Re: Post Liver Transplant X14 months.

[Guest guest]

It can be difficult to remember to take meds post transplant. You have

to take them regularly just when you're starting to get involved in life

again. The solution I've found is to set an alarm in my cell phone to

remind me, and to carry an extra dose of meds with my on my keychain

(they sell little water resistant pill bottles for this). That way, if

I forget, I'll be reminded, and be able to take my meds even if I forgot

to bring them with me. So far I've only missed about four doses since

my transplant a year and a half ago.

I also use a pill organizer so I only have to pull all the pill bottles

out once a week. Being able to just grab my pills quickly makes me much

more likely to actually take them!

As far as how long you can go without taking meds before it causes

problems, I think it's unlikely that missing a single dose every once in

a while will cause a problem, but remember that some people end up with

rejection even when they don't forget meds, so any lowering of immune

suppression makes that more of a risk.

athan

[Guest guest]

>

> My 18 year old son had his transplant 07/04/07 after being diagnosed

> with PSC in 2005. He is now off to college and I am worried that he

> will get distracted and forget to take his meds. ... Any

> feedback??? Reassurance????

It is important to get into a schedule where missing a dose is

unlikely, e.g. if I try to take my meds at 9 am & pm I often find I am

absorbed with something and time flys by sometimes to the point of

early morning or missing a dose. But if I take my meds when I wake up

and before the evening meal, I get them down as certainly as I go to

the bathroom and want to eat. Although we are conditioned after our

transplants to take meds every 12 hours, and some (parents especially

I believe) take this as a sacred time period, attempting to hold to it

to the minute, this is hardly necessary with drugs like Prograf which

have relatively long half-lives (48 hours in the case of Prograf

(tacrolimus)). I wouldn't worry about timing even if I were getting up

at noon and eating dinner at 5 pm. I do worry about totally missed

doses. As athan said rejection can occur even when on a regular

schedule. So it is important to keep up a regular intake and regular

testing to make sure everything is stable and remains that way.

As reassurance, a single missed dose won't change blood levels much.

" When the patient is taking a medication on a regular basis, there is

an ongoing process of drug absorption in the form of each dose of the

drug and, concurrently, an ongoing process of drug removal with the

drug's metabolism and clearance. Eventually, there comes a point when

the amount of drug going in is the same as the amount of drug getting

taken out. We call this " steady state. " It takes somewhere between 5

and 6 half-lives for a medication to reach steady state. Thus,

medications with short half-lives reach steady state relatively

quickly, while those with long half-lives take a long time to reach

steady state. " (http://www.medscape.com/viewarticle/448250_3). Thus it

takes about 10 days to reach steady state levels of Prograf. A missed

dose will thus cause a drop of about 5%, but it takes over a week to

build back up to the full levels desired.

Tim R, ltx 4/4/98, 6/18/07 & 7/7/07

[Guest guest]

>

> It can be difficult to remember to take meds post transplant. You have

> to take them regularly just when you're starting to get involved in

life

> again. The solution I've found is to set an alarm in my cell phone to

> remind me, and to carry an extra dose of meds with my on my keychain

> (they sell little water resistant pill bottles for this). That way, if

> I forget, I'll be reminded, and be able to take my meds even if I

forgot

> to bring them with me. So far I've only missed about four doses since

> my transplant a year and a half ago.

>

> I also use a pill organizer so I only have to pull all the pill bottles

> out once a week. Being able to just grab my pills quickly makes me

much

> more likely to actually take them!

>

> As far as how long you can go without taking meds before it causes

> problems, I think it's unlikely that missing a single dose every

once in

> a while will cause a problem, but remember that some people end up with

> rejection even when they don't forget meds, so any lowering of immune

> suppression makes that more of a risk.

>

> athan

> Thank you for the feedback, I already have him doing all of the

above suggestions you have made, down to the little pill capsule to

keep the meds with him. I am just being a neurotic Mom. He is a very

responsible kid. It is just so hard after going through 3 years of

constant worry to find yourself in a situation that you can no longer

closely oversee. I have to trust him to do the right thing...

Rita

[Guest guest]

> >

> > My 18 year old son had his transplant 07/04/07 after being diagnosed

> > with PSC in 2005. He is now off to college and I am worried that he

> > will get distracted and forget to take his meds. ... Any

> > feedback??? Reassurance????

>

> It is important to get into a schedule where missing a dose is

> unlikely, e.g. if I try to take my meds at 9 am & pm I often find I am

> absorbed with something and time flys by sometimes to the point of

> early morning or missing a dose. But if I take my meds when I wake up

> and before the evening meal, I get them down as certainly as I go to

> the bathroom and want to eat. Although we are conditioned after our

> transplants to take meds every 12 hours, and some (parents especially

> I believe) take this as a sacred time period, attempting to hold to it

> to the minute, this is hardly necessary with drugs like Prograf which

> have relatively long half-lives (48 hours in the case of Prograf

> (tacrolimus)). I wouldn't worry about timing even if I were getting up

> at noon and eating dinner at 5 pm. I do worry about totally missed

> doses. As athan said rejection can occur even when on a regular

> schedule. So it is important to keep up a regular intake and regular

> testing to make sure everything is stable and remains that way.

Thank you, your explanation of half-life is helpful. I was thinking it

would take a while to deplete it from the system.I will check out the

link you enclosed as well.

Rita

>

> As reassurance, a single missed dose won't change blood levels much.

> " When the patient is taking a medication on a regular basis, there is

> an ongoing process of drug absorption in the form of each dose of the

> drug and, concurrently, an ongoing process of drug removal with the

> drug's metabolism and clearance. Eventually, there comes a point when

> the amount of drug going in is the same as the amount of drug getting

> taken out. We call this " steady state. " It takes somewhere between 5

> and 6 half-lives for a medication to reach steady state. Thus,

> medications with short half-lives reach steady state relatively

> quickly, while those with long half-lives take a long time to reach

> steady state. " (http://www.medscape.com/viewarticle/448250_3). Thus it

> takes about 10 days to reach steady state levels of Prograf. A missed

> dose will thus cause a drop of about 5%, but it takes over a week to

> build back up to the full levels desired.

>

> Tim R, ltx 4/4/98, 6/18/07 & 7/7/07

>