immunosuppressant drugs

10 Things You Should Know About Immunosuppressants

A Kidney transplant is the best treatment for most patients with end-stage renal disease and is associated with significant improvement in quality of life and survival of patients with successful kidney grafts. Because patient and graft survivor rates one year after transplantation are currently higher than 95% for recipients of living and deceased donor kidneys, there will be large numbers of successful recipients requiring long-term care and chronic immunosuppression.

Immunosuppressant drugs have to be taken during and after any kind of organ transplant. Primary care physicians, internists and the general public are becoming increasingly involved in this type of care, and will need basic information about immunosuppression and the medical management of these patients. Here are a few things you need to know about immunosuppressants.

What are immunosuppressants?

Immunosuppressants are drugs or medicines that suppress or reduce the strength of the body’s immune system and lower the body’s ability to reject a transplanted organ. That is, they help to accept the organ from someone else body. Another term for these drugs is anti-rejection drugs.

Uses of Immunosuppressants

Almost everyone who receives an organ transplant has to take immunosuppressant drugs. The body recognizes a transplanted organ as a foreign mass. This triggers a response by the body’s immune system to attack it.

By weakening the immune system, immunosuppressant drugs decrease the body’s reaction to the foreign organ. The drugs allow the transplanted organ to remain healthy and free from damage.

The goal is to adjust these drugs to prevent rejection and to minimize any side effects of the drugs.

Types of Immunosuppressant Drugs: There are 2 types of immunosuppressants

  1. Induction drugs: Powerful antirejection medicine used at the time of transplant
  2. Maintenance drugs: Antirejection medications used for the long term.

Think of a real estate mortgage; the down payment is like the induction drug and the monthly payments are like maintenance drugs. If the down payment is good enough you can lower the monthly payments, the same as for immunosuppression.

How Are the Drugs Administered?

All immunosuppressant drugs are only available with a prescription from a physician. They can be administered as tablets, capsules, liquids, and injections. A physician determines the best course of treatment using a combination of drugs. The goal of immunosuppressant therapy is to find the course that will prevent rejection and have the least harmful side effects.

A person taking immunosuppressant drugs must take them exactly as prescribed every day. Even the slightest change from the medication regimen can trigger an organ rejection. After missing a dose, it’s important to contact a physician immediately.

Regular blood tests are used to monitor the effectiveness of the drugs and the need for adjustments.

Side Effects

The most significant side effect of immunosuppressant drugs is an increased risk of infection. Other, less serious side effects can include loss of appetite, nausea, vomiting, increased hair growth, and hand trembling. These effects typically subside as the body adjusts to the immunosuppressant drugs.

The following side effects indicate the need for immediate attention:

  • A feeling of being unusually tired or weak
  • Fever above 100 degrees or chills
  • Frequent urination or burning when you pass your urine
  • A cold or cough that will not go away

Does everyone who gets a new kidney have to take immunosuppressants?

Almost everyone who has a transplant must take these drugs every day as directed. Even missing a single dose may make it more likely for you to have a rejection. The only time you should skip a dose is if your doctor or other health care team member tells you to do so. If you are not sure, call your doctor. Also, when you have a clinic visit, you should not take your immunosuppressant medicines until your blood is drawn for lab work.

Because of the large number of pills you may need to take each day, forgetting a dose is easy to do. You can do three things to help you remember your medicine:

  • Know the name of each drug you take and what it does. If you have a good understanding of your drugs, you will be less likely to forget one.
  • Use a pill box or organizer. This allows you to set up an entire week of pills. Once the week is set up, all you have to do is take the pills in each on the right day and time.
  • Try to take your medicine at the same time every day.

What should I do if I miss a dose?

Take it as soon as you remember and call your doctor. If it is time for the next dose, do not take a double dose.

Are there any signs or symptoms I should watch for?

Yes. Even though you are taking your medicines every day, you may still develop rejection of the kidney transplant. You need to know your body very well. If you have any of the following, you should call your transplant center right away:

  • A drop in your urine output
  • A fever above 100 degrees
  • Tenderness of your new kidney
  • Bloody urine
  • Flu-like feelings
  • Weight gain or development of swelling

Are there other medicines and food that can act against immunosuppressants?

Yes. There are many other medicines, food, and supplements that can change the levels (up or down) of immunosuppressants in the blood. Some of the common ones are grapefruit juice, erythromycin, anti-TB (tuberculosis) medicines, anti-seizure medicines and some blood pressure medicines.


