Transplant Medications: Forget Me Not!

By Tracy Anderson-Haag, PharmD

A question for our transplant recipients: When is the last time you missed a dose of your medications? Can you remember being late taking your medications? Do you find yourself forgetting to take a dose of your immunosuppressive or other medications?

Most transplant patients are taking between 5 and 15 medications daily, with doses due one to four times daily. This is a very complicated medication regimen! It is not surprising that 20-60% of transplant patients report missing medication doses or non-adherence to their medication regimen. Unfortunately, these missed doses or forgotten medications can lead to serious problems in transplant patients including acute rejection, chronic transplant damage and ultimately the failure of a transplant.

With so much at stake, why is non-adherence to medications so common after transplant? There are many reasons. The most frequent reason given for missing medication doses is “I forgot.” Intense medication regimens required after transplant are difficult to manage and remembering to take pills two or three times a day can be a challenge while trying to maintain a good quality of life. Additionally, immunosuppressive medications prevent rejection and transplant patients do not necessarily feel a beneficial effect when they take their medications. In fact, sometimes the side effects of the medications make you feel worse! These medication side effects may include pain or tingling in the hands or feet, tremors, cosmetic changes like weight gain or hair growth or gastrointestinal problems like nausea or diarrhea. Intolerable side effects are commonly blamed for patients missing doses or stopping medications all together. Another concern is cost. Medications to prevent rejection and treat other complications common in transplant patients often carry a high price tag. Patients may be forced to pick and choose which medications they can afford at their pharmacy.

What can we do to improve compliance with medications?

1. Understand why you are taking each of your medications. It is valuable for transplant patients to work with their clinic pharmacist, nurse or doctors to become educated about their medication regimen. Although immediate symptom relief is not seen with medications for preventing rejection or treating high blood pressure or cholesterol, the long-term benefit of using these medications is very high!
2. Communicate concerns about medicines to your transplant team. This includes reporting problematic side effects, medications with complicated instructions (for example: three or four times daily dosing) or medications that are too expensive for the transplant patient to afford. It may be possible to change medications to alleviate side effects, reduce cost or simplify medication regimens.
3. Develop a reliable system for remembering your medications. Get refills in advance to prevent running low on pills. Use medication boxes to set up your meds to keep your pills organized and handy. This also makes it easy to see if you've taken those morning medications yet or not. Take your pills as a part of your usual morning and evening routine, or set a reminder alarm (cell phones work great!) to alert you when doses are due.
4. Utilize family members and other support systems. The family and friends of transplant patients are invested in your good health (perhaps they donated your organ!). A supportive parent, spouse or child may go a long way in encouraging a transplant recipient to keep up with their complicated medication schedule.

Remember, transplant recipients are the most important player on the post-transplant team. If unable to comply with their medication regimen, outcomes will not be satisfactory for the patient or the health care team. Good communication between the players including your health care providers and social workers can improve patient compliance, outcomes and quality of life