Immunosuppressants: Classes, Uses, Side Effects and Guidelines

Immunosuppressants are medicines that lower or suppress the activity of the body’s immune system. After an organ transplant, such as a heart, kidney or liver transplant, they help keep the immune system from rejecting the new organ. That is why they are also known as anti-rejection drugs.

These drugs are also used for autoimmune diseases, in which the body’s immune system attacks its own healthy tissue. Common examples are lupus (SLE), rheumatoid arthritis and psoriasis. In these conditions, immunosuppressants calm an overactive immune response.

Because these medicines weaken the immune system, they raise the risk of infections. If your doctor prescribes an immunosuppressant, it helps to know what the drug does, how it works, and what side effects to watch for.

Types of Immunosuppressants

In transplant medicine, immunosuppressants are often grouped into two main types.

1- Induction Drugs

These are powerful anti-rejection drugs given around the time of the transplant. As the name suggests, they are used to "induce" strong immune suppression when the organ is first transplanted.

2- Maintenance Drugs

After the induction phase, anti-rejection drugs are taken long term to keep the immune system from attacking the transplanted organ.

Common classes of maintenance drugs include

• Calcineurin Inhibitors (such as tacrolimus and cyclosporine)
• Antiproliferative agents (such as mycophenolate)
• mTOR inhibitor (such as sirolimus)
• Steroids (such as prednisone)

Other immunosuppressants used for autoimmune diseases include biologics (such as adalimumab and infliximab) and Janus kinase (JAK) inhibitors.

The dose and type of immunosuppressant vary from patient to patient and transplant to transplant, depending on the condition being treated, its severity, and other health problems.

What do The Immunosuppressants treat?

Autoimmune Diseases

Cleveland Clinic lists many autoimmune diseases treated with immunosuppressants, such as

• psoriasis
• lupus
• rheumatoid arthritis
• Crohn’s disease
• multiple sclerosis
• alopecia areata

In an autoimmune disease, the immune system attacks the body’s own tissue. Immunosuppressants lower the activity of the immune system, which reduces this reaction and helps ease the signs and symptoms of the disease.

Organ Transplant

People who receive an organ transplant, such as a heart, kidney or liver, need immunosuppressants. The immune system sees the new organ as foreign and starts to attack it. This transplant rejection can damage the organ and may even lead to losing it.

Immunosuppressants weaken this immune response, which allows the transplanted organ to stay healthy in the body. They are also used after stem cell (bone marrow) transplants.

What Are The Common Side Effects Of Immunosuppressants?

Side effects depend on the specific drug and dose, and not everyone gets them. The most important risk is infection, because these medicines weaken the immune system. Some drugs act broadly on the immune system, which can also lower the body's defense against some cancers over time.

Other possible side effects, depending on the drug, include

• Moon face (with steroids)
• hypertension
• Peptic ulcer
• Fever
• bloody urine
• flu-like feelings
• weight gain
• dyslipidemia
• GIT disturbance
• hyperglycemia
• lipodystrophy
• liver injury
• kidney injury.

Many immunosuppressive drugs also interact with other medicines and affect how they work. Always tell your doctor and pharmacist about every medicine and supplement you take. Some immunosuppressants can also cause birth defects, so talk to your doctor before trying to conceive.

If A Dose Is Missed, What Should Be Done?

Take these medicines exactly as prescribed. Skipping doses can trigger an autoimmune flare-up or raise the risk of transplant rejection.

If you miss a dose, call your doctor or transplant team for advice. Do not take a double dose unless they tell you to.

What to Avoid While On Immunosuppressants? – The Basic Food Guidelines to Follow

Immunosuppressant drugs weaken your body’s immune system, so the body becomes more vulnerable to foodborne illness. That is why food safety matters during treatment. Your doctor or transplant team will give you guidelines.

The FDA advises people with weakened immune systems, including transplant patients, to follow food safety rules like these:

• Wash fresh fruits and vegetables before peeling
• Avoid raw or undercooked eggs, meat, poultry, fish and seafood.
• Avoid unpasteurized (raw) milk, cheese made from raw milk, and unpasteurized fruit or vegetable juices.
• Cook eggs thoroughly, and avoid foods that contain raw eggs, such as some homemade mayonnaise and dressings and raw cookie dough.
• Avoid raw sprouts, such as alfalfa and bean sprouts.
• Ask your care team whether you need to boil well water or avoid buffets and salad bars.

These precautions lower the risk of infection while you take immunosuppressants. Ask your doctor for any special instructions for your situation.

HP Thoughts: Did you know that immunosuppressants could be used to treat a particular type of skin disease? Find out what this is: Systemic Lupus.

Sources

• Immunosuppressants, Cleveland Clinic
• People at Risk of Foodborne Illness, U.S. Food and Drug Administration