Lung transplant medicines

You will need to take immune suppressant medicines to reduce the risk of lung rejection. The doses of these medicines usually reduce over time, but some immunosuppressant medicines will be needed for the lifetime of the lung transplant.

Common immunosuppressants and their side effects include:

• Tacrolimus: in high doses, this can impair kidney function. Blood tests are needed to make sure the correct dose is given. Blood sugars can be raised. Tremors can occur.
• Steroids (e.g. prednisolone): this can cause high blood pressure, increased appetite and thinned skin. Blood sugars can be raised.
• Mycophenolate mofetil: this can cause diarrhoea or nausea. The number of white cells in the blood can be reduced. Women who wish to get pregnant and are taking mycophenolate mofetil should discuss with their transplant team if they need an alternative immunosuppressant.

You will need antibiotic and antiviral medicines to reduce the risk of infection. These usually stop between 3 and 12 months after a transplant, but your transplant team will advise you about this.

You may need medicines to lower your blood sugar levels, especially if you had diabetes before the transplant.

You may need medicines to lower your blood pressure.

These are known as anticoagulants and work to thin your blood and prevent clots. Some transplant patients will be prescribed anticoagulants to reduce the risk of blood clots.

Some immunosuppressants and blood thinners can cause stomach irritation, so you are likely be given medicines to protect the lining of your stomach.

Unless your doctor says otherwise, you will need to continue to take any medicines you were taking before your transplant for other health issues. You may also need other medications for new health issues that have been diagnosed during or since your transplant.

Some of the immunosuppressant medicines can weaken your bones (osteoporosis). This is particularly true for women after the menopause.

Your lung transplant team will advise you whether you need a bone scan to measure how strong your bones are (“bone density”), and whether you need medication to strengthen your bones. If you break a bone following your lung transplant, tell your transplant team.

Weight gain is common after a lung transplant, especially in the first year. Some of the medication, in particular, prednisolone, may cause weight gain or increase your appetite.

Other contributing factors include your diet often being less restrictive after transplant, and a good appetite being a sign of improving health. But too much weight gain places a strain on your heart so it’s important to eat healthily and stay active as much as possible.

Patients who have diabetes before the transplant may find that their blood sugars are more difficult to control in the first three to six months after the transplant. This is usually due to the immunosuppressant medicines, which can increase your blood sugars. Some patients that weren’t diabetic before the transplant become diabetic following the transplant. Again, this is usually due to the immunosuppressant medicines, and also due to weight gain.

Increased blood pressure can occur with some immunosuppressant medicines. This can often be resolved by amending the dosage, if possible.

Immunosuppressants can irritate your stomach lining. Your care team is likely to give you medication to help protect your stomach and prevent these side effects.