Your medicines

What it does

  • It helps prevent or treat herpes simplex (cold sores) and shingles. Both are diseases caused by viruses.
  • It helps prevent the CMV (cytomegalovirus) infection. This is a virus that is a member of the herpes family.

How to take it

  • Drink a lot of liquids when you take this medicine.
  • Most patients will take this medicine for four months after a transplant.

Precautions

Tell a member of your transplant team if you have any of the below side effects.

Possible side effects

  • headaches, confusion or shaking
  • skin rash, itching
  • fever of 100.5 F or higher
  • chills
  • kidney problems
  • lowered white blood cells
  • upset stomach, vomiting, diarrhea, stomach pain

What it does

It is a medicine used to keep your bones strong.

How to take it

  • Fosamax: Take with six to eight ounces of plain water at 30 minutes before you have your first food, beverage or medicine of the day.
  • Boniva: Take with six to eight ounces of plain water at 60 minutes before you have your first food, beverage or medicine of the day.
  • Take either with a calcium with vitamin D supplement. (Follow your transplant doctor's directions.)

Precautions

  • Fosamax: Do not lie down for at least 30 minutes after taking it.
  • Boniva: Do not lie down for at least 60 minutes after taking it.
  • Tell a member of your transplant team if you have any of the below side effects.

Possible side effects

  • ulcer in your esophagus (the tube that carries food and fluids from your mouth to your stomach)
  • acid reflux (when stomach contents - food or liquid - leak from the stomach into the esophagus)
  • muscle pain

What it does

  • It helps reduce your risk for rejection.

How to take it

  • You will receive this medicine in the hospital.
  • It will be given by an intravenous (IV) line.

Precautions

  • Your transplant team will discuss precautions with you when administering this medicine.

Possible side effects

  • while you receive it:
    • mild fever
    • chills
    • itching or hives
  • increased risk for infection

What it does

It is a salicylate medicine. It acts as a "blood thinner" to keep platelets from clumping together.

How to take it

  • Take aspirin once every day.
  • If you need surgery, call the transplant clinic to ask if you should stop taking aspirin before your surgery.
  • You do not need to stop taking aspirin before you have an angiogram.

Precautions

  • Do not take more aspirin than your transplant doctor says.
  • Take aspirin with food or buy coated aspirin to keep from getting an upset stomach.

Possible side effects

  • upset stomach
  • bleeding problems

What it does

It is an immunosuppressant. It helps to keep your body from rejecting your new heart.

How to take it

  • Follow the directions carefully from your transplant doctor or coordinator.
  • Take this medicine at the same time every day.
  • Take Imuran with food to decrease stomach upset.

Precautions

  • Never skip a dose of azathioprine.
  • Keep this medicine at room temperature.
  • Keep this medicine in its original container.
  • Tell your transplant doctor or coordinator before you start any new medicines. This includes any over-the-counter medicines.
  • Tell your transplant doctor, coordinator or transplant pharmacist if you have any unusual bruising or bleeding.

Possible side effects

  • increased risk of infection
  • upset stomach
  • heartburn
  • lowered white blood cells
  • increased risk of cancer 

What it does

  • It helps reduce your risk for rejection.

How to take it

  • You will receive this medicine in the hospital.
  • It will be given by an intravenous (IV) line.

Precautions

Your transplant team will discuss precautions with you when administering this medicine.

Possible side effects

  • nausea
  • diarrhea
  • constipation

What it does

It is an anti-fungal medicine. It helps prevent or treat thrush (candidiasis), a yeast infection in your mouth.

How to take it

  • Mycelex Troche: This is used only with cyclosporine.
    • Let the lozenge slowly melt (dissolve) in your mouth. after meals.
    • Do not chew the lozenge.
    • Do not swallow the lozenge whole.
  • Nystatin:
    • Rinse your mouth and swallow.
    • Hold the liquid in your mouth for 10 to 15 seconds before you swallow it.
    • Do not eat or drink for 15 minutes after you take it.
  • Most patients take this medicine for three months after a transplant.

Precautions

  • Take good care of your teeth and gums.
  • If you are taking tacrolimus, you will only be able to take nystatin.

Possible side effects

  • upset stomach, vomiting
  • mouth irritation
  • diarrhea
  • bad or odd taste in your mouth 

What it does

  • It is an immunosuppressant. It helps to keep your body from rejecting your new heart.

