Immunosuppressants: What are they? Types, Classes, Uses, Side Effects and Interactions

They are medications that decrease the body’s ability to reject a transplanted organ.

Another term for these drugs is anti-rejection drugs.

Types of immunosuppressants

Induction medicines:

Powerful anti-rejection medication used at the time of transplant.

Maintenance medications:

Anti-rejection drugs are used in the long term.

Think of a real estate mortgage, the down payment is like the induction medication, and the monthly payments are like maintenance medications. If the down payment is good enough, you can reduce the monthly costs and immunosuppression.

There are usually four kinds of maintenance medications:

  • Calcineurin inhibitors: tacrolimus and cyclosporin.
  • Agents have antiproliferative properties: micofenolato de mofetilo, micofenolato sódico y azathioprine.
  • Inhibidor de mTOR: Sirolimus.
  • Steroids: Prednisone .


When you undergo a kidney transplant, your body knows that the new kidney is foreign (that is, it is not originally part of your body).

Your body will attack the new kidney and try to damage or destroy it. Immunosuppressive medications suppress your body’s ability to do this. The goal is to adjust these medications to avoid rejection and minimize the side effects of drugs.


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

Almost all transplant recipients should take these medications every day as directed. However, if your new kidney comes from an identical twin, you may not have to accept them.

Even losing a single dose can make it more likely to have rejection.

The only time you should skip a dose is if your doctor or another member of the health care team tells you to do so. If you are not sure, call your doctor. Also, when you have a visit to the clinic, you should not take your immunosuppressant medications until your blood is drawn for laboratory work.

Because of the many pills you may need to take each day, it is easy to forget a dose. You can do three things to remember your medication:

Know the name of each medication you take and what you do. If you understand your medications well, you are less likely to forget one.

Use a pillbox or organizer. This allows you to set up a whole week of pills. Once the week is set, all you have to do is take the drugs 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?

Please take it as soon as you remember it and call your doctor. Do not take a double dose if it is time for the next dose.

Are there any signs or symptoms that I should observe?

Yes. Even if you take your medications every day, you can still develop kidney transplant rejection. You need to know your body very well. If you have any of the following symptoms, you should call your transplant center immediately:

  • A drop in your urine production.
  • A fever of more than 100 degrees.
  • Urine with blood.
  • Symptoms similar to the flu.
  • Weight gain (more than 3 pounds in two days).

The transplant center will probably ask you to do some blood tests and maybe other tests. The long-term success of your kidney transplant depends to a large extent on careful follow-up and a good working relationship between you and your transplant team.

Side effects

One of the side effects of these medications is a greater chance of infections. This is more of a problem in the initial period after the transplant or after the treatment of rejection because the dose of these medications is higher at this time.

The most common side effects of immunosuppressant medications are “upset stomach.” If this happens, ask your doctor if you can space your medicines at different times to help with this problem.

Approximately six months to one year after transplantation, immunosuppression is usually reduced, and the possibility of side effects must be below. If you still have side effects, talk with your transplant team to change the dose or change to a different medication.

Changes in immunosuppressant medications should only be made after consultation with your transplant center.


Many other medications, foods, and supplements can change the levels (up or down) of immunosuppressants in the blood.

Some of the most common are grapefruit juice, St. John’s wort, erythromycin, anti-tuberculosis drugs (TB), anti-seizure medications, and common medications for blood pressure (Cardizem or diltiazem and verapamil ).