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patient services, transplant pharmacy

Patient Services  |  Biological Transplant Medications

INDEX

 

Envarsus XR®

 

FDA approved uses: Prevent rejection of kidney transplants along with other medications as prescribed by your doctor.

 
“Off-label” use in transplantation: This product is FDA approved for kidney transplant patients, but may be used by your doctor for other medical conditions not listed here.

 
Drug classification: Anti-rejection Medication. Envarsus XR is a calcineurin-inhibitor immunosuppressant indicated for the prevention of organ rejection in kidney transplant patients.

 
Usual dose in Antibody Mediated Rejection (AMR): To convert from a tacrolimus immediate-release product to ENVARSUS XR, administer an ENVARSUS XR once daily dose that is 80% of the total daily dose of the tacrolimus immediate-release product. Monitor tacrolimus whole blood trough concentrations and titrate ENVARSUS XR dosage to achieve target whole blood trough concentration ranges of 4 to 11 ng/ml.

 
How long will you take this medication? If your doctor feels this product is keeping you from losing the transplanted kidney, it may continue for as long as the doctor feels is helpful.

 
Tell your doctor if: Call your doctor right away if you have symptoms of an infection such as: fever, cough or flu-like symptoms, warm, red, or painful areas on your skin, muscle aches, sweats or chills.

 
How do I take this medication? Take ENVARSUS XR once daily with fluid (preferably water) on an empty stomach at the same time each day (preferably in the morning). Take ENVARSUS XR tablets whole. Do not chew, divide or crush ENVARSUS XR tablets before swallowing. If you cannot swallow ENVARSUS XR tablets whole, tell your doctor. If you miss your dose of ENVARSUS XR, it should be taken as soon as possible, but no longer than 15 hours after missing your dose. If the time after you miss your dose is more than 15 hours, the missed dose should be skipped and the next dose should be taken the following morning at your regularly scheduled time. Do not take 2 doses at the same time. If you take too much ENVARSUS XR, call your doctor or go to the nearest hospital emergency room right away.

 
Potential Side Effects: Envarsus XR may increase the risk of some cancers including skin and lymph gland cancer (lymphoma). You may also have an Increased risk of infection. ENVARSUS XR can lower the ability of your immune system to fight infections. Serious infections can happen in people receiving ENVARSUS XR that can cause death. Call your doctor right away if you have symptoms of an infection such as: fever, cough or flu-like symptoms, warm, red, or painful areas on your skin, muscle aches, sweats or chills.

 
How do I store this Medication? Store ENVARSUS XR at room temperature between 68 °F to 77 °F (20 °C to 25 °C)

 

Nulojix® (belatacept) Injection

 

FDA approved uses: Prevent rejection of kidney transplants along with other medications as prescribed by your doctor.

 

‘Off-Label’ use in transplantation: This product is FDA approved for kidney transplant patients, but may be used by your doctor for other medical conditions not listed here.

 

Drug Classification: Anti-rejection Medication. Nulojix® blocks specific T lymphocytes (T-cells) which are necessary to make antibodies. Antibodies are responsible for causing rejection of your kidney.

 

Usual dose in Antibody Mediated Rejection (AMR): The dose is based on your current weight at 10mg/kg. The first dose is administered on the day of the transplant and day 5 after transplantation. The dose is repeated at the end of week 2, week 4, week 8, and week 12. At the end of week 16, your doctor will begin a dose of 5mg/kg every 4 weeks.

 

Usual dose for Desensitization before transplant: This product is generally not used prior to transplant, but is administered on the day of your transplant.

 

How long will you take this medication? If your doctor feels this product is keeping you from losing the transplanted kidney, it may continue for as long as the doctor feels is helpful.

 

Tell your doctor if: You have taken any other medications that lower your chance of fighting infection or if you have received any vaccines (such as flu vaccine), have cancer, diabetes, have tuberculosis or a family member with tuberculosis, pregnant or breast feeding.