How to take it

  • Follow the directions carefully from your transplant doctor or coordinator.
  • The two types of cyclosporine are not the same. Do not mix them. Make sure your refill is the same medicine each time.
  • Your doctor will likely change your dose often.
  • Take this medicine every 12 hours.
    • For example, if you take the first dose at 7 a.m., take the second dose at 7 p.m.
  • Take this medicine at the same time every day.
  • Either take this medicine with or without food. But be consistent. If you start taking it with your evening meal, keep doing so.
  • Do not take this medicine with grapefruit, grapefruit juice or pomegranate juice. They change the way your body takes in this medicine.
  • Directions for taking the liquid cyclosporine:
    • Carefully measure the liquid dose. Use the syringe you were given.
    • Mix the liquid dose with milk, chocolate milk or orange juice in a glass or hard plastic container.
    • Drink right after you mix it.
    • Rinse the glass with more milk or orange juice and drink it.
    • Once the bottled of liquid is opened, it is good for two months.

Precautions

  • Never skip a dose of cyclosporine.
  • Do not start taking any new prescription or over-the-counter medicine until your transplant doctor, coordinator or transplant pharmacist says it's OK. This includes antibiotics and pain medicines.
  • Your transplant doctor will monitor the level of cyclosporine in your blood. He or she may change your dose to prevent side effects (if levels are too high) or to prevent risk of rejection (if levels are too low).
  • Keep this medicine at room temperature. Do not keep it in the refrigerator or in your car.
  • Take good care of your teeth and gums. Cyclosporine can cause swollen gums.

Possible side effects

  • increased risk of infection
  • kidney problems
  • high blood pressure
  • increased cholesterol
  • increased risk of cancer
  • headaches or seizures
  • upset stomach or diarrhea
  • trouble sleeping
  • high blood glucose
  • increased hair growth
  • shaking, numbness or tingling in your hands or feet
  • swollen gums 

What it does

It is a medicine used to increase your magnesium level.

How to take it

  • Do not take more of this medicine than prescribed.
  • Take this medicine with or without food.
  • Take this medicine at least two hours before or after taking mycophenolate mofetil (CellCept/MMF).

Precautions

Be sure to drink enough liquids each day.

Possible side effects

  • diarrhea
  • flushing

What it does

It is a medicine used to reduce blood pressure and swelling (edema). It causes you to urinate more to get rid of extra fluids.

How to take it

  • Take this medicine in the morning or early afternoon so you don't have to get up at night to go to the bathroom.
  • Take this medicine exactly as prescribed.
  • Do not take extra medicine unless you are told to do so by a member of your health care team.

Precautions

  • Your kidneys will be tested to make sure the medicine doesn't affect them.
  • Your electrolyte level will be checked often to make sure your body has enough potassium, salt and other minerals.
  • Tell a member of your transplant team if you have any of the below side effects.
  • This medicine may make your skin extra sensitive to sunlight. Wear sunscreen and protective clothing when you are outside.

Possible side effects

  • upset stomach, vomiting
  • stomach cramping
  • low blood pressure
  • feeling dizzy or lightheaded
  • headache
  • thirst (more than normal)
  • dry mouth
  • rash
  • hearing problems

What it does

It is a medicine used to lower blood pressure.

How to take it

  • Take this medicine exactly as prescribed.
  • Take this medicine at the same time each day.
  • Do not use salt substitutes while you are taking this medicine. They contain potassium and the medicine can cause your body to hold onto it.

Precautions

  • Tell a member of your transplant team if you have any of the below side effects.
  • Use caution in hot weather and while you exercise. Be sure you drink enough water and don't overdo it.

Possible side effects

  • low blood pressure
  • headaches, dizziness
  • drowsiness (feeling sleepy)
  • upset stomach, vomiting, diarrhea, stomach pain
  • dry cough that won't stop
  • kidney problems
  • increase in potassium level
  • rash
  • change in taste

What it does

It is a medicine used to lower blood pressure.

How to take it

  • Take this medicine exactly as prescribed.
  • Take this medicine at the same time each day.
  • Take this medicine with or without food.

Precautions

  • This medicine may make your skin extra sensitive to sunlight. Wear sunscreen and protective clothing when you are outside.
  • Tell a member of your transplant team if you have any of the below side effects.

Possible side effects

  • low blood pressure
  • feeling dizzy or lightheaded

What it does

It is a medicine used to lower blood pressure.

How to take it

  • Take this medicine exactly as prescribed.
  • Take this medicine at the same time each day.
  • For tablet or capsule: do not crush or chew it. Swallow it whole.

