List of organ transplant medications

The organ transplant is basically a surgical operation through which a failing or damaged organ in the human body can be removed and replaced with the functioning one. The donated organ can be from a deceased Or living donor. In a few cases an artificial organ can be used.

Azathioprine:

Azathioprine is recommended in order to prevent the rejections of liver Or kidney allografts, basically in conjunction with the other therapies including the corticosteroids, immunosuppressants, and local radiation therapy. The administration protocol initiated either at about the time of the transplantation or within the following a couple of days. 

Note: A few other indications of azathioprine are: Rheumatoid Arthritis & Inflammatory Bowel Disease. 

Dose: The dose of Azathioprine is needed in order to prevent as well as resist the rejection and to reduce/minimize the toxicity would vary with the individual patients; this required careful management. The starting dose is 3 to 5 mg/kg per day, beginning at about the time of the transplant. This drug should be given as a single daily dose on the day of, and in less cases 1-3 days prior to transplantation. Azathioprine dose must not be boosted to toxic levels just because of the threatened rejection.

When to Take: Taking the medication twice daily instead of all at once, or taking it after eating, may help avoid these problems.

Missed Dose: If you forgot to consume a dose, catch it immediately if you remember. But, don’t take a couple of doses at one time without informing a transplant office. 

Precautions: Patients who are on azathioprine 50 mg tablet should have complete blood counts, including counts of platelet, weekly during initial month, two times in a month for the 2'nd and 3'rd months of the treatment.

Common Side Effects: The most common adverse effects of this drug (azathioprine) are stomach, liver intestines, and pancreas and the blood cells.

Sirolimus:

Sirolimus is mainly a prescription drug used in order to prevent the rejection (anti-rejection medicine) in patients 13 years of age and those who are older or who have taken a kidney transplant. 

Sirolimus is mainly used with the other drugs called cyclosporine (Gengraf, Sandimmune), and corticosteroids.

Note: Sirolimus, a prescription medicine also used to treat lymphangioleiomyomatosis (LAM). LAM is a quite rare progressive disease of the lung that mainly affects the predominantly women of the childbearing age.

Dose: Sirolimus tablets are available in 1 mg and 2 mg strength. This is a once per day dosing schedule. The dose should be adjusted according to the values of the laboratory. It is important to have a lab drawn 24 hours after your last dose prior to your next dose. Liquid comes as 1 mg/mL and must be mixed with the orange juice or with water in a glass of water or in a plastic container.

When to Take: If you also consume Cyclosporine (Neoral or Gengraf) as the other immunosuppressant drug, you must consume the Sirolimus 1 mg at about four hours after the dose of Cyclosporine as these drugs must not be consumed at the same time. 

If you consume Tacrolimus it is alright in order to consume Sirolimus at about the same time. 

Missed Dose: If you missed any specific dose, make it up immediately. But avoid the consumption of two doses at about one time. 

Precautions: Please communicate with the transplant team prior to considering becoming pregnant.

It is recommended that mothers do not breastfeed when taking this medication.

Common Side Effects: Some side effects of this drug (Sirolimus) are:

• changes in blood counts
• anemia (low red blood counts)
• low platelets
• low white blood cells
• Other side effects may include:
• Mouth sores
• Rash
• Poor wound healing
• Headaches
• Diarrhea
• Tremors
• Swelling
• Kidney damage

Everolimus: 

Everolimus is a mTOR inhibitor immunosuppressant indicated for the prophylaxis of organ rejection in adult patients: 

Kidney transplant: at low-moderate immunologic risk. Use in combination with basiliximab, cyclosporine (reduced doses), and corticosteroids.

Liver transplant: recommended no earlier than one month post-transplant. Should be used together with the tacrolimus (decreased doses) and corticosteroids.

Dose:

Kidney transplantation: initial dose should be of 0.75 mg two times daily as soon after the transplantation.

Liver transplantation: initial oral dose of 1.0 mg twice daily starting 30 days after transplantation. 

When to Take: This drug should be taken about twice daily for the initial one month. 

Missed Dose: If you missed any dose, catch it immediately. But, don’t consume two doses.

