Immunosuppressants are drugs that are used to weaken the body's immune system. The immune system protects the body from infections and diseases.
Sometimes the immune system can cause harm to the body, and immunosuppressants are needed to prevent or minimize damage. For instance, immunosuppressants are commonly used to treat autoimmune disorders, such as lupus, rheumatoid arthritis, and multiple sclerosis (MS). Autoimmune disorders occur when the immune system launches an attack against body cells because they are mistaken for harmful invaders, such as bacteria. Left untreated, the immune system can potentially destroy body tissues and organs, which may lead to organ failure. Organ failure is fatal unless the patient receives an organ transplant.
Immunosuppressants are also used to prevent transplant rejection in patients who receive transplanted organs. Transplant rejection occurs when the recipient's immune system does not recognize the donated organ as part of its own body. The white blood cells attack the new organ because it is identified as a harmful foreign invader. Therefore, patients who receive an organ transplant take a combination of immunosuppressants for the rest of their lives to prevent the body from destroying the new organ.
Immunosuppressants are only available by prescription. Commonly prescribed immunosuppressants include cyclosporine (Neoral®, Sandimmune®, Gengraf®), azathioprine (Azasan®, Imuran®), basiliximab (Simulect®), aclizumab (Zenapax®), muromonab CD3 (Orthoclone OKT3®), tacrolimus (Prograf®), glatiramer acetate (Copaxone®), mycopehnolate (CellCept®), and sirolimus (Rapamune®). They are available in tablet, capsule, liquid, and injectable forms. The recommended dosage depends on the specific drug, condition it is being used for, as well as the age and overall health of the patient.
Patients who are taking immunosuppressants should visit their healthcare providers regularly to monitor treatment and check for unwanted side effects. Patients should also take medications exactly as prescribed.
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Azasan®, CellCept®, Copaxone®, Gengraf®, Imuran®, Meticorten®, Neoral®, Orthoclone OKT3®, Prograf®, Rapamune®, Sandimmune®, SangCya®, Simulect®, Zenapax®.
side effects and complications
General: Side effects of treatment depend on the specific dose and medication, as well as the overall health of the patient. Some of the most common side effects include high blood pressure, increased hair growth, loss of appetite, vomiting, and upset stomach. Some patients may develop serious side effects, including kidney problems or decreased levels of red or white blood cells. Patients should tell their healthcare providers if they experience any of these symptoms.
Cancer: Patients who take immunosuppressants long-term (such as organ transplant recipients) have an increased risk of developing certain cancers, especially skin cancer and cancer of the lymph nodes (lymphoma). To help avoid the risk of skin cancer, patients should wear a sunblock with a sun protection factor (SPF) of 15 or higher. The sunblock should offer protection against both ultraviolet A and ultraviolet B rays. Patients should look for products that are PABA-free. PABA is a chemical that is found in many sunblocks, and it has shown to cause irritation in sensitive patients. Tanning beds should be avoided. There is currently no known method of prevention for lymphoma.
Infections: Since immunosuppressants weaken the immune system, patients have an increased risk of developing infections. Patients should regularly wash their hands with soap and water. Avoiding close contact with individuals who have contagious illnesses may help reduce the risk of contracting infections. Patients should consult their healthcare providers if they develop symptoms of an infection, such as fever, sore throat, or enlarged lymph nodes.
Potassium levels: Some immunosuppressants, including cyclosporine (Neoral®, Sandimmune®, Gengraf®), have been shown to increase potassium levels in the blood. Therefore, patients should minimize or avoid foods that have high amounts of potassium such as bananas, tomatoes, dried fruit, and low sodium salt. Patients should not take potassium supplements with immunosuppressants.
Co-existing medical conditions: Patients should tell their healthcare providers if they have any other medical conditions. Immunosuppressants can worsen symptoms of some conditions, including chicken pox or a viral infection of the nerves called shingles. Immunosuppressants may have increased effects if taken in patients with liver disease or kidney disease because the body is slow to break down the drug. Immunosuppressants may be weakened if patients have gastrointestinal problems because the drug may not be absorbed properly.
Interactions: Patients should tell their healthcare providers if they are taking any other drugs (prescription or over-the-counter), herbs, or supplements because they may interact with treatment.
Patients should not eat grapefruit or drink grapefruit juice one hour before taking cyclosporine (Neoral®, Sandimmune®, Gengraf®) because the fruit may break down the drug before it is absorbed into the bloodstream.
The effects of azathioprine (Azasan®, Imuran®) may be stronger in patients who take allopurinol (Aloprim®, Zyloprim®), a medicine used to treat gout. This combination may cause immunosuppressants to weaken the immune system too much, and it may lead to an increase in side effects. Therefore, patients taking these drugs may require lower doses of allopurinol and/or azathioprine.
The effects of cyclosporine (Neoral®, Sandimmune®, Gengraf®) may be stronger when taken with female hormones (estrogens), male hormones (androgens), antifungals such as asketoconazole (Nizoral®), ulcer drugs such ascimetidine (Tagamet®), or erythromycins, which are used to treat infections. These combinations may cause immunosuppressants to weaken the immune system too much, and it may lead to an increase in side effects. Patients may require lower doses of the medications.
If sirolimus (Rapamune®) is prescribed in combination with cyclosporine (Neoral®, Sandimmune®, Gengraf®), it should be taken four hours after cyclosporine. This reduces the risk of side effects.
Immunosuppressants should be used cautiously with other drugs that weaken the immune system, such as corticosteroids (such as prednisone) or anticancer drugs, such as chlorambucil (Leukeran®), cyclophosphamide (Cytoxan®), or mercaptopurine (Purinethol®).
Pregnancy and breastfeeding: Patients should tell their healthcare providers if they may be pregnant or are thinking about becoming pregnant because immunosuppressants may cause serious side effects in the fetus. This may occur if the medication is taken during pregnancy or if the male or female takes the drug during conception.
Patients taking immunosuppressants should not breastfeed their babies. The drugs can pass into the breastmilk and may cause serious side effects in the baby.
Treatment adherence: Patients should take their medications exactly as prescribed by their healthcare providers. Patients should not change the dose or stop taking the medication without first consulting their healthcare providers.
Vaccines: Before receiving vaccines, patients should tell their healthcare providers if they are taking immunosuppressants. In general, vaccines may be less effective in patients who are taking immunosuppressants. Live viral vaccines that contain a live virus, such as small pox or chickenpox, should not be given to patients taking immunosuppressants. This is because live viral vaccines may infect recipients who have weakened immune systems. Patients may even become infected if they come into close contact with a recently vaccinated individual. While this is uncommon, it occurs most often in individuals who have weakened immune systems.