No, we can only supply medications for your Liver.

We will supply your medications from our outpatient pharmacy. If you are attending clinic you will pick up your medications whilst you are here and if you have a telephone appointment the medications will be posted out to you. Please let the doctor who carries out your clinic appointment know that you need a supply of your medications.

Medications that will be issued by the transplant team are:

• Tacrolimus (Advagraf, Prograf, Envarsus, Adoport)
• Mycophenolate Mofetil
• Azathioprine
• Sirolimus
• Ciclosporin (Neoral, Deximune)
• Tenofovir
• Entecavir
• Lamivudine
• Valganciclovir
• Hepatitis B immunoglobulin (Zutectra)

Please ensure that you ask for a supply of any liver medications you are not able to get from your GP each time you are in clinic so you don’t run out between appointments. If you are running out of these medications between appointments then please email the liver pharmacy team.  We will arrange to have the supply sent out to you from our outpatient pharmacy.

All other medications that you are prescribed should be supplied from your GP.  If you are having issues with prescribing of your other regular medications from your GP we can assist with this. Please let us know in clinic or via email.

You should ask for a prescription at each of your appointments so you have enough to last you to your next appointment with us.

Contact details for Liver Pharmacy Team

The quickest resolution would be to email the liver pharmacy team and we can arrange a supply of your medications to be ready for collection from the outpatient pharmacy.

If you or a representative are unable to travel to King’s then we can have the supply sent out to you.

The decision to prescribe immunosuppressant medications is made locally, many GPs are not able to prescribe these medicines. If this is the case then you will need to request a prescription at your clinic appointment. If you are running out between appointments then please email the liver pharmacy team.

We can issue your prescriptions from King’s. Please request a supply whilst you are at your liver clinic appointment.

Contact details for the Liver Pharmacy team.

We will give you a prescription that lasts you safely through to your next appointment. I.e. if you are on 3 monthly appointments we will give you a 3 monthly prescription. This is to ensure you have enough medication so you don’t run out but also if your dose changes we don’t waste a large amount of medication.

Please note – we cannot issue a prescription if you are not regularly attending appointments and/or have not had recent blood tests.

Advagraf is ordered slightly differently from other medications and it might just be that your pharmacy does not know this. If your pharmacy is having issues ordering in Advagraf then please ask them to contact Astellas directly on 0203 379 8721 and they will be able to assist them. If there are still issues then please contact the liver pharmacy team via the email and we will be able to help resolve this.  Please do not take your prescription to multiple pharmacies.  The best resolution is to leave the prescription at your pharmacy of choice and get in touch with the liver pharmacy team who will be able to resolve any perceived issues by the local pharmacy team.

We are no longer prescribing immunosuppression on FP10 prescriptions, your supply will be from our outpatient pharmacy. If you are having telephone appointments then the supply of medications will be sent to you from our outpatient pharmacy.

Contact details for the Liver Pharmacy Team.

When traveling abroad remember to divide your supply of medications between hand luggage and your hold luggage. This will ensure you have a supply of medications should your suitcase go missing. Remember to take a greater supply than you need to avoid running out.

Your local travel clinic will be the best people to ask about the requirements for travel to each particular area. You should not have any live vaccines, you can email the liver pharmacy team to check if the vaccines they recommend are safe for you to take. If you need to take malaria prophylaxis then find out which options the travel clinic would recommend and then you can email us to confirm if there are any interactions with your liver medications.

There are lots of different cold and flu remedies and each of these contains slightly different ingredients. If you email the liver pharmacy team asking about a specific preparation then we can confirm if this is okay to take with your immunosuppressant medications.

There is no information available about interactions between herbal medications and conventional medications so we would advise you to avoid all herbal medications as they might interfere with the levels of your immunosuppressant medications.

Please contact us using the pharmacy email address and we can look into if the new medication is okay to take alongside your existing medications. If your GP or other healthcare provider is not sure if a certain medication is okay for them to prescribe then they can email us and we can look into it.

According to Public Health England (PHE), who write the guidelines for vaccine use, the pneumococcal vaccine does not need to be repeated in most patients.

