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- Co–existing medical conditions: Patients should tell their healthcare providers if they have any other medical conditions. Immunosuppressants can worsen symptoms of some conditions, including chicken pox or a viral infection of the nerves called shingles. Immunosuppressants may have increased effects if taken in patients with liver disease or kidney disease because the body is slow to break down the drug. Immunosuppressants may be weakened if patients have gastrointestinal problems because the drug may not be absorbed properly.
- Interactions: Patients should tell their healthcare providers if they are taking any other drugs (prescription or over–the–counter), herbs, or supplements because they may interact with treatment.
- Patients should not eat grapefruit or drink grapefruit juice one hour before taking cyclosporine (Neoral ®, Sandimmune ®, Gengraf ®) because the fruit may break down the drug before it is absorbed into the bloodstream.
- The effects of azathioprine (Azasan ®, Imuran ®) may be stronger in patients who take allopurinol (Aloprim ®, Zyloprim ®), a medicine used to treat gout. This combination may cause immunosuppressants to weaken the immune system too much, and it may lead to an increase in side effects. Therefore, patients taking these drugs may require lower doses of allopurinol and/or azathioprine.
- The effects of cyclosporine (Neoral ®, Sandimmune ®, Gengraf ®) may be stronger when taken with female hormones (estrogens), male hormones (androgens), antifungals such as asketoconazole (Nizoral ®), ulcer drugs such ascimetidine (Tagamet ®), or erythromycins, which are used to treat infections. These combinations may cause immunosuppressants to weaken the immune system too much, and it may lead to an increase in side effects. Patients may require lower doses of the medications.
- If sirolimus (Rapamune ®) is prescribed in combination with cyclosporine (Neoral ®, Sandimmune ®, Gengraf ®), it should be taken four hours after cyclosporine. This reduces the risk of side effects.
- Immunosuppressants should be used cautiously with other drugs that weaken the immune system, such as corticosteroids (such as prednisone) or anticancer drugs, such as chlorambucil (Leukeran ®), cyclophosphamide (Cytoxan ®), or mercaptopurine (Purinethol ®).
- Pregnancy and breastfeeding: Patients should tell their healthcare providers if they may be pregnant or are thinking about becoming pregnant because immunosuppressants may cause serious side effects in the fetus. This may occur if the medication is taken during pregnancy or if the male or female takes the drug during conception.
- Patients taking immunosuppressants should not breastfeed their babies. The drugs can pass into the breastmilk and may cause serious side effects in the baby.
- Treatment adherence: Patients should take their medications exactly as prescribed by their healthcare providers. Patients should not change the dose or stop taking the medication without first consulting their healthcare providers.
- Vaccines: Before receiving vaccines, patients should tell their healthcare providers if they are taking immunosuppressants. In general, vaccines may be less effective in patients who are taking immunosuppressants. Live viral vaccines that contain a live virus, such as small pox or chickenpox, should not be given to patients taking immunosuppressants. This is because live viral vaccines may infect recipients who have weakened immune systems. Patients may even become infected if they come into close contact with a recently vaccinated individual. While this is uncommon, it occurs most often in individuals who have weakened immune systems.
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