This information is designed to give you some general background knowledge about your medicines. It does not contain fully comprehensive information so it may not list all known side effects. Always read the package insert with your medicine. If you have any concerns or questions about any medicines you are given please ask your doctor or pharmacist.
This information has been provided by the Kings Liver Pharmacy Team
General Information
This information is designed to give you some general background knowledge about your medicines. It does not contain fully comprehensive information so it may not list all known side effects. Always read the package insert with your medicine. If you have any concerns or questions about any medicines you are given please ask your doctor or pharmacist.
- Let your doctor know if you experience any unwanted effects from your medicines (even if they are not mentioned in the leaflet), particularly if they persist.
- Check with your doctor/pharmacist before starting any new medicines, including herbal and over the counter medicines as they may interact with your medication.
- Whilst taking immunosuppressant medications you must never receive live vaccinations. Please see the travel information section.
- Whilst taking immunosuppressant medications you should wear protective clothing and use a sunscreen with a high protection factor (SPF 30 or over) to limit your exposure to sunlight and UV light.
- Whilst taking immunosuppressant medications, women of child bearing age should use contraceptives. If you are considering having a baby you must involve the hepatology team to discuss options for treatment beforehand.
- If you have to go into hospital, always remember to bring in your medicines.
- Always bring an up-to-date list of your medicines when you come to an outpatient appointment. Medication cards are available from the transplant coordinator or pharmacist if you need a new or updated one.
- When you are discharged from hospital you will receive at least two weeks supply of your medicines. Please see your GP at least five working days before you run out of supplies. If you have any problems contact your doctor, pharmacist or transplant coordinator.
Medicines commonly used after Liver transplant
These are some of the medicines frequently used before or after Liver
tranplantation. Please note you will not be on all these medications
but you might find the list useful as a reference guide for the future.
Tacrolimus Capsules
(Brand Names: PROGRAF®, ADVAGRAF® and ENVARSUS®)
Prograf®, Advagraf® and Envarsus® are NOT interchangeable. Prograf® is an immediate release, TWICE daily preparation and Envarsus® and Advagraf® are modified release ONCE daily preparations. Please be aware of which product you are on and do not switch between brands unless this is planned by the liver transplant team.
General information
Capsule strength:
Prograf®: 0.5mg, 1mg, 5mg
Advagraf®: 0.5mg, 1mg, 3mg, 5mg
Envarsus®: 0.75mg, 1mg, 4mg
Indication: Immunosuppression – to prevent rejection of the liver
Expected length of time on drug: Lifelong
Possible side effects
Headaches, tremors, can affect kidney function tests, raised blood pressure, increased blood sugars, and an increase in the risk of certain cancers.
What if I take too many capsules?
Contact your doctor immediately.
How do I get further supplies of this medication?
Your GP might prescribe this medication for you. If not then you can get an outpatient prescription when you come to clinic. If you are running out between appointments then please email the liver pharmacy team.
What if I forget to take a dose?
If you forget to take a dose, take it as soon as you remember and then continue as normal. If it is less than six hours before the next dose, skip the missed dose and continue as normal. Do not take extra capsules to catch up.
What happens if I get admitted to another hospital?
Please make sure to take your tacrolimus medications with you as your local hospital may not be able to supply this. Please let the coordinators at King’s know if you have been admitted for any reason.
Special Instructions
- Take on an empty stomach, at least one hour before or two hours after food.
- Swallow the capsules whole with water.
- Do not take the dose on the morning of any clinic appointments. Bring the dose with you to take immediately after your blood test.
- Prograf® is usually taken twice a day, 12 hours apart.
- Advagraf® and Envarsus® are taken once daily, in the morning.
- You must never take more than one preparation of tacrolimus at any one time
Do not drink grapefruit juice; or take St John’s Wort (hypericum perforatum), pomelos or Seville oranges (usually found in Seville marmalade) if you are on tacrolimus.