The only groups of patients who need a repeat dose every 5 years are those with chronic kidney disease and those who do not have a functioning spleen.

There are two versions of the Shingles vaccine available, one of these is a live vaccine and the other is not. The non-live vaccine is called Shingrix and this is safe for liver transplant patients to have. Your GP should contact you when you are eligible for the vaccine.

Partners and close household contacts can have either type of the vaccine. If they develop any lesions following the vaccine then these should be covered up until they are dry/crusted over to prevent transmission of the virus. If they don’t have any lesions then you do not need to take any additional precautions.

It is very important for liver transplant patients to have the flu vaccine every year as soon as it is available.  This is not a live vaccine (as long as it is the injectable vaccine)

The nasal vaccine given to children is a live vaccine.  There is a theoretical risk of transmission of the flu from someone vaccinated with the live nasal vaccine and an immunosuppressed patient. However, in practice there are no reports of an immunosuppressed patient catching the flu from a child who has had the live nasal vaccine. To eliminate any risk, you should have your flu vaccine 2 weeks before children you have close contact with receive the nasal flu vaccine.

Hair loss

Unfortunately hair loss can be a side effect of tacrolimus and this can be very distressing

If this happens early post-transplant then we would hope that hair loss would become less severe over time as the level of tacrolimus that we aim for will hopefully reduce slightly (although this is based on a number of clinical factors). One thing that can help improve hair loss is to take a supplement containing selenium and zinc. . Before you start taking any new supplements or vitamin tablets then you can email the pharmacy the details of the product and we can look into if it will be safe for you to take.

Osteoporosis

Being on steroids can reduce your bone density. This tends to be a side effect of long-term treatment and not shorter courses.  Not everyone who has a liver transplant will need to be on long-term steroids but if you do need to be then we will keep you on as low a dose of steroids as possible in order to minimise side effects.

Patients who have had a transplant should have a bone density scan (DEXA scan) every two years so if you haven’t had one in the last 2 years then discuss with the doctor that you see in clinic or with your GP.  Taking a calcium and vitamin D supplement is a good idea for all liver transplant patients, particularly those on long-term steroids or who have had a DEXA scan that shows low bone density.

Unlike prescribed medications, which have been through rigorous testing to confirm that they are safe and effective and have been manufactured to the required standard, we can’t be sure exactly what has gone into homeopathic or complementary medications. We also don’t have information available about interactions between the ingredients of the homeopathic or complementary medications and other prescribed medications. For these reasons we would advise you to avoid homeopathic and herbal medications in order to prevent any potential interactions with your immunosuppressant medications or harm to your liver.

This depends on the manufacturer but there are two different variations.

If it says Expiry: 10/2020 – it means it is in date until the end of October 2020.

If it says “use by” or “best before” then it should not be used from the date given. For example, “use by 09/2020” means that it should not be used after midnight on 31^st August 2020.

If you do have expired medicines don’t try to dispose of them yourself -take them to your local pharmacy and they will be able to safely dispose of them.

No – you need enough water to make sure they go down – but not necessarily a whole glass of water.

Calcium:

Calcium tablets tend to come in combination with vitamin D, there are a few different brands.  The dose will depend on the type of calcium tablet that you are on so you should follow the instructions on the box.

Vitamin D:

The use of vitamin D depends on whether you are taking vitamin D because you are deficient, or whether you are just taking a supplement.

If you have low levels then we will give you a high dose of vitamin D to replace your levels. This might be something like 40,000 units a week for 7 weeks or 40,000 units a day for 7 days. After the course of high dose vitamin D you will move onto the maintenance dose.

The maintenance dose of vitamin D is usually 800-1000 units a day.

You can buy vitamin D supplements from most pharmacies, supermarkets and Holland and Barrett if your GP will not prescribe these or if you pay for prescriptions (as it is often cheaper to buy).

Absolutely – as long as you are taking it on an empty stomach then it is fine to take it at whatever time fits into your routine best. It doesn’t matter how long it is until you eat it just needs to be at least an hour before and at least two hours after food.