powder to make into a solution.
  • Fosrenol (lanthanum) is a phosphate binder which doesn’t contain calcium or aluminium. It should be chewed and taken immediately after meals. Side effects include feeling sick if taken before food. Fosrenol is also available as a powder to make into a solution.
  • Velphoro (sucroferric oxyhydroxide) is a phosphate binder which contains iron. It should be chewed and not swallowed whole. Tablets can be crushed.

Reducing the amount of phosphate in your body can only be done in combination with controlling your diet, these tablets will not work alone.

Taking your medicine
These tablets are best taken about ten minutes before meals. You should chew the tablets before swallowing or let them dissolve in your mouth. Alucaps, Renagel, Renvela, Renacet and Phosex should be swallowed whole.

Phosphate binders only work if taken with foods containing phosphate.

They should be taken with meals or snacks which include meat, fish, eggs, cheese, milk and pulses.

They should NOT be taken with meals or snacks which do not include protein foods, such as toast, jam or salad sandwiches, biscuits or fruit. This may mean that you take more binders with a main meal or include one with a snack. You should still aim to take the total number prescribed each day.

Unwanted effects
The most common side effects with these tablets are constipation or diarrhoea, feeling sick and a chalky taste in your mouth.

If you do not like the taste, most phosphate binders can be swallowed whole, 15 minutes before meals. Fosrenol should always be taken after meals. Velphoro can make your stools appear black.

Storing your medicine

Store the tablets in their original packet in a cool, dry place out of the sight and reach of children. Only remove the tablets from the container when it is time to take them.

Do not throw out any expired or unwanted medicine by flushing them down the toilet or throwing them away. Take them to your local pharamcy which will dispose of them for you.

This leafet only gives a brief outline of some of the more important points about phosphate binders. If you would like any further information, ask your doctor, pharmacist, dietitian or transplant nurse.

Last reviewed August, 2019

Other Medication

People with kidney failure often need to take several medicines to help keep them healthy. This page lists some of the medicines that are commonly taken and a few side effects.

Vitamin D Tablets

Alphacaldcidol is a Vitamin D capsule. It is given to increase your blood calcium level and keep it normal. Over time this helps to keep your bones healthy. It is unsually taken once a day in the morning or three times a week with each haemodialysis session. Side effects can include feeling sick. If this happens try taking it with food. Liquid drops are also available if you have trouble swallowing, or prefer to avoid capsules that contain gelatin, for example, if you are a strict vegetarian.

Relieve Constipation

Lactulose, Docusate and Senna are laxitives and are given to treat constipation. Senna is usually taken in the evening, lactulose and docusate can be taken once or twice a day. They may take a day or so to be effective. Side effects can include belching and stomach cramps

To Thin the Blood

Aspirin is a tablet given to help thin your blood to stop your dialysis lines or fistula from becoming blocked. Some people also take aspirin for heart problems. It is normally taken once a day in the morning. Aspirin may irritate your stomach or cause indigestion, this can be reduced by taking the tablet with food and dissolving it in water before swallowing.

Reduce Cholesterol in the Blood

Simvastatin, Prevastatin or Atorvastatin help to reduce cholesterol levels. The tablets should be taken at bedtime. Possible side effects include headache, feeling sick, muscle pain. If you suffer from muscle pain you should tell your doctor.

Dieuretics (Water Tablets)

Often high blood pressure in kidney disease is due to a build up of fluid. Taking a diuretic (water tablet) can sometimes lower your blood pressure by making you pee out some of this extra fluid. They are usually taken in the morning and sometimes a second dose may be needed at lunchtime.

Examples of water tablets include Furosemide, Bumetanide and Bendroflumethiazide

Side effects include stomach upset and can upset water and salt levels in the blood leading to thirst, headache, low blood pressure and muscle cramps.

Last reviewed August, 2019

Side effects of Steroids

Steroids such as prednisolone, have been shown to be effective in managing some kidney disorders, such as nephrotic syndrome, and following transplantation. Unfortunately, they can have side effects :-

Cushingoid effect
Named after the Canadian physician who first noted the effect, there is a tendency for the cheeks and stomach to increase in size, whilst the limbs become thin. Some patients develop facial hair and the face is flushed. Appetite may increase. Fortunately, most of these side effects improve if the drug can be reduced.

Bone problems
A common effect of long term use of steroids is osteoporosis, thinning of the bones. Bone density in people taking steroids can be measured with a special X-ray machine (called a DEXA scan), and anyone on steroids should ask their doctor if they should have one of these scans to check the density of their bones.

AVN (avascular necrosis) is a distressing condition of the joints, especially the hips. Pain on walking can vary from mild to severe, uncontrolled by painkillers. Replacement of hip, knee and shoulder joints have very good results.

Other
A few patients may find they have raised blood pressure and there is a tendency to diabetes, particularly if there is a family history of this condition. Some patients find they have mood changes, a state of euphoria especially post-transplant when high doses of steroids may be used. Reducing the dose may be helpful in these circumstances. Steroids may also cause the levels of cholesterol or other fats in the blood to rise. Blood tests should be done to check the cholesterol level.

Some points to remember when buying medicines

You may have a number of medical conditions and are therefore prescribed several medicines from your doctor. As a result, some of the medicines that can be bought over the counter from pharmacies and other shops may be unsuitable for you.

  • It is very important to tell any doctor or pharmacist recommending a medicine for you about your renal condition and the medicines you are taking.
  • You should only treat minor ailments by yourself for a few days. If your symptoms change, get worse or last for more than a couple of days, see your doctor.
  • Be aware that some of the tablets your doctor gives you can also be bought over the counter. Be careful not to take double the dose.
  • Remember to tell the pharmacist if you are diabetic or have had an allergic reaction to any medicine.
  • Try to use the same pharmacy so that the pharmacist can build up a complete picture of all the drugs you are taking. He/she will then be able to provide you with the best advice.
  • If you find that you need to treat the same symptoms frequently, please do not forget to mention them to your doctor at your next visit.
  • Be careful not to take more than one preparation with Paracetamol in - do not forget that Co-codamol and Co-proxamol (Distalgesic) contain Paracetamol.
  • Effervescent tablets are best avoided because they contain sodium.
  • If you have a transplant try not to take any indigestion remedies for one hour before or after your transplant medicines.
  • You should remember that, although some medicines are not recommended for you to buy, they may be safe for your doctor to prescribe them.

Last reviewed August, 2019

The National Kidney Federation (NKF) cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.