The most important step in maintaining your health after your transplant is to take your medicines exactly as prescribed. These drugs help prevent rejection and infection. You might need to take some of these medicines for the rest of your life.

What should I know about taking my medicines?
Before your doctor prescribes any medicine, he or she will ask you:

• If you are allergic to any medicines
• If you are currently taking any other medicines (including over-the-counter medicines)
• If you have problems taking any medicines

The type of medicines, the dosage, and side effects might be different for each patient. Your Transplant Team will teach you about your medicines and give you information sheets describing each drug and how to take it. You should always know:

• The name of the drugs prescribed and their action (Please note: all medicines have two names — the generic or chemical name and the brand name.)
• The dosages, how to take them, and the time of day to take them
• The side effects and how you can treat or prevent them

Your nurse and/or pharmacist will provide you with a medicine sheet describing each medicine and how you should take it.

Your family members are encouraged to learn about your medicines.

Autologous — Patients will receive written prescriptions at the time of discharge that can be filled at your preferred pharmacy.

Allogeneic — If approved by your prescription plan, most prescriptions are provided by the Cancer Center Pharmacy. These prescriptions usually include a 1-month supply with refills. When you are notified that your prescriptions are ready, please send a family member, along with your prescription card, to pick up your medicines. Before you go home, you, your care-partner, and your nurse must verify the medicine dosages. Please review the information on your prescription labels. This includes the medicine name, dose, instructions on how to take, and remaining refills.

Prescription refills — When your initial supply of medicine is running low, you may call your nurse coordinator with your preferred pharmacy’s phone number and your prescription number so the refill can be called in.

Do not wait until you are completely out of medicine before filling your prescriptions.

If there are no remaining refills, notify your nurse coordinator at least 1 week before the medicine will run out.

Mail-order programs — Many prescription benefits plans offer a mail-order program. These are provided to decrease your prescription co-pay. It is necessary to plan ahead, since initial prescriptions can take up to 3 weeks to receive. Notify your nurse coordinator if you plan to use this benefit.

Will the drugs I’m taking cause any side effects?
Some of the drugs prescribed for you might cause unwanted side effects such as weight gain, acne, or excess hair growth. Despite these side effects, never change the dose or stop taking your medicines without first checking with your doctor. Many of the side effects can be controlled. Your doctor might adjust your dosage or offer other suggestions for managing the side effects. Keep all appointments with your doctor so your response to the drug can be monitored.

The individual drug information sheets contained in this notebook describe the common side effects of each drug and how to manage them.

Call your health care provider if you become sick and vomit soon after taking your medicine. If you vomit within 30 minutes of taking the medicine, repeat the dose. If you are unable to keep down the second dose, call your health care provider. Also call if you have any other symptoms that are persistent or severe.

Does it really matter if I miss a dose?
Yes. It is very important to always follow the instructions for your medicines every day to prevent rejection or infection.

What if I forget to take my medicines at the scheduled time?
If you miss a dose of your medicine at the scheduled time, don’t panic. Take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and return to your regular medicine schedule.

As you begin to feel well, it might be easy to forget to take your medicines, but always remember that your body never stops requiring the transplant medicines. By taking your medicines consistently and following-up with your doctor routinely, you are assuming the most important job after your transplant.

Dose changes
Your doctor will periodically change the dose of your medicines. The dose might be changed because you are having uncomfortable side effects or because blood test results indicate that a different dose is needed.

You will receive a medicine dosage record to write down your medicines and dosages. Every time your doctor tells you to change the dose of your medicine, cross out the previous dose and write in the new dose. (Use ink, not pencil, and do not erase previous information so you have a record of your earlier doses). Remember, never change the dose of your medicine unless your doctor has told you to do it.

Other medicines
Never take other medicines without first talking to your doctor, including over-the-counter drugs (those you can buy without a prescription). Some over-the-counter drugs — including aspirin, ibuprofen (Advil®, Nuprin®), naproxen (Aleve®), vitamins, cold medicine, antihistamines, antacids, herbs, laxatives, and sleeping pills — might decrease the effectiveness of your transplant medicines and can cause unwanted side effects.

Can I get financial assistance to help pay my medicine expenses?
Yes. Your health care providers realize your medicines are expensive, especially since you might take them for the rest of your life. There are several government and state programs that offer financial assistance for medicine expenses. Please ask your social worker what programs are available for you. You can also ask to see a financial counselor who can answer questions about insurance coverage and Medicare benefits related to your medicine expenses.

Will any new medicines be available?
Exciting developments in drug research are creating new immunosuppressive medicines. You might be asked to participate in one of these programs after your transplant. All programs are strictly voluntary and have no influence on your transplant status.

General medicine guidelines
Note: these are general guidelines. Be sure to ask your doctor or pharmacist for guidelines specific to your medicine.

• Keep a list of your medicines and their dosages with you.

• Take your medicines exactly as prescribed, at the same time(s) every day. Do not stop taking or change your medicines or the dosages unless you first talk with your doctor. Even if you feel good, continue to take your medicines. Stopping some medicines suddenly might make your condition worse.

• Have a routine for taking your medicines. Consider getting a pill box that is marked with the days of the week. Fill the pill box at the beginning of each week to make it easier for you to remember. If you are taking Neoral® or cyclosporine, keep these medicines in their original packaging.

• Keep a medicine calendar and note every time you take a dose. Your prescription label tells you how much to take at each dose, but your doctor might change your dosage periodically, depending on your response to the medicine. On your medicine calendar, you can list any changes in your medicine dosages as prescribed by your doctor.

• If your doctor has discontinued a medicine, place the discontinued medicine in a separate area away from your current medicines. Your doctor might re-prescribe this medicine at a later date.

• Wash your hands before preparing or taking medicines.

• Take your time. Double check the name and dosage of all your medicines before using them.

• Regularly fill your prescriptions and ask your pharmacist any questions you have about refilling your prescription. Know your pharmacy phone number, prescription number, medicine name, and dose so you can easily call for refills. Try to fill all your prescriptions at the same pharmacy so the pharmacist can monitor for interactions, and provide proper dosing and refills. If your refill medicine does not look right, ask your pharmacist to verify that you have received the correct prescription.

• Do not decrease your medicine dosage to save money. You must take the full amount to get the full benefits. Talk with your doctor about ways you can reduce the costs of your medicines.

• If you have prescription coverage, make sure you know the terms of your policy. Remind your doctor about the type of insurance coverage you have.

• Do not stop taking a medicine. Talk to your doctor if you have concerns about a medicine and how it is working.

• Keep medicines stored in a sealed containers. Store according to the instructions given with the prescription.

• Check liquid medicines often. If they have changed color or formed crystals, throw them away and get new ones.

• When traveling, keep your medicines with you so you can take them as scheduled. On longer trips, take an extra week’s supply of medicines and copies of your prescriptions in case you need to get a refill.

• Always keep medicines out of the reach of children.

• Never give your medicine to others.

• What is the name of the medicine?

• Why do I need to take it?

• How often should I take it?

• What time of day should I take it?

• Should I take it on an empty stomach or with meals?

• Where should I store the medicine?

• What should I do if I forget to take a dose?

• How long should I expect to take the medicine?

• How will I know it is working?

• What side effects should I expect?

• Will the medicine interfere with driving, working, or other activities?

• Does the medicine interact with any foods, alcohol, or other medicines (including over-the-counter medicines)?

© Copyright 1995-2009,The Cleveland Clinic Foundation. All rights reserved.

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional written health information, please contact the Health Information Center at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771 or visit www.clevelandclinic.org/health/.

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