Your dose of tacrolimus is based on the levels in your blood, your kidney and liver function and your general response to the medication. Taking too much may increase the chance of side effects, while taking too little may lead to rejection of your new liver. Initially, we will aim for higher levels of tacrolimus and this will be gradually reduced over the weeks and months following your transplant. It is very important you take as directed by the liver team.
Stopping tacrolimus will increase the chance of rejection. Do not stop taking tacrolimus unless your doctor tells you to.
You must not receive live vaccines while on tacrolimus.
Prednisolone
(Steroids)
General information
Tablet strength:
5mg
Indication:
Immunosuppression – to prevent rejection of the liver
Expected length of time on drug:
In some patients, we aim to stop prednisolone after 3 months. Some patients may need to stay on a small dose of prednisolone long-term – this depends on the indication for transplant. Do not stop taking prednisolone unless your doctor has told you to.
Possible side effects
Increased appetite, weight gain, fluid retention, indigestion, increased blood sugars, osteoporosis, stomach irritation or indigestion (you will be given omeprazole to prevent this), mood swings.
What if I take too many tablets?
Contact your doctor immediately.
How do I get further supplies of this medication?
Your GP should prescribe this medication for you. If not then you can get an outpatient prescription when you come to clinic.
What if I forget to take a dose?
If you forget to take a dose, take it as soon as you remember and then continue as normal. If you do not remember until the next day, skip the missed dose and continue as normal. Do not take extra tablets to catch up.
Special Instructions
- This drug is a steroid.
- Take with food in the morning.
- You will be given a small blue card (called a steroid card) which you will need to carry at all times.
Mycophenolate Mofetil Tablets
(MMF)
General information
Tablet strength:
250mg tablets and 500mg tablets
Indication:
Immunosuppression – to prevent rejection of the liver. If you develop problems with your kidneys as a result of tacrolimus, mycophenolate may be added to reduce the amount of tacrolimus you need.
Expected length of time on drug:
Lifelong
Possible side effects
Stomach upsets, diarrhoea, reduced white blood cells, increased risk of developing cancer (particularly of the skin), increased risk of infections (Report any signs of infection, for example a sore throat to your doctor.).
What if I take too many tablets?
Contact your doctor immediately.
How do I get further supplies of this medication?
Your GP might prescribe this medication for you. If not then you can get an outpatient prescription when you come to clinic. If you are running out between appointments then please email the liver pharmacy team.
What if I forget to take a dose?
If you forget to take a dose, take it as soon as you remember and then continue as normal. If you do not remember until the next day, skip the missed dose and continue as normal. Do not take extra tablets to catch up.
Stopping Mycophenolate may increase the chance of rejection. Do not stop taking Mycophenolate unless your doctor tells you to.
Special Instructions
- Swallow whole
- You should take it twice a day, approximately 12 hours apart.
- You must not receive live vaccines while on Mycophenolate.
Pregnancy & Contraception
Mycophenolate use is not recommended in pregnancy due to the potential risk to the unborn child. Women of child bearing age must be using TWO forms of highly effective contraception before starting mycophenolate, whilst taking mycophenolate, and for six weeks after stopping mycophenolate. Please inform the doctor you see in liver outpatient clinic if you are considering having a baby.
Azathioprine Tablets
General information
Tablet strength:
25mg and 50mg tablets
Indication: Immunosuppression – to prevent rejection of the liver. If you develop problems with your kidneys as a result of tacrolimus, azathioprine may be added to reduce the amount of tacrolimus you need.
Expected length of time on drug: Lifelong
Possible side effects
Reduced white blood cells, increased risk of developing cancer (particularly of the skin), increased risk of infections. (Report any signs of infection, for example a sore throat to your doctor.)
What if I take too many capsules?
Contact your doctor immediately.
How do I get further supplies of this medication?
Your GP might prescribe this medication for you. If not then you can get an outpatient prescription when you come to clinic. If you are running out between appointments then please email the liver pharmacy team.
What if I forget to take a dose?