Precautions

  • Tell a member of your transplant team if you have any of the below side effects.
  • This medicine may increase your levels of cyclosporine and tacrolimus. When you start taking this medicine, your level will be checked often.
  • Do not stop taking this medicine without your transplant doctor's or nurse's OK.

Possible side effects

  • low blood pressure
  • headaches, dizziness
  • upset stomach, constipation, stomach cramps
  • swelling in your ankles

What it does

It is a medicine that reduces the amount of cholesterol your liver makes.

How to take it

Take this medicine at bedtime. (Your liver makes more cholesterol at night.)

Precautions

  • Tell a member of your transplant team if you have any of the below side effects.
  • You will have blood tests while on this medicine to make sure your liver is working well and to test your creatinine level.

Possible side effects

  • muscle aches or pains
  • rash, itching
  • chest pain
  • upset stomach, diarrhea, stomach pain

What it does

It is a medicine that helps prevent stomach ulcers.

How to take it

  • If you take one dose one time a day, take it at night.
  • Most people take this medicine as long as they take prednisone.

Precautions

Do not take any other over-the-counter antacids or heartburn medicine. Talk with your transplant doctor or nurse first.

Possible side effects

  • headache
  • dizziness
  • drowsiness (feeling sleepy)
  • upset stomach, diarrhea or constipation
  • rash

What it does

It is an immunosuppressant. It helps to keep your body from rejecting your new heart.

How to take it

  • Follow the directions carefully from your transplant doctor or coordinator.
  • Take this medicine at the same time every day.
  • Take this medicine every 12 hours. For example, if you take the first dose at 7 a.m., take the second dose at 7 p.m.
  • Do not open, break, crush or chew this medicine before swallowing it.
  • If you take antacids (such as Tums® or Rolaids®) or medicine that has "aluminum" or "magnesium," take them one hour before or two hours after taking your mycophenolate mofetil.

Precautions

  • Never skip a dose of mycophenolate mofetil.
  • Your transplant doctor will monitor the level of this medicine in your blood. He or she may change your dose to prevent major side effects or if you have many rejection episodes.
  • Keep this medicine at room temperature. Do not keep it in the refrigerator or in your car.
  • Tell your transplant doctor or coordinator if you have any unusual bruising or bleeding.
  • Tell your transplant doctor or coordinator before you start any new medicines. This includes any over-the-counter medicines.
  • Keep this medicine in its original container.
  • Keep this medicine at room temperature

Possible side effects

  • increased risk of infection
  • lowered white blood cells, platelets or both
  • upset stomach, vomiting or diarrhea
  • loss of appetite
  • stomach pain
  • increased risk of cancer

What it does

It prevents your body from rejecting your new heart.

How to take it
  • Follow the directions carefully from your transplant doctor or coordinator.
  • Take this medicine at the same time every day.
    • If you are taking only one dose a day, take it in the morning.
  • Take this medicine every 12 hours.
    • For example, take the first dose at 7 a.m., take the second dose at 7 p.m.
  • Do not take prednisone within one hour of taking antacids (such as Tums® or Rolaids®).
  • Take prednisone with food.

Precautions

  • Never skip a dose of prednisone.
  • Don't stop taking prednisone suddenly without your transplant doctor or coordinator's supervision.

Possible side effects

  • increased risk of infection
  • upset stomach, heartburn, ulcers, stomach bleeding
  • red or dark tarry stools
  • water and salt retention
  • weight gain
  • puffiness in the face
  • increased appetite
  • muscle weakness or cramping
  • mood changes, anxiety or depression
  • weak, brittle bones (osteoporosis)
  • problems with wounds healing
  • skin infections
  • increased blood glucose
  • cataracts (cloudy vision) 

What it does

It is a steroid. It is given in high doses to reverse an episode of rejection.

How to take it

  • Your nurse will give you one dose a day.
  • It is given through an intravenous (IV) line in your hand or arm.

What it does

It is an immunosuppressant. It helps to keep your body from rejecting your new heart.

How to take it

  • Follow the directions carefully from your transplant doctor, coordinator or transplant pharmacist.
  • Your doctor will likely change your dose often.
  • Take this medicine at the same time every day.
  • Either take this medicine with or without food. But be consistent. If you start taking it with your evening meal, keep doing so.
  • Take sirolimus at least four hours after taking cyclosporine.
  • Do not take sirolimus with grapefruit, grapefruit juice or pomegranate juice. They change the way your body takes in this medicine.

