IMMUNOSUPPRESSANT DRUGS SPECIAL CONDITIONS
Category: Online Pharmacy Drugs
Abstract : Special conditions People who have certain diseases or disorders, or who are
taking certain other medicines may have problems if they take immunosuppressant
drugs. Before taking these drugs, patients should inform the prescribing
physician about any of the following conditions: ALLERGIES. Anyone who has
had unusual reactions to immunosuppressant drugs in the past should let
Special conditions
People who have certain diseases or disorders, or who are
taking certain other medicines may have problems if they take immunosuppressant
drugs.
Before taking these drugs, patients should inform the prescribing
physician about any of the following conditions:
ALLERGIES.
Anyone who has
had unusual reactions to immunosuppressant drugs in the past should let his or
her physician know before taking the drugs again. The physician should also be
told about any allergies to foods, dyes, preservatives, or other substances.
PREGNANCY. Azathioprine has been considered a cause of birth defects.
The British National Formulary, however, states: “Transplant patients
immunosuppressed with azathioprine should not discontinue it on becoming
pregnant; there is no evidence that azathioprine is teratogenic. There is less
experience of ciclosporin in pregnancy but it does not appear to be any more
harmful than azathioprine. The use of these drugs during pregnancy needs to be
supervised in specialist units. Any risk to the offspring of
azathioprine-treated men is small.” Nonetheless, patients who are taking any
immunosuppressive drug should consult with their physician before conceiving a
child, and they should notify the doctor at once when there is any indication of
pregnancy.
Basiliximab should not be used during pregnancy. The
manufacturer recommends using adequate contraception during use of this drug,
and for eight weeks following the final dose.
The manufacturers warn
against the use of tacrolimus and mycophenolate during pregnancy, on the basis
of findings from animal studies. They recommend using adequate contraception
while taking these drugs, and for six weeks after the last dose.
The
safety of corticosteroids during pregnancy has not been absolutely determined.
There is some evidence that use of these drugs during pregnancy may affect the
baby’s growth; however, this result is not certain, and may vary with the
medication used. Patients taking any steroid drug should consult with their
physician before starting a family, and should notify the doctor at once if they
think they are pregnant.
Most of these medicines have not been studied
in humans during pregnancy. Women who are pregnant or who may become pregnant
and who need to take immunosuppressants should consult their physicians.
LACTATION. Immunosuppressant drugs pass into breast milk and may cause
problems in nursing babies whose mothers take it. Breastfeeding is not
recommended for women taking immunosuppressants.
OTHER MEDICAL
CONDITIONS. People with any of the following conditions may have problems if
they take immunosuppressant drugs:
• People who have shingles (herpes
zoster) or chickenpox, or who have recently been exposed to chickenpox, may
develop severe disease in other parts of their bodies when they take these
medicines.
• Immunosuppressants may produce more intense side effects in
people with kidney disease or liver disease, because their bodies are slow to
get rid of the medicine.
• Oral forms of immunosuppressants may be less
effective in people with intestinal problems, because the medicine cannot be
absorbed into the body.
Before using immunosuppressants, people with
these or other medical problems should make sure their physicians are aware of
their conditions.
Side effects
Increased risk of infection is a
common side effect of all immunosuppressant drugs. The immune system protects
the body from infections; when the immune system is suppressed, infections are
more likely. Taking such antibiotics as co-trimoxazole prevents some of these
infections. Immunosuppressant drugs are also associated with a slightly
increased risk of cancer because the immune system plays a role in protecting
the body against some forms of cancer. For example, the longterm use of
immunosuppressant drugs carries an increased risk of developing skin cancer as a
result of the combination of the drugs and exposure to sunlight. Other side
effects of immunosuppressant drugs are minor and usually go away as the body
adjusts to the medicine. These include loss of appetite, nausea or vomiting,
increased hair growth, and trembling or shaking of the hands. Medical attention
is not necessary unless these side effects continue or cause problems.
The treating physician should be notified immediately if any of the
following side effects occur:
• unusual tiredness or weakness
• fever or
chills
• frequent need to urinate
Interactions
Immunosuppressant
drugs may interact with other medicines. When interactions occur, the effects of
one or both drugs may change or the risk of side effects may be greater. Other
drugs may also have adverse effects on immunosuppressant therapy. It is
particularly important for patients taking cyclosporin or tacrolimus to be
careful about the possibility of drug interactions.
Other examples of
problematic interactions are:
• The effects of azathioprine may be greater
in people who take allopurinol, a medicine used to treat gout.
• A number of
drugs, including female hormones (estrogens), male hormones (androgens), the
antifungal drug ketoconazole (Nizoral), the ulcer drug cimetidine (Tagamet), and
the erythromycins (used to treat infections), may intensify the effects of
cyclosporine.
• When sirolimus is taken at the same time as cyclosporin, the
blood levels of sirolimus may be increased to a level that produces severe side
effects. Although these two drugs are usually used together, the dose of
sirolimus should be taken four hours after the dose of cyclosporin.
•
Tacrolimus is eliminated through the kidneys. When this drug is used with other
medications that may harm the kidneys, such as cyclosporin, the antibiotics
gentamicin and amikacin, or the antifungal drug amphotericin B, the blood levels
of tacrolimus may rise. Careful kidney monitoring is essential when tacrolimus
is given with any drug that might cause kidney damage.
• The risk of cancer
or infection may be greater when immunosuppressant drugs are combined with
certain other drugs that also lower the body’s ability to fight disease and
infection. These drugs include corticosteroids, especially prednisone; the
anticancer drugs chlorambucil (Leukeran), cyclophosphamide (Cytoxan), and
mercaptopurine (Purinethol); and the monoclonal antibody muromonab-CD3
(Orthoclone), which is also used to prevent transplanted organ rejection.
Not every drug that may interact with immunosuppressant drugs is listed
here. Anyone who takes immunosuppressant drugs should give their doctor a list
of all other medicines that he or she is taking and should ask whether there are
any potential interactions that might interfere with treatment.
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