Medications Associated With Liver Transplants
Medication and Task Schedule
Prescriptions | Medications | Vomiting
After a liver transplant at Cincinnati Children's Hospital Medical Center, special medications may be prescribed for your child.
Pediatric Liver Care Center team members are leading an important initiative at Cincinnati Children's related to medication safety in transplant recipients. It is part of the Robert Wood Johnson Foundation Pursuing Perfection initiative, a national project with the goal of dramatically improving the delivery of health-care services in America.
The transplant medication team promises:
- All patients will receive all and only the medications they need, in the best formulation and by the best route, and based on the best available knowledge
- All patients will be free from harm due to medication misuse
- System resources will not be wasted
- All patients and their families / caregivers and care providers will be knowledgeable about safe medication practices
- Medication will be available in a timely fashion and be administered on time
- Care will be individualized and not discriminatory
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Prescriptions
The liver transplant coordinator renews prescriptions Monday through Friday, 8 am to 4:30 pm. Please monitor your medication supply and call the liver transplant office during these hours when a prescription refill is needed.
For emergency prescription needs after these hours, the on-call liver transplant physician calls in only the required amount of medication needed until the next business day Your child's primary coordinator will call in the remainder of the prescription after reviewing your child's chart on the next business day.
Please make sure to call if you are having trouble getting medications at your pharmacy
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Medication Side Effects and Tips
Cincinnati Children's offers special tips on taking and giving medicines and possible side effects to watch for. Your child may not be on all of these medicines, but you may hear about or see many of them after the liver transplant. Please ask your liver transplant coordinator any questions you have about your child's medicines.
Caring for the new liver is a lifelong commitment, requiring frequent blood tests and daily medications for the rest of your child's life.
- Aldactone" (Spironolactone)
- Eliminates extra fluid from the body by increasing urine flow.
Side effects: Headache, fever, rash, loss of appetite, nausea, vomiting and increase in serum potassium level
Administration: Comes in liquid or pill form - Baby Aspirin
- Prevents blood clotting following transplantation. Typically administered for 100 days post-transplant.
Side effects: Nausea, vomiting, rash, bleeding and ulcers
Administration: Give with food or after meals to help prevent stomach upset - Bactrim" (Trimethoprim and Sulfamethorazole)
- Prevents pneumonia. Typically administered for one year post-transplant. If your child is allergic to Bactrim, he / she will receive aerosolized pentamidine monthly for one year.
Side effects: Nausea, vomiting, skin rash, sensitivity to the sun and low blood counts
Administration: Comes in liquid or pill form - Cellcept" (Mycophenolate Mofetil)
- Helps prevent rejection.
Side Effects: Increased susceptibility to infection; decreased blood levels of white blood cells and platelets; nausea, vomiting and diarrhea.
Administration: Comes in liquid or capsule form. - Cytogam (Cytomegalovirus Hyper-Immunoglobulin)
- Prevents and treats CMV and EBV infections.
Side Effects: Fever, chills, shortness of breath and nausea.
Administration: Given through an IV. - Diflucan" (Fluconazole)
- Prevents fungal infections.
Side effects: Nausea, vomiting, diarrhea, headache, rash and kidney problems
Administration: Comes in liquid or pill form - Enalapril (Vasotec, Vasotec IV)
- Manages mild to severe hypertension, congestive heart failure and asymptomatic left ventricular dysfunction.
Side effects: Fatigue, vertigo, insomnia, dizziness and headache.
Administration: Comes in pill form.
- Gancyclovir / Ganciclovir
- Prevents and treats viral infections.
Side effects: Swelling, irregular heartbeat, high blood pressure, kidney problems, decreased blood cell counts, headache, seizures, nervousness, dizziness, nausea, vomiting and diarrhea
Administration: Given through an IV. Use chemotherapy precautions. - Imuran" (Azathioprine)
- Helps prevent rejection.
Side effects: Increased susceptibility to infection; decreased blood levels of white blood cells, red blood cells and platelets; nausea and vomiting
Administration: Comes in a liquid and tablet form - Lasix" (Furosemide)
- Eliminates fluid from the body by increasing urine flow.
Side effects: Dizziness, weakness, dry mouth, increased urination and low potassium level
Administration: Comes in tablet or liquid form. Plan your child's activities so that a bathroom is easily accessible. - Mycelex", Mycostatin", Nilstat" (Nystatin)
- Prevents fungal infections in the mouth and throat. Typically administered for six months post-transplant.
Side effects: Mild diarrhea and nausea.
Administration: Comes in liquid or wafer form. In the liquid form, swab the mouth with the liquid or swish and swallow. The tablet form should be kept in the mouth until it is gone, without chewing. Do not allow the child to eat or drink for 30 minutes after the dose. - Mylanta", Maalox" (Aluminum Hydroxide, Magnesium Hydroxide)
- An antacid.
Side effects: Diarrhea
Administration: Given between meals and at bedtime. Comes in liquid or chewable tablet form. Give at least two hours before and two hours after Cyclosporin, Neoral" or Prograf. - Neoral" (Cyclosporine Microemulsion)
- Helps prevent rejection. Administered for lifetime.
Side effects: Trembling and shaking hands, kidney dysfunction, high blood pressure, increased susceptibility to infection, increased hair growth, headache, leg cramps, swollen gums, and nausea or vomiting.