 

How do I take this medication? This medication will be administered by a clinician through a vein for over at least 30 minutes in your home.

 

Potential Side Effects: Skin rash, mood changes, vision changes, diarrhea, fever, chills, sore throat, weak or tired, confusion, blood in urine, stomach pain. This medicine can cause a serious brain infection that may cause death. If you have problems seeing, thinking, speaking, walking or standing tell your doctor right away. Ask your doctor or pharmacist for complete list of side effects.

 

How do I store this Medication? This medication is stored in the refrigerator at 2-8 degrees C, 36-46 degrees F, protected from light.

 

Velcade® (bortezomib) Injection

FDA approved uses: Velcade® is a drug to treat cancer (chemotherapy) such as multiple myeloma, lymphoma, and other cancers.

 

‘Off-Label’ use in transplantation: Can be used before or after kidney transplantation to prevent loss of your kidney.

 

Drug Classification: Antineoplastic drug -proteasome inhibitor. Velcade® stops your cells from producing more antibodies that may attack the transplanted kidney and lead to transplant loss.

 

Usual dose in Antibody Mediated Rejection (AMR): The dose is based on your weight at 1.3mg/m2 (body surface area) given as an injection into your vein 2 times per week for 4 doses. Some doctors give the dose only 1 time per week for 4 doses. Your doctor may choose to repeat this cycle.

 

Usual dose for Desensitization before transplant: The same dose of 1.3mg/m2 is given as 4 doses along with other medications as ordered by your physician. Your doctor may choose to repeat this cycle.

 

How long will you take this medication? Your doctor will do blood tests to determine if the Velcade® is working and may continue for additional cycles, if necessary.

 

Tell your doctor if: You are pregnant, have heart failure, have peripheral neuropathy (numbness or tingling in hands or feet), allergy to boron or Mannitol, or have any problems with your liver.

 

How do I take this medication: This medication will be administered by your doctor or other health care provider. It is given through a vein.

 

Potential Side Effects: Weakness, feeling tired, diarrhea, nausea, excessive bleeding when cut or bruised, fever, vomiting, weight loss. Report any unusual effects to your physician promptly. Ask your doctor or pharmacist for a complete list of potential side effects.

 

How do I store this Medication? This medication needs to be stored at room temperature (20-28 degrees C, 68-77 degrees F)

 

Vistide® (cidofovir) Injection

 

FDA approved uses: Vistide® is a drug used to treat CMV (cytomegalovirus) infections of the eye in patients with AIDS (acquired immunodeficiency syndrome).

 

‘Off-Label’ use in transplantation: Patients receiving transplant rejection drugs, or who have received a transplanted kidney, may develop viral infections including CMV retinitis. Cidofovir is used to treat infections with certain viruses as determined by your doctor.


Drug Classification: Antiviral drug

 

Usual dose for viral infections: The dose is based on your weight and is usually 5mg/kg given once weekly every 2 weeks. The doctor may then choose to continue the dose at 3 to 5 mg/kg once every 2 weeks after the initial doses. You must also take a drug called probenecid that your doctor will prescribe. Routine examinations will be done to determine your response to the drug.

 

Usual dose in Antibody Mediated Rejection (AMR): Not used.

 

Usual dose for Desensitization before transplant: Not used.

 

How long will you take this medication? Vistide® will be prescribed by your doctor for as long as necessary to treat the infection. This medication may have to be taken for life.

 

Tell your doctor if: You are allergic to sulfa or probenecid, are pregnant or plan to become pregnant, are severely dehydrated, have received foscarnet recently, or have diabetes.

 

How do I take this medication: This medication will be administered by your doctor or other health care provider. It is given through a vein.

 

Potential Side Effects: Skin rash, breathing problems, ringing in your ears, eye sight changes, fever, chills, sore throat, weakness, flu-like symptoms, fast heartbeat. Report any unusual side effects to your doctor promptly. Ask your doctor or pharmacist for a complete list of potential side effects.

