The need to take medications does not end with your transplant. After transplantation a number of drugs will be prescribed to prevent rejection or help you avoid or treat infections. Certain medications prescribed to prevent complications after a transplant can affect behavior or emotions. This article aims to make transplant patients and family members aware of medications that may contribute to a mood or behavior change. It is important to emphasize that most of these types of symptoms are from causes other than medications, such as infection, recent surgery, or lack of sleep.
Patients may receive medications to prevent or treat rejection that can affect behavior. These include corticosteroids such as Methylprednisolone (Solo-Merol ®) or Prednisone (Deltasone ®); Tacrolimus (Prograf ® ), or Cyclosporine (Sandimmune®, Neoral®, Gengraf®), and Muromonab-CD3 (Orthoclone ® OKT3).
Of these, the most frequent psychological side-effects are seen as a result of taking corticosteroids and include making you more emotional in what are called “mood swings.” Patients may have a feeling of euphoria, which is an exaggerated feeling of happiness; then, they may shift to feelings of sadness or irritability. Patients may experience hallucinations where they may see or hear new or unusual things that are not there, feel unusual sensations, or smell unusual things. They may also feel paranoia or fearful. High doses of corticosteroids can cause depression and mania. Signs of depression include difficulty sleeping or concentrating, decreased or increased appetite, decreased interest in previously enjoyable activities, or feelings of sadness or self worth. Patients may have manic type reactions, where their thoughts rapidly change, they experience euphoria, or they seem more physically active than usual. The effects described above generally occur within the first two weeks of therapy. Mild symptoms may disappear within 2-3 days without discontinuing the medication. For more severe symptoms, your physician may decrease the dose of your cotricosteroids. If the corticosteroid cannot be reduced or stopped, you physician may give an additional medication to control more severe symptoms. Tacrolimus and Cyclosporine can cause emotional and psychological side effects like anxiety and depression as well, but these are generally managed by adjusting the dosage.
Patients may be given antibiotics or antiviral drugs to prevent or treat infections following their transplant. Antibiotics commonly prescribed that can affect behavior include Cotrimoxazole, Dapsone, Ciprofloxican, Ganciclovir, and Acyclovir. In general, these side effects are rare and can be treated when recognized by switching to another antibiotic or antiviral drug.
Metoclopramide (Reglan®) is commonly given to diabetic patients to improve digestion and prevent nausea, vomiting, and abdominal pain. Metoclopramide has been reported to cause depression. Patients may have episodes of crying for no reason, suicidal thoughts, or may appear disinterested in their jobs or activities. The behavioral effects of Metoclopramide appear to be dose-related. To manage the depressive side effects, the physician can reduce the does and then gradually increase the dose over 1-2 months. If the does is increased slowly, patients are less likely to experience depressive symptoms.
Most of the medications listed here are given to patients at home. It is important that patients and family members be aware of the medications that can contribute to behavioral changes. However, it is important to stress that patients should not stop taking a medication on their own if they suspect it is contributing to a change in behavior or mood. This could increase the risk for infection or rejection. The patient should contact either the transplant coordinator’s office or their physician for further instruction. While the patient is in the process of contacting the doctor, there are some things he or she and the family can do to help ease the situation:
Instructions for family members
• Provide calm, consistent surroundings
• Avoid going places with lots of noise, people and activity
• Minimize the number of caregivers
• Remind the patient of where they are.
Instructions for the patient
• Take part in activities that make you feel better
• Do not withdraw from others; talk to your family and friends
• Eat healthy, well-balanced meals
• Avoid drinking alcohol or using illegal drugs
• Exercise several times a week
• Get enough rest and keep a regular sleep pattern
And remember
• Take your medication as prescribed
• Be aware of side effects of your medications and tell your doctor about any problems
• Tell your doctor or pharmacist if you are taking any other medications including store-bought medications
• Do not take anything without first checking with your doctor
• Do not stop taking medications on your own without discussing it with your doctor
-Laura Lees, PharmaD., Pharmacist, 410-955-6460, and David Edwin, Ph.D., Psychologist, 410-955-3268
Bridges 2001