Dr. P. N. Gupta

A graduate of K.G. Medical College, Lucknow, Dr Gupta obtained his DNB in Nephrology from Batra Hospital, New Delhi. He has worked at Fortis, Vasant Kung, Medanta, The Medicity and has obtained Fellowship in Kidney Transplantation. He worked with Prof Montgomery at Johns Hopkins, and has also obtained a visiting fellowship in ABO incompatible Kidney Transplantation. His special interest is in Kidney Transplantation and Dialysis in Acute Renal Failure and Chronic Renal Failure. He is currently Sr. Consultant, Nephrology & Transplant Physician at Paras Hospital, Gurgaon.


  1. Maria Marinucci · May 24, 2018 Reply

    I was in stage 2-3 fibrosis until my PCP gave me a prescription for a skin infection and it was an antibiotic. I wasn’t sure I should have taken it, and didn’t know to ask anyone, but after taking it, my fibrosis turned into cirrhosis. I can’t believe my doctor gave me that, knowing I was on immunosuppressants. I am extremely upset now that I damaged my liver to the point of no return.

  2. Syed Ali · June 20, 2018 Reply

    Hi DR Gupta,

    My brother diagnosis by Aplastic Anemia and he under Immunosuppressants therapy and having difficult time. Could you please give us any advice.

    Kind Regards

  3. Dr. P. N. Gupta
    P N Gupta · June 21, 2018 Reply

    Dear Mr. Ali,

    Aplastic anemia also requires immunosuppressive medications. Can you share the difficulties which your brother is facing.

    I am a Nephrologist, and will suggest you to get in touch with Haematologist for a better opinion.

    Thank You

  4. VisalM · July 17, 2018 Reply

    Hello Dr. Gupta,

    I was diagnosed with iGaN last December. I’m about to start my Immunosuppressant therapy. Please suggest some precautions that I need to take as I live in Delhi. I had suffered from 3 bouts of cough between Jan and July. I was prescribed 10mg of steroids and 5mg of Immunosuppressant daily.

  5. Abraham · August 19, 2018 Reply

    After kidney transplant my potassium level is increasing. what to do?

  6. Rajany pk · December 2, 2018 Reply

    Sir , my 24 urine protein is 1200. My father died with renal failure. What step I have to take at this stage. My age is 48 . Please advice

  7. Spencer Ryce · March 15, 2019 Reply

    Treatment that lowers the activity of the body’s immune system. This reduces its ability to fight infections and other diseases, such as cancer. Immunosuppressive therapy may be used to keep a person from rejecting a bone marrow or organ transplant. It may also be used to treat conditions in which the immune system is overactive, such as autoimmune diseases and allergies. Some types of immunosuppressive therapy may increase a person’s risk of cancer by lowering the body’s ability to kill cancer cells.

  8. Kellianne Birchler · April 4, 2019 Reply

    Hi I was diagnosed with Lupus . Will the immunosuppressant help or worsen the situation?

  9. Irina Zviadadze · February 13, 2020 Reply

    Dr. P. N. Gupta
    My son (11 years old now ) had a renal transplantation as a result of PUV posterior urethral valve.
    Our problem is frequent UTI , urological problems solved, but cant get of rid UTI , in urine culture found bacteria: escherichia coli, after -pseudomonas putida and klebsiella pneumoniae
    used antibiotics: augmentin, cipro, amikacin, lemoxol – all of them solve the problem instantly but not for a long time …. kidney works ok , creatinine is around 0,75-0.9 mg/dl ,
    he gets 2-2 prograf, 2-2 myfortic
    how can we get rid of UTI?

  10. Linda Drobney · March 1, 2020 Reply

    Dr.Gupta, Are you related to Manish Gupta, a transplant surgeon at OSF in Peoria, Il? We are so lucky to have him. He comes to PKD walks with his trick dog and plays football with the kids. I especially like him because he tells you everything. I have a kidney transplant for 19yrs.I inherited PKD from my father who died at 38 with a cerebral aneurysm. I had lots of infections and 3 cyst drainage operations. I am blessed.

  11. Bhupendra Jangir · March 21, 2020 Reply

    Hlo Dr. Gupta Ji.
    My wife has diagnosed with overactive immune system in a test ANA. The reading is 134.5 and the normal range is <30. She has general weakness and is loosing her eyebrows hairs. Plz solve her problems.

  12. Vishant · March 29, 2020 Reply

    Why is it necessary to stay hungry before taking immunosuppressants?

  13. World Fertility Services · June 21, 2022 Reply

    Thanks for sharing this informative site and articles and good knowledge…

  14. Ritika Dubey · February 26, 2023 Reply

    Is the side effects of immunosuppression reversible?

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