If you forget to take a dose, take it as soon as you remember and then continue as normal. If you do not remember until the next day, skip the missed dose and continue as normal. Do not take extra tablets to catch up.
Stopping azathioprine may increase the chance of rejection. Do not stop taking azathioprine unless your doctor tells you to.
Special Instructions
- Do not take allopurinol (a gout medication) whilst you are on azathioprine.
You must not receive live vaccines while on azathioprine.
Sirolimus Tablets
(Brand Names: RAPAMUNE®)
General information
Tablet strength:
0.5mg, 1mg and 2mg tablets
Indication:
Immunosuppression – to prevent rejection of the liver. Sirolimus may be used together with tacrolimus to reduce the amount of tacrolimus you need.
Expected length of time on drug:
Lifelong
Possible side effects
Abdominal pain, diarrhoea, headache, nausea, oedema, can affect kidney function tests, delayed wound healing, high cholesterol, mouth ulcers, fever, increased blood sugars.
What if I take too many tablets?
Contact your doctor immediately.
How do I get further supplies of this medication?
Your GP might prescribe this medication for you. If not then you can get an outpatient prescription when you come to clinic. If you are running out between appointments then please email the liver pharmacy team.
What if I forget to take a dose?
If you forget to take a dose, take it as soon as you remember and then continue as normal. If you do not remember until the next day, skip the missed dose and continue as normal. Do not take extra tablets to catch up.
Stopping sirolimus may increase the chance of rejection. Do not stop taking mycophenolate unless your doctor tells you to.
Special Instructions
- Sirolimus is taken once a day, usually in the morning.
- You need to be consistent in taking the tablets either with food or without food and at the same time each day.
- You should avoid grapefruit juice and St. John’s Wort (Hypericum Perforatum) whilst on Sirolimus.
- You must not receive live vaccines while on Sirolimus.
Ciclosporin Capsules
(Brand Names: NEORAL®, DEXIMUNE®)
General information
Capsule strength:
10mg, 25mg, 50mg, 100mg
Indication:
Immunosuppression – to prevent rejection of the liver
Expected length of time on drug:
Lifelong
Possible side effects
Headaches, tremors, can affect kidney function tests, can raise blood pressure, can increase blood sugars, and can cause certain cancers.
What if I take too many capsules?
Contact your doctor immediately.
How do I get further supplies of this medication?
Your GP might prescribe this medication for you. If not then you can get an outpatient prescription when you come to clinic. If you are running out between appointments then please email the liver pharmacy team.
What if I forget to take a dose?
If you forget to take a dose, take it as soon as you remember and then continue as normal. If you do not remember until the next day, skip the missed dose and continue as normal. Do not take extra tablets to catch up.
Stopping Ciclosporin may increase the chance of rejection. Do not stop taking Mycophenolate unless your doctor tells you to.
Special Instructions
- Make sure that you stay on the same brand of Ciclosporin (either Neoral® or Deximune®)
- Do not take your dose on the morning of your clinic appointment. Bring your dose with you so that you can take it after you have had your blood test.
- You should avoid grapefruit juice and St. John’s Wort (hypericum perforatum) whilst on Ciclosporin.
Fluconazole Capsules
General information
Capsule strength:
50mg, 150mg, 200mg
Indication:
Prevention and treatment of fungal infection. We also use this to boost the amount of Tacrolimus in the blood.
Expected length of time on drug:
Varies but can be up to 6 weeks.
Possible side effects
Nausea, stomach discomfort, diarrhoea, rash and headache.
What if I take too many capsules?
Contact your doctor immediately.
How do I get further supplies of this medication?
This is usually only or a short course and the whole course will be supplied on discharge from hospital or from liver outpatients. If fluconazole is needed long-term then your GP should be able to prescribe this.
What if I forget to take a dose?
If you forget to take a dose, take it as soon as you remember and then continue as normal. If you do not remember until the next day, skip the missed dose and continue as normal. Do not take extra tablets to catch up.