Administration: Must be given on time. Must be given within 15 minutes of scheduled time. Comes in liquid or capsule form. Must be given the same way each dose; for example, mix with milk or juice or give by itself. This medication may not be taken with grapefruit juice, which interferes with the absorption of the medicine. If your child vomits within 30 minutes after the dose, the entire dose must be given again. If your child vomits 30 minutes to one hour after the dose, one half of the dose must be given again. If your child vomits more than one hour after the dose, there is no need to give the dose again. - Norvasc" (Amlodipine)
- Helps keep blood pressure normal and protects the kidneys from the side effects of your child's other medications.
Side effects: Headache, irregular heartbeat, dizziness, fatigue, nausea and lowered blood pressure.
Administration: Comes in a pill form. May be crushed and mixed with liquid or food. - Nifedipine" (Procardia")
- Anti-hypertensive agent (helps to lower blood pressure). Given intermittently for high blood pressure.
Side effects: Dizziness, headache, nausea, weakness, shortness of breath, cough, irregular heartbeat and low blood pressure.
Administration: Comes in liquid-filled capsule. The capsule is 10 milligrams. Some patients require less than 10 milligrams for treatment of high blood pressure. If this is the case with your child, you need to puncture the capsule with a needle, draw up the appropriate amount in the syringe, remove the needle and squirt the medication under the tongue. Call the liver transplant coordinator on-call if your child's blood pressure is higher than the parameters set by the doctors before giving any blood pressure medication. - OKT3"
- Treats severe rejection.
Side effects: Fever, chills, shortness of breath, wheezing, increased susceptibility to infection, diarrhea and severe allergic reaction.
Administration: Given in the hospital through an IV. - Pantoprazole (Protonix)
- Treats and maintains healing of erosive esophagitis associated with gastroesophageal reflux disease (GERD); adjunctive therapy of duodenal ulcers associated with Helicobacter pylori (unlabeled use).
Side effects: Headache, dizziness, vertigo, insomnia, anxiety, fever, nervousness, confusion, depression, sudden changes in emotions, and hallucinations.
Administration: Comes in pill form. - Pentamidine (NebuPent, Pentam-300)
- Treats and prevents pneumonia caused by Pneumocystis carinii in patients who cannot tolerate or who fail to respond to sulfamethoxazole and trimethoprim.
Side effects: Dizziness, fever, fatigue and delirium.
Administration: I.M. (intramuscular injection). Given through an IV (preferred). - Peridex" (Chlorohexidine Gluconate)
- Prevents or treats infections in the mouth.
Side effects: Darkened teeth.
Administration: Swish in the mouth and spit the medication out. Do not swallow. May also be swabbed in the mouth. Do not allow your child to eat or drink for 30 minutes after the dose. - Prednisone
- Helps prevent rejection.
Side effects: Fluid retention, weight gain, increased appetite, increased blood sugar, brittle bones, muscle weakness, round full face, thin arms and legs, mood swings, difficulty sleeping, stomach ulcers and sweating.
Administration: Comes in a liquid and tablet form. May be crushed and mixed with liquid or food. - Prograf" (Tacrolimus, Fk506)
- Immunosuppressive agent. Helps prevent rejection. Administered for the child's lifetime.
Side effects: High blood pressure, high blood sugar, trembling, shaking hands, kidney dysfunction, headaches, increased susceptibility to infection, nausea, diarrhea, high potassium levels, hair loss, sleep disturbances and lymphoproliferative disorder.
Administration: Must be given on time. Must be given within 15 minutes of the scheduled time. Comes in capsule or liquid form. Liquid must be shaken. Must be given the same way each dose and on an empty stomach. Your child may not eat 60 minutes before and 60 minutes after taking Prograf. If your child is on tube feeding, you must stop the tube feedings one hour before and not resume until one hour after giving the Prograf. The medication may not be taken with grapefruit juice as this interferes with the absorption of the medication.
If your child vomits within 30 minutes after the dose, the entire dose must be given again. If your child vomits 30 minutes to one hour after the dose, one half of the dose must be given again. If your child vomits more than one hour after the dose, there is no need to give the dose again. - Rapamune" (Sirolimus)
- Helps prevent rejection.
Side effects: Increased susceptibility to infection, increased triglyceride and cholesterol levels, decreased potassium levels and "rash."
Administration: Comes in a liquid form. - Sandimmune" (Cyclosporine)
- Helps prevent rejection. Typically administered for a lifetime.
Side effects: Trembling and shaking hands, kidney dysfunction, high blood pressure, increased susceptibility to infection, increased hair growth, headache, leg cramps, swollen gums, nausea or vomiting, high potassium levels, sleep disturbances and lymphoproliferative disorder
Administration: Must be given on time. Must be given within 15 minutes of scheduled time. Comes in liquid and capsule form. Liquid must be shaken. Must be given the same way each dose; for example, mix with milk or juice or give by itself. The medication may not be taken with grapefruit juice as this interferes with the absorption of the medication. - If your child vomits 30 minutes after the dose, the entire dose must be given again. If your child vomits 30 minutes to one hour after the dose, one half of the dose must be given again. If your child vomits more than one hour after the dose, there is no need to give the dose again.
- Zantac" (Rantidine)
- Helps prevent or treat ulcers.
Side effects: Headache, constipation, nausea, dizziness, fever and fatigue.
Administration: Comes in liquid or pill form.
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Vomiting Prograf / Cyclosporine
| Timing | Dosage |
|---|
| Vomiting 30 minutes or less after medication | Repeat entire dose |
| Vomiting 30 - 60 minutes after medication | Repeat half of the dose |
| Vomiting after 60 minutes | Do not repeat the medication |
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Written 5/03, rev. 6/07