Precautions

  • Never skip a dose of sirolimus.
  • Tell your transplant doctor or coordinator before you start any new medicines. This includes any over-the-counter medicines.
  • Keep the sirolimus tablets in their original container. Keep them at room temperature.
  • Keep the sirolimus liquid in the refrigerator. Use it within one month of opening the bottle.

Possible side effects

  • increased risk of infection
  • increased cholesterol (especially triglycerides)
  • headache
  • shakiness
  • sleeping problems
  • skin rash or acne
  • high blood pressure
  • upset stomach, vomiting, diarrhea or constipation
  • lowered white blood cells, red blood cells, platelets or both

What it does

  • It is an immunosuppressant. It helps to keep your body from rejecting your new heart.

How to take it

  • Follow the directions carefully from your transplant doctor or coordinator.
  • Your doctor will likely change your dose often.
  • Take this medicine every 12 hours.
    • For example, if you take the first dose at 7 a.m., take the second dose at 7 p.m.
  • Take this medicine at the same time every day.
  • Either take this medicine with or without food. But be consistent. If you start taking it with your evening meal, keep doing so.
  • Do not take this medicine with antacids (such as Tums® or Rolaids®).
  • Do not take this medicine with grapefruit, grapefruit juice or pomegranate juice. They change the way your body takes in this medicine.

Precautions

  • Never skip a dose of tacrolimus.
  • Do not start taking any new prescription or over-the-counter medicine until your transplant doctor, coordinator or transplant pharmacist says it's OK. This includes antibiotics and pain medicines.
  • Your transplant doctor will monitor the level of tacrolimus in your blood and change your dose to prevent side effects (if levels are too high) or to prevent risk of rejection (if levels are too low).
  • Keep this medicine at room temperature. Do not keep it in the refrigerator or in your car.

Possible side effects

  • increased risk of infection
  • kidney problems
  • high blood pressure
  • increased cholesterol
  • increased blood glucose
  • increased risk of cancer
  • headaches, dizziness or feeling tired
  • upset stomach or diarrhea
  • trouble sleeping or anxiety
  • increased hair growth
  • shaking, numbness or tingling in your hands or feet
  • if you have gout, it may get worse
  • blurred vision or light sensitivity
  • ringing in the ears

What it does

It is a sulfa. It is given to help prevent infection.

How to take it

  • Follow the directions carefully from your transplant doctor or coordinator.
  • Drink a lot of liquids when you take this medicine.
  • Most patients will take this medicine for one year after a transplant.

Precautions

  • Tell a member of your transplant team if you have any of the below side effects.
  • You are at an increased risk for bleeding if you take warfarin (Coumadin® or Jantoven®).

Possible side effects

  • headaches, confusion or shaking
  • upset stomach, vomiting, diarrhea, stomach pain
  • loss of appetite
  • kidney problems
  • increased sensitivity to sunlight
  • blood in urine
  • skin rash, itching

What it does

It helps prevent and treat the CMV (cytomegalovirus) infection.

How to take it

  • Take this medicine once a day.
  • Take this medicine with food.
  • Do not break or crush the tablets.
  • Most patients will take this medicine for six to nine months after a transplant.

Precautions

Tell a member of your transplant team if you have any of the below side effects.

Possible side effects

  • decreased number of blood cells
  • upset stomach, vomiting, diarrhea, stomach pain
  • headaches
  • trouble sleeping

What it does

  • It is an anti-fungal medicine. It helps prevent infections from fungus (such as athlete’s foot).

How to take it

  • Follow the directions from your transplant doctor or coordinator.
  • Take this medicine every 12 hours.
  • Take this medicine at the same time every day. Take it 30 to 60 minutes before you eat meals.
  • Do not take this medicine with grapefruit, grapefruit juice, pomegranate seeds or pomegranate juice. They change the way the medicine works in your body.

Precautions

  • Never skip a dose of voriconazole.
  • Keep this medicine at room temperature. Do not keep it in cold, warm or humid areas (such as the refrigerator, bathroom sink or your car.)

Possible side effects

  • headache
  • dizziness
  • blurred vision
  • light sensitivity
  • ringing in your ears
  • having hallucinations (seeing things that are not real)

Source: Allina Health's Patient Education Department, Care After Heart Transplant, cvs-ah-95405 (1/18)
First Published: 01/06/2013
Last Reviewed: 01/19/2018