Precautions:

• Inform your healthcare provider if you are suffering with the frequent urination, hunger or increased thirst.
• Inform your healthcare provider right away if you have a new or worsening cough, shortness of breath, difficulty breathing or wheezing. 
• Do not interrupt taking your dose of cyclosporine or tacrolimus unless your doctor instructed you to.
• Your doctor will do regular blood tests to check your kidney function while you take everolimus tablets. It is necessary that you should get these tests done when your healthcare provider instructs you to. Blood tests should be monitored about how your kidneys are functioning and help in making sure that you are taking the appropriate dose  and other transplant medicines they may be on (cyclosporine and tacrolimus). 
• Patients must be informed that the use of the everolimus may be responsible for the fluid accumulation, impaired or delayed wound healing, and required for the careful observation of the site of incision. 

Common Side Effects:

Kidney transplantation: 

• hypertension
• peripheral edema
• nausea
• anemia
• UTI
• constipation
• hyperlipidemia.

Liver transplantation:

• diarrhea
• headache
• peripheral edema
• hypertension
• nausea
• pyrexia
• abdominal pain
• leukopenia
• hypercholesterolemia.

Mycophenolate mofetil: 

Mycophenolate is an immunosuppressant medication that helps prevent rejection. This drug is mainly recommended for use after the heart, kidney, and liver transplant. 

Myfortic is an enteric-coated form of Mycophenolate that can have less stomach and bowel side effects.

Note: Apart from organ transplant, it can also be used in the treatment of:

• Crohn's disease
• Behçet's disease
• pemphigus vulgaris
• immunoglobulin A nephropathy
• small vessel vasculitis
• psoriasis
• retroperitoneal fibrosis

Dose: Mycophenolic acid is available in 250 mg strength and 500 mg tablets. Note that these tablets also come in the strength of 500 mg, but the strength of 250 mg will be easier in order to make the change in dosage. 

Myfortic basically exists in 180 mg as well as 360 mg tablets. Liquid comes in a form of 200 mg/ml strength. Be sure to check the bottle you get from your pharmacy to make sure you have the right dose. Avoid crushed or chewed Myfortic tablets.

When to Take: 

AM Dose: consume with morning breakfast (usually around 9am).

PM Dose: after 12 hours of your AM dose (usually around 9pm).

Missed Dose: If you have not taken a dose, take it immediately. But, never consume a couple of doses at about one time. 

Precautions: Antacids like Maalox and Mylanta may decrease Mycophenolate absorption. You must not consume these while on the Mycophenolate 500 mg. We do suggest that you should continue consuming drugs such as Pantoprazole (Protonix), Lansoprazole (Prevacid) or Omeprazole (Prilosec) etc. while you consume Mycophenolate. You should not take Mycophenolate (Cellcept or Myfortic) for at least 3 months before conceiving children, so check with the transplant office if you are considering adding to your family.

Common Side Effects:

• decreased white blood count
• diarrhea
• abdominal pain
• ulcers
• inflammation of the pancreas

Tacrolimus: 

Tacrolimus is an immunosuppressant medication that helps following the allogeneic organ transplant in order to lower the risk of organ rejection.

It is also recommended for the severe refractory uveitis following the transplantation of bone marrow. 

Note: Other indications of this drug are as follows:

• Eczema
• Ulcerative colitis
• Lupus Nephritis
• Segmental vitiligo
• Kimura's disease

Dose: The tablets exist as strength of 0.5 mg, 1 mg, and 5 mg; liquid is 0.5 mg/ml. The liquid should be specially prepared by the pharmacist. The dose should be adjusted by the laboratory values. It is quite necessary to have labs drawn 12 hours after the last dose of Tacrolimus and prior to consumption of your morning drugs for precise adjustment of this drug.

When to Take:

AM Dose: consume with breakfast after the completion of your lab work (usually around 9am).

PM Dose: after 12 hours your AM dose (usually around 9pm).

Missed Dose: If you forget to consume a dose, consume it immediately.

Precautions: Tacrolimus capsules (Prograf) can be altered by some medications. Prior to the consumption of the maiden drugs including over the counter drug and drugs prescribed by your healthcare provider please contact the transplant office. It is recommended that mothers do not breastfeed when taking this medication. You must avoid the grapefruit as well as grapefruit juice.