Valganciclovir Tablets
General information
Tablet strength:
450mg
Indication:
Antiviral agent used to prevent and treat cytomegalovirus (CMV)
Expected length of time on drug:
3 months
Possible side effects
Low white blood cells and platelets, stomach upsets (for example: nausea, vomiting, diarrhoea and stomach pain), confusion and drowsiness. Valganciclovir may affect your kidney function (this will be regularly monitored in clinic).
What if I take too many tablets?
Contact your doctor immediately.
How do I get further supplies of this medication?
An outpatient prescription when you come to your liver outpatient appointment. You should be given the whole course when you are started on Valganciclovir as GPs are not able to prescribe this medication.
What if I forget to take a dose?
If you forget to take a dose, take it as soon as you remember and then continue as normal. If you do not remember until the next day, skip the missed dose and continue as normal. Do not take extra tablets to catch up.
Special Instructions
Valganciclovir is taken once a day, usually in the morning. The tablets should be swallowed whole, with or after food.
Pregnancy & Contraception
For female patients, effective contraception (barrier and oral) is required during treatment and for 30 days after treatment has finished. Male patients should practise barrier contraception during, and for at least 90 days following treatment with Valganciclovir, unless it is certain the female partner is not at risk of pregnancy.
Co-Trimoxazole
(Brand Names: SEPTRIN®)
General information
Tablet strength:
480mg
Indication:
Antibiotic agent used to prevent Toxoplasmosis
Expected length of time on drug:
6 weeks
Possible side effects
High potassium, headache, rash, nausea and diarrhoea.
What if I take too many tablets?
Contact your doctor immediately.
How do I get further supplies of this medication?
You will be given the full 6 week supply on discharge from hospital so should not need any further supply.
What if I forget to take a dose?
If you forget to take a dose, take it as soon as you remember and then continue as normal. If you do not remember until the next day, skip the missed dose and continue as normal. Do not take extra tablets to catch up.
Special Instructions
Co-trimoxazole is taken once a day, usually in the morning. The tablets should be swallowed whole, with or after food.
Lamivudine
General information
Tablet strength:
100mg
Indication:
To prevent infection with Hepatitis B
Expected length of time on drug:
Lifelong
Possible side effects
Alopecia, muscle pain and disorders, nasal symptoms, nerve tingling
What if I take too many tablets?
Contact your doctor immediately.
How do I get further supplies of this medication?
An outpatient prescription when you come to your liver outpatient appointment. Your GP will not be able to prescribe this medication and we cannot send a community prescription for this item so it is important that you always get a supply when you come to your outpatient appointment.
What if I forget to take a dose?
If you forget to take a dose, take it as soon as you remember and then continue as normal. If you do not remember until the next day, skip the missed dose and continue as normal. Do not take extra tablets to catch up.
Special Instructions
Lamivudine is taken once a day, usually in the morning. The tablets should be swallowed whole.
Omeprazole
General information
Capsule strength:
20mg
Indication:
Protects stomach whilst on steroids and reduces acid release into stomach, reducing reflux.
Expected length of time on drug:
If you were not on omeprazole before transplant this will only be required whilst you are on more than 10mg of Prednisolone daily. It may continue after this if there is another reason you need stomach protection (ongoing acid reflux, a previous stomach bleed or a stomach ulcer).
Possible side effects
Headache, stomach pain, constipation, diarrhoea, flatulence, nausea and vomiting
What if I take too many tablets?
Contact your doctor immediately.
How do I get further supplies of this medication?
Your GP will prescribe this on your repeat prescription
What if I forget to take a dose?
If you forget to take a dose, take it as soon as you remember and then continue as normal. If you do not remember until the next day, skip the missed dose and continue as normal. Do not take extra tablets to catch up.
Special Instructions
Swallow whole with water
Aspirin
General information
Tablet strength:
75mg
Indication:
Aspirin is used to prevent blood clots from forming in the vessels supplying blood to your new liver. It is also used to reduce blood clots in the arteries to prevent angina and clotting in coronary artery grafts and valves, which have been replaced or repaired.