 

How do I store this Medication? This medication should be stored at room temperature (20-25 degrees C, 68-77 degrees F).  If compounded from the pharmacy, storage is 24 hours refrigerated at 2-8 degrees C or 36-46 degrees F.

 

Sandimmune® (cyclosporine) Injection and Oral Medication

 

FDA approved uses: Cyclosporine is used to prevent the loss of a transplanted organ, to treat arthritis and psoriasis. It is also used in an eye drop for dry eyes.

 

‘Off-Label’ use in transplantation: This product is approved for use in heart, kidney, and liver transplant patients.

 

Drug Classification: Immune suppressant. Cyclosporine blocks T-cell activation which prevents the production of antibodies that may lead to loss of the transplanted organ.

 

Usual dose in Antibody Mediated Rejection (AMR): This medication is dosed based on your weight up to 7mg/kg in divided doses each day. This drug will be used in combination with other drugs as determined by your doctor. Cyclosporine oral (by mouth) is normally continued after transplantation, and will be slowly tapered off as determined by your physician. Lab tests will be done to determine the correct dose for you.

 

Usual dose for Desensitization before transplant: Cyclosporine may be given as a single dose by mouth prior to transplant, or may be give by intravenous route based on your weight. Doses up to 15mg/kg are given by mouth as a single dose. Lab tests will be done to determine the correct dose for you.

 

How long will you take this medication? Normally the doctor will begin to reduce the oral (by mouth) dose over 2-4 months after your transplant, then the medication will be stopped. This will be determined by your doctor based on other factors.

 

Tell your doctor if: You have high blood pressure, cancer, previous radiation therapy, coal tar treatments or ultraviolet light therapy, allergy to corn oil, alcohol, dyes or preservatives, if you are pregnant or breast feeding. Make sure your doctor has a complete list of all of your medications as cyclosporine may interfere with other medicines.

 

How do I take this medication? The oral (by mouth) cyclosporine is best taken with a full glass of water. Avoid grapefruit juice. Take the medication at the same time each day and do not exceed the dose. Do not stop this medication without speaking to your doctor first. The cyclosporine injection will be given in a hospital or clinic.

 

Potential Side Effects: Skin rash, eyesight changes, high blood pressure, dizziness, numbness and tingling in the hands and feet, stomach pain, vomiting, yellowing of the skin or eyes. This is not a complete list of side effects. Ask your doctor or pharmacist for a complete side effect list.

 

How do I store this Medication? Store the oral medication at room temperature (between 59°F and 86°F) in the original packaging. You will not be given the cyclosporine injection to take home. Keep away from children and pets. Do not store medications in the bathroom or areas with excess moisture.

 

Foscavir® (foscarnet) Injection

 

FDA approved uses: Foscarnet is approved to prevent and treat viral infections in acquired immunodeficiency syndrome (AIDS) patients, such as Herpes type viruses and Cytomegalovirus (CMV).

 

‘Off-Label’ use in transplantation: This product is used to prevent viral infections in transplant patients who are at a high risk of viral infection.

 

Drug Classification: Antiviral medication.

 

Usual dose for viral infections: This medication may be used prior to or after your transplant to prevent viral infections if your doctor chooses. The dose is based on your weight and urine output. The dose is between 40mg/kg to 90mg/kg given as an IV infusion through a vein. Doses up to 120mg/kg have also been used in certain patients.

 

Usual dose in Antibody Mediated Rejection (AMR): Not used for rejection.

 

Usual dose for Desensitization before transplant: Not used for desensitization.

 

How long will you take this medication? The initial dose may be given for up to 3 weeks, then the doctor will decide if you require longer treatment based on response to the medication. In some cases, this medicine may be taken for life.

 

Tell your doctor if: You have heart disease/kidney disease, low blood calcium, seizures, breast feeding, have anemia, or have any nervous system disease.

 

How do I take this medication? This medication is administered through a vein.