Common Side Effects: The common adverse reactions of Tacrolimus are:

• Headaches
• Diarrhea
• Seizures
• High blood pressure
• Tremors
• Rash
• Mental status changes
• Decreased magnesium
• Insomnia
• High blood sugar
• Anemia
• High potassium
• Nausea/vomiting
• Decreased kidney function
• Decreased appetite
• Leg cramps
• Hair Loss

Antithymocyte Globulin 

It is an immunosuppressant agent used in combination with other medications for the treatment of the body from kidney transplant rejection.

Note: It is also effectively used in the treatment of aplastic anemia.

Dose: It is available in an injectable solution of 50mg/mL vial. 

This drug is injected intravenously.

Missed Dose: Take the medication as soon as you can. Do not consume two doses, as it can cause an excess dose.

Precautions: 

Hypertension, thrombocytopenia, avoid the live vaccines, and avoid pregnancy during this drug uptake.

Common Side Effects: Some common adverse effects include:

• Rash
• Leukopenia
• Fever
• Thrombocytopenia
• Chills
• Pain at the infusion site
• Dermatologic reactions
• Diarrhea
• Nausea
• Night sweats
• Systemic infection
• Hypotension.

Cyclosporine: 

Cyclosporine is an immunosuppressant medication that helps in the treatment and prevention of the graft-versus-host disease in transplantation of bone marrow and in the prevention of the rejection of heart, kidney, and liver transplants.

Note: Other uses are as following:

• rheumatoid arthritis and psoriasis
• persistent nummular keratitis after the adenoviral keratoconjunctivitis
• meibomian gland dysfunction
• severe atopic dermatitis
• Kimura disease
• pyoderma gangrenosum
• chronic hives
• acute systemic mastocytosis
• posterior or intermediate uveitis

Dose: Cyclosporine drug is available in 25 mg and also strength of 100 mg; liquid is 100 mg/ml. Never combine the sorts of cyclosporine you consume. 

Contact the transplant healthcare professional team for any questions. The dose should be adjusted by your laboratory values. It is very crucial to have patient labs drawn about 12 hours after the last dose of Cyclosporine and prior to the consumption of your morning drugs for appropriate adjustment of this drug.

When to Take: 

AM Dose: take this drug with your breakfast after the completion of your lab work (usually around 9am).

PM Dose: 12 hours later your AM dose (Usually around 9pm).

For patients who are children should take these medications 3 times a day, the additional dose must be consumed at noon with lunch.

Missed Dose: If you forget to eat your dose, make it as soon as you can. But, never eat two doses back to back without informing your doctor.

Precautions: Cyclosporine can be altered by some medications. Prior to consumption of any maiden drugs such as over the counter, medications prescribed by your doctor please communicate to the transplant office. It is recommended that mothers do not breastfeed when taking this medication. Grapefruits as well as grapefruit juice may interfere with the level of cyclosporine. You should not take grapefruit as well as grapefruit juice.

Common Side Effects:

• Headaches
• Loss of Appetite
• Tremors
• Diarrhea
• Seizures
• Nausea/vomiting
• Nightmares
• Rash
• Memory loss
• Hair growth
• Fluid retention
• Gum swelling
• Decreased kidney function
• Increased risk of infection
• Elevated potassium levels
• Joint discomfort
• High blood pressure
• Leg cramps
• Hot flashes

Valganciclovir: 

Prevents or treats viral infections such as CMV, cold sores, herpes zoster, and chicken pox.

Valganciclovir is recommended in order to prevent CMV disease in patients after a kidney transplant (120 days to sixteen years of age) and heart transplant (30 days to sixteen years of the age) at a high risk. 

Valganciclovir also can be used in order to prevent the cytomegalovirus disease in those patients who are with the kidney, kidney-pancreas or heart transplant and are at the risk of catching CMV disease. 

Dose & When To Take: Valganciclovir is available in 450 mg tablets. The dose for adults is 900 mg, should be taken per day for the initial 3-4 months after the transplant but depends on the function of the kidney. Acyclovir exists in 200 mg capsules, 800 mg tablets or in the form of liquid  (200 mg/5 ml). The dose of adults is usually 800 mg four times in a day for 3-4 months after the transplant. Dose for children’s is directly based on the body weight. 