Expected length of time on drug:
May be lifelong
Possible side effects
Stomach upset, bleeding
What if I take too many tablets?
Contact your doctor immediately.
How do I get further supplies of this medication?
Your GP will prescribe this on your repeat prescription
What if I forget to take a dose?
If you forget to take a dose, take it as soon as you remember and then continue as normal. If you do not remember until the next day, skip the missed dose and continue as normal. Do not take extra tablets to catch up.
Special Instructions
- Aspirin comes as dispersible tablets that can be dissolved in water or swallowed whole.
- Take with food.
- DO NOT take other medicines containing Aspirin.
Magnesium Aspartate
General information
Sachet strength:
10mmol of magnesium per sachet
Indication:
To increase magnesium levels
Expected length of time on drug:
Until magnesium levels are in range
Possible side effects
Diarrhoea, nausea
What if I take too many sachets?
Contact your doctor immediately.
How do I get further supplies of this medication?
Your GP will be able to prescribe this or you can get an outpatient prescription when you come to your liver outpatient appointment.
What if I forget to take a dose?
If you forget to take a dose, take it as soon as you remember and then continue as normal. If you do not remember until the next day, skip the missed dose and continue as normal. Do not take extra sachets to catch up.
Special Instructions
Dissolve in 50-200mL water, tea or orange juice and stir until dissolved. Drink immediately after reconstitution.
Amlodipine
General information
Tablet strength:
5mg or 10mg
Indication:
For high blood pressure
Expected length of time on drug:
Lifelong
Possible side effects
Most people do not experience any problems when taking Amlodipine. However, sometimes it can cause headache, flushing, rash, nausea, ankle swelling, tiredness and a rapid heart rate.
What if I take too many tablets?
Contact your doctor immediately.
How do I get further supplies of this medication?
Your GP will be able to prescribe this on your repeat prescription.
What if I forget to take a dose?
If you forget to take a dose, take it as soon as you remember and then continue as normal. If you do not remember until the next day, skip the missed dose and continue as normal. Do not take extra tablets to catch up.
Statins
(Simvastatin, Pravastatin, Atorvastatin)
General information
Tablet strength:
Depends on the statin
Indication:
To reduce the amount of lipids (cholesterol) in your blood. High levels of lipids can cause narrowing (or even blocking) of the vessels, which supply the heart muscle with blood. This can lead to angina and heart attacks. There is an increased risk of high lipids in some family groups, but for many people the reason for high lipid levels is an excessive fat intake from food and large amounts being made by the liver. Some drugs, such as sirolimus can cause high lipid levels.
Expected length of time on drug:
Lifelong
Possible side effects
Headache, nausea and vomiting, tiredness, rashes, muscle problems (Tell your doctor if you experience any unusual muscle pain, weakness or cramps)
What if I take too many tablets?
Contact your doctor immediately.
How do I get further supplies of this medication?
Your GP will be able to prescribe this on your repeat prescription.
What if I forget to take a dose?
Leave out that dose completely. Take your next dose at the right time.
Special Instructions
- Cholesterol production occurs mainly at night and therefore the best time to take these drugs is in the evening or at night.
- Avoid consuming grapefruit juice if you are taking statin
Complementary Medicines
It is recommended that you should avoid using complementary medicines if you are:
- Receiving immunosuppression therapy following transplant
- Receiving chemotherapy
- Epileptic
- Pregnant or breast feeding
There is little known about many complementary medicines and how they may interact with conventional medicines or what adverse effects they may have on you. A plant contains several active chemicals in varying amounts, which can be different between batches or different brands of complementary medicines and therefore a variable dose of the chemicals administered with them.
Combinations of complementary medicines are often used and this further complicates the picture, as interactions are possible between them as well as between conventional and complementary medicines.
Evidence to support the possible benefits of complementary medicines is often poor or unreliable.
The risk of suffering severe consequences following a drug interaction or adverse effect outweighs the potential benefits. You are therefore strongly recommended to avoid using complementary medicines.