 

Potential Side Effects: Skin rash, breathing problems, eyesight changes, fever, chills, sore throat, muscle twitch, trouble passing urine or change in amount of urine, unusual bleeding or bruising, weakness or feeling tired. This is not a complete list of side effects. Ask your doctor or pharmacist for a complete side effect list.

 

How do I store this Medication? When compounded by pharmacy, store in a refrigerator at 2-8 degrees C or 36-46 degrees F.  Follow directions from the pharmacist on proper storage of the IV medication.

 

Cytovene® (ganciclovir) Injection and Oral Medication

 

FDA approved uses: Ganciclovir is approved to treat herpes type viral infections and Cytomegalovirus (CMV) viral infections in Human Immunodeficiency Virus (HIV+) patients as well as patients that are immunocompromised.

 

‘Off-Label’ use in transplantation: Ganciclovir is approved to prevent or treat viral infections in transplant patients.

 

Drug Classification: Antiviral medication.

 

Usual dose in viral infections: Ganciclovir may be prescribed if you are at risk of developing a viral infection either before or after your transplant. Usual dose is 5 mg/kg IV twice daily for 7—14 days, followed-up by 5 mg/kg IV once daily 7 days per week or 6 mg/kg IV once daily 5 days per week.

 

Usual dose in Antibody Mediated Rejection (AMR ): Not used for AMR.

 

Usual dose for Desensitization before transplant: Not used for desensitization.

 

How long will you take this medication? Your doctor will determine if your infection is treated and will stop the medication then. However, you will need to get repeated check-ups to see if you need to continue the medication. This medication may be a life-long treatment.

 

Tell your doctor if: You are pregnant or trying to become pregnant, breast-feeding, have problems with your kidneys, have low blood counts like red blood cell, platelets or white blood cells. Make sure your doctor has a complete list of all the medications you currently take to avoid drug interactions.

 

How do I take this medication? Injections of ganciclovir will be done in a hospital, clinic or at your home by a trained health care professional. The oral (by mouth) medication should be taken with plenty of water. Do not take more medication than prescribed by your doctor. Take the doses at the same time each day and do not skip any doses unless your doctor tells you to do so.

 

Potential Side Effects: Skin rash, itching, swelling of the face, lips, or tongue, breathing problems, dizziness or lightheaded, fever, chills, sore throat, mouth sores, pain, tingling or numbness in your hands or feet, trouble passing urine or changes in the amount of urine, unusual bleeding or bruising, weakness or feeling tired.

 

How do I store this Medication? Medication given to you to take by mouth should be stored away from children or pets. Keep the medication at room temperature (between 59°F and 86°F) and away from direct sunlight or moisture. If you are prescribed IV ganciclovir to infuse in your home, keep the medication refrigerated until time for the infusion. Follow directions from the pharmacist on proper storage of the IV medication.

 

IVIg (intravenous immune globulin) injection (Gammagard®, Gamunex-C®, Octagam®, Privigen®, Gammaaked®, Gammaplex®, Flebogamma®, etc. )

 

FDA approved uses: Many different name brands of IVIg are marketed for sale. IVIg is indicated to treat neuropathy, thrombocytopenia purpura, chronic lymphocytic leukemia (CLL), prevention of bacterial infections, and Kawasaki disease (thyroid disease). This is not a complete list of approved uses.

 

‘Off-Label’ use in transplantation: IVIg has been shown to improve the outcomes of kidney and other organ transplants when used before and after the transplant. IVIg is used in combination with other drugs and therapies such as plasmapharesis and rituximab that may help prevent organ rejection.

 

Drug Classification: Immunoglobulin.

 

Usual dose in Antibody Mediated Rejection (AMR): There are many different treatment schedules for use in AMR. Your doctor will decide the best treatment plan for you. In general, the IVIg is given based on your weight at 0.4g -1gm/kg and given as 1 or 2 doses each month, or over several days each month. Other treatment options may only last for 10-15 days and include plasmapharesis. IVIg is given along with other medications as ordered by your doctor.