Adults are generally treated for the 90 days after the transplant. 

Children are basically treated for 4-6 months after the transplant.

Missed Dose: Take as soon as you remember. Never double dose.

Side Effects:

• May include decreased white count. 
• Dosage can be reduced for people who are with kidney problems.

Darbepoetin:

Darbepoetin alpha is a hyperglycosylated erythropoiesis-stimulating protein, produced by recombinant DNA technology. It is recommended for treating anemia because of chronic renal failure, including patients on dialysis and not on dialysis. 

Dose: The recommended starting dose of darbepoetin for the correction of anemia in patients with chronic renal failure is 0.45 mcg/kg administered as a single IV or subcutaneous injection once weekly. 

When To Take: Darbepoetin is recommended as a subcutaneous injection once weekly. 

Missed Dose: In missed dose circumstances, report to your healthcare provider. Do not consume back to back doses in order to catch up for a missed dose. 

Precautions: After the initiation of therapy of darbepoetin, the hemoglobin must be followed once in a week until the stabilization and should be monitored at once in a month thereafter. 

Probable Side Effects: The most common adverse effects are:

• Nausea
• Congestive heart failure
• cardiac arrhythmia, 
• hypertension
• hypotension
• Sepsis
• headache
• Myalgia
• Diarrhea
• Vascular access thrombosis

Ganciclovir: 

Cymevene is used for the treatment of cytomegalovirus infections in people whose immune system is not working properly. These include people who have AIDS, people who have received organ transplants or people who are having chemotherapy. It is also used to prevent cytomegalovirus disease in people who are at risk of getting this infection. Cymevene functions by resisting the growth as well as spread of the virus.

List of Surgery for Prostate Cancer

The radical prostatectomy, basically a process for removal of the entire prostate gland, the seminal vesicles, and the vas deferens, is performed for malignant cancer. There are various ways through which radical prostatectomy surgery can be performed. Surgery for prostate cancer treatment involves removing the prostate gland, surrounding tissue, and a few lymph nodes. The entire prostate gland must be removed in order to make sure cancer cells aren’t left behind. This procedure is known as radical prostatectomy or “RP.”

Robotic-Assisted Laparoscopic Radical Prostatectomy: 

With the help of a robotic system (a mechanical device) that basically holds the surgical tools as well as camera. The prostate gland is removed through several 1- or 2-inch incisions into your belly. The success rate of this surgery generally depends upon how experienced your surgeon is. The more surgeries your doctor has done, the better he/she will be at performing this surgery.

Laparoscopic Radical Prostatectomy: 

Your surgeon will make six 1-inch cuts in your belly. Surgical tools and a small video camera fit through the incisions in order to remove your prostate.

Radical Retropubic Prostatectomy (Open): 

Your healthcare provider will make a cut in your lower belly for removing your prostate. This kind of surgery allows your healthcare provider in order to access the prostate gland and surrounding tissue at the same time, while reducing injury to other nearby organs.

Transurethral resection of the prostate: 

This is the standard surgical treatment for benign enlargement of the prostate.
This surgical procedure is used in order to relieve symptoms of urinary retention caused by the large prostate tumor, but it is not used in order to treat the cancer itself. Transurethral resection is done under spinal anesthesia, a kind of resectoscope is inserted inside the penis and the extra prostatic tissue is cut for clearing the way in order to pass the urine.

What can I expect after surgery:

As a patient you can expect to stay in the hospital for a few days after the surgery. You will return home with a catheter. Your doctor removes it at your first office visit, usually from 1 to 2 weeks after the surgery. In the case of confined prostate cancer, your doctor will go through with a screening test in order to check your PSA (prostate-specific antigen) level every 6 to 12 months. If your cancer has spread, your healthcare provider can recommend additional therapies, such as hormone therapy or radiation therapy.

When is surgery the best treatment:

Discuss with your healthcare provider as well as your family in order to find out appropriate treatment. But before making a decision you must consider the following:

• Your cancer stage and grade: Surgery is effective for prostate cancer stages T1 or T2 (cancer confined to the prostate) and sometimes stage T3 (cancer has spread outside the prostate). 
• Your overall health and age: Surgery is more suitable to those men who are healthy enough in order to handle the major operation and likely to live ten years or more. 
• Your intent: Some men with prostate cancer out there positively want their cancer completely removed. Others usually concerns about the several side effects from their treatment may affect their quality of life.