 

Usual dose for Desensitization before transplant: There are many different treatment schedules for use in desensitization. Your doctor will decide the best treatment plan for you. In general, the IVIg is given based on your weight at 0.4g -1gm/kg and given as 1 or 2 doses, or over several days each month. IVIg is also given along with other medications as ordered by your doctor.

 

How long will you take this medication? In most cases, the medication will be given for at least 6 months, and longer if your doctor determines that you need more injections. Your doctor will monitor blood levels to determine if you need more IVIg.

 

Tell your doctor if: You recently were given any vaccinations (flu vaccine, etc), you are taking aspirin or other products like aspirin, you have diabetes, heart disease, history of blood clots or strokes, any infection, any allergies to blood products or albumin, allergy to sugars such as maltose or sucrose, if you are pregnant or breast-feeding.

 

How do I take this medication: This medication will be administered by your doctor or other health care provider. It is given through a vein. This product can also be administered in your home through a vein by a health care professional.

 

Potential Side Effects: Skin rash, ‘flu-like’ symptoms including fever and chills, headache, nausea and vomiting, neck pain or difficulty moving your neck, sudden weight gain, swelling of feet or ankles, trouble passing urine or change in the amount of urine. Ask your doctor or pharmacist for a complete list of potential side effects.

 

How do I store this Medication? IVIg products are stored refrigerated before they are injected. If you are getting infusions in the home, follow the directions from the pharmacist on proper storage of your medication. Do not freeze IVIg. Keep this medication away from children. Throw away any unused or expired medication.

 

Solu-Medrol® (methylprednisolone) Injection

 

FDA approved uses: There are many FDA approved uses for methylprednisolone, including treatment of inflammation and swelling of various areas of the body, asthma, allergies, arthritis, and some diseases of the blood and adrenal glands. This is not a complete list of approved uses.

 

‘Off-Label’ use in transplantation: Methylprednisolone and other types of corticosteroids are used commonly in transplantation. Because of the potential to suppress the immune system, these drugs are useful along with other medications to prevent loss of the transplanted organ.

 

Drug Classification: Immune suppressant and anti-inflammatory (corticosteroid).

 

Usual dose in Antibody Mediated Rejection (AMR): There are many dosing options that your doctor can choose, but more commonly the dose of methylprednisolone will be 250-500mg/day given as an injection into a vein. This dose will be for 3-5 days and may be followed by oral (by mouth) corticosteroids.

 

Usual dose for Desensitization before transplant: There are many dosing options that your doctor can choose, but a more common dose is methyprednisolone 125mg/day given as an injection into a vein. This dose can be higher if your doctor chooses. This is done 5-7 days prior to the transplant, then you may receive oral (by mouth) corticosteroids after the transplant.

 

How long will you take this medication: Methylprednisolone is given for the shortest time possible to get the best results for your condition. In most cases, the methylprednisolone will not be given for more than 5 -7 days in a row. It can also be used before other medications are given to you , such as IVIg.

 

Tell your doctor if: You have just received a vaccination of any type (such as flu vaccine), you have cataracts or glaucoma, diabetes, heart disease, infections including tuberculosis, recent surgery, seizures, colitis, thyroid problems, any allergy to benzyl alcohol or other corticosteroids. Tell your doctor about all the medications you currently take.

 

How do I take this medication: Methylprednisolone is generally given in the hospital or clinic. This medication is given into a vein by a health care professional. This medication can also be given as an injection in your home.

 

Potential Side Effects: Skin rash, itching, hives, swelling of the face, lips, or tongue, bloody or tarry stools, eyesight changes, fever, sore throat, cough or signs of infection, wounds that won’t heal, irregular heartbeat, swelling of the ankles, feet, or hands, weakness, insomnia, weight gain or loss. Ask your doctor or pharmacist for a complete list of potential side effects.

 

How do I store this Medication? In most cases, this medication will not be provided to you but will be administered in a health care setting such as the hospital or clinic. If this medication is administered in the home, follow the storage instructions provided by the pharmacist. This medication can be stored at room temperature or refrigerated depending on how it is shipped to you. Keep out of reach of children.

 

Rituxan® (rituximab) Injection

 

FDA approved uses: Rituximab is approved for use in certain types of cancer, rheumatoid arthritis, and a rare blood vessel disorder.

 

‘Off-Label’ use in transplantation: Rituximab reduces the formation of B-cells which produce antibody. By slowing the antibody production you can slow the chance of your body rejecting the transplanted organ.

 

Drug Classification: Immune modulator; chemotherapy drug.

 

Usual dose in Antibody Mediated Rejection (AMR): The dose is based on your body surface area, which the doctor will calculate to determine the dose. Rituximab is usually only 1 dose at 375mg/m2, given with other medications after your transplant. Your doctor may decide to give additional doses based on your response.

 

Usual dose for Desensitization before transplant: The dose is based on your body surface area, which the doctor will calculate to determine the dose. Rituximab is usually only 1 dose at 375mg/m2, given with other medications before your transplant. You may also have plasmapharesis along with the rituximab. Your doctor may decide to give additional doses based on your response.

 

How long will you take this medication? In most cases, rituximab will only be one dose administered along with other medications to reduce the chance of organ rejection. However, your doctor will do blood tests and may give you additional doses if needed.

 

Tell your doctor if: You have a history of Hepatitis B or herpes infections, received any vaccinations recently (such as the flu vaccine), heart disease, kidney disease, lung disease (like asthma), irregular heartbeat, lupus, any blood disorders, are pregnant, breast feeding, or plan to become pregnant. Tell your doctor all of the medications that you currently take.

 

How do I take this medication: This medication will be administered by your doctor or other health care provider.

 

Potential Side Effects: Allergic reactions including skin rashes, itching or hives, swelling of the face, hands or tongue, fever, chills, cough, sore throat, pain on passing urine, confusion, irregular heartbeat, mouth sores, stomach pain, redness or peeling of the skin. This is not a complete list of potential side effects. Ask your doctor or pharmacist for a complete list of potential side effects.

 

How do I store this Medication? This medication is stored in the refrigerator at 2-8 degrees C, 36-46 degrees F.

 

Soliris® (eculizumab) Injection

 

FDA approved uses: FDA approved for paroxysmal nocturnal hemoglobinuria (PNH) which is a rare blood disorder and atypical hemolyticuremic syndrome (aHUS) which is another blood disorder.

 

‘Off-Label’ use in transplantation: Eculizumab blocks a critical pathway in the formation of proteins that can cause you to lose the transplanted organ. This drug is used in combination with other drugs, as ordered by your doctor, to prevent rejection of your transplanted organ.

 

Drug Classification: Complement inhibitor.

 

Usual dose in Antibody Mediated Rejection (AMR): There is no widely accepted dose of eculizumab in rejection, but some transplant centers use a dose of 600mg on day 1 of transplant, then 600mg weekly for 4 weeks after your transplant. If you are receiving plasmapharesis as well, your doctor may have to give additional doses. This will be used along with other medications to help prevent loss of the transplanted organ.

 

Usual dose for Desensitization before transplant: This drug is generally not used prior to transplantation. However, your doctor may choose to use this product based on your own medical condition.

 

How long will you take this medication? There is no available information on how long to continue this medication. Your doctor will do additional blood tests to determine if you need additional doses.

 

Tell your doctor if: You are pregnant or breast feeding, have a current infection or fever, any genetic deficiency in complement, or have had meningitis.

 

How do I take this medication? This medication requires you and your doctor to enroll in a special program called Soliris Safety Registry® before use.

 

Potential Side Effects: Headache, meningitis, back pain, nausea, vomiting, fatigue, cough muscle pain, anemia, fever. This is not a complete list of possible side effects. Ask your doctor or pharmacist for a complete list of side effects.

 

How do I store this Medication? This medication should be stored refrigerated at 2-8 degrees C, 36-46 degrees F.