What are the side effects of surgery: 

Your side effects may be based on your health and age, and the type of the surgery you choose. But you may deal with:

• Erectile dysfunction: In some cases, erections can be recovered in about 24 months or sometimes longer. In case of not any effect, medicines, devices or surgery may help. Your healthcare provider can also prescribe drugs and devices during recovery in order to help bring back the erection function.
• Bladder problems (incontinence): Trouble controlling your urine is often temporary, but can last 6 to 12 months. You could also develop bladder irritation or infection, urine leakage, and blockage of the urine flow.                                                                                                  Physical therapy can improve bladder control.
• Changes in the shape of penis: There are chances of having a curve or a slight shortening of the length of the penis.
• Bleeding: A patient can be instructed in order to donate their own blood prior to the surgery or take a hormone in order to boost the blood count.
• Blood clots in the leg or pelvic veins: This occurs in a very small group of patients.
• Infertility: After surgery, a patient may no longer be a father through sexual intercourse. If this situation, discuss with your healthcare provider about alternate options, like artificial insemination.

Note: Apart from surgery, there are various FDA approved prostate cancer medications that are popular amongst the doctors in order to treat prostate cancer. These medications are as follows:

• Abiraterone Acetate: This medication (abiraterone 250 mg) is combined with other corticosteroids for the treatment of metastatic high-risk Castration sensitive prostate cancer and metastatic castration-resistant prostate cancer.  Abiraterone belongs to an antineoplastic class of drugs and is available in tablet form.

• Apalutamide: It is a non-steroidal anti-androgen medication used in the treatment of non-metastatic castration-resistant prostate cancer. It is consumed orally in the form of a tablet.

• Bicalutamide: This drug is an anti-androgen medication which is combined with gonadotropin-releasing hormone (GnRH) analog for the treatment of prostate cancer. It comes in a form of tablets.

• Cabazitaxel: It belongs to the microtubule inhibitor class drug used in the treatment of Castration resistant metastatic prostate cancer. This drug blocks the growth of cancerous cells by inhibiting its division.

• Casodex (Bicalutamide): It is an anti-androgen drug that is used for the treatment of prostate cancer it works by inhibiting the production of the male hormones and slowing down the growth of the cancerous cells. It is inhibited to be used in women or children.

• Darolutamide: It is a synthetic nonsteroidal androgen receptor (AR) commonly used in the treatment of non-metastatic castration-resistant prostate cancer. The highly recommended dosage of darolutamide is 300 mg available in tablet form.

• Degarelix: It is a hormonal therapy used in the treatment of advanced prostate cancer. It belongs to a group of the class called gonadotropin-releasing hormone (GnRH) receptor antagonists.

• Docetaxel: This drug is used in the treatment of prostate cancer, breast cancer, advanced stomach cancer, non-small cell lung cancer, pancreatic cancer, ovarian cancer, melanoma, soft tissue sarcoma, and head cancer. It is injected intravenously and the dose depends upon various factors such as age, weight, height, stage of cancer, and type of cancer.

• Eligard (Leuprolide Acetate): It is a palliative treatment of advanced prostate cancer. It is a prescribed drug that is injected intravenously.

• Enzalutamide: Enzalutamide 40 mg is a type of hormonal therapy used in the treatment of metastatic prostate cancer that has spread to other parts of the body.

• Erleada (Apalutamide): It belongs to a class of drugs known as anti-androgen which works by inhibiting the production of the male hormone. This drug is generally used in the case of Advanced prostate cancer.

• Firmagon (Degarelix):  it belongs to a hormonal therapy class drug that is used for the treatment of hormone-sensitive prostate cancer. It is a GnRH antagonist drug that has the ability to reduce serum testosterone.

• Flutamide: It is a nonsteroidal antiandrogen (NSAA) used in the treatment of androgen-dependent problems such as high androgen levels, excessive hair growth, and acne. It is consumed orally 3 times a day.

• Goserelin Acetate: This medication used to suppress the production of sex hormones (testosterone and estrogen), specifically for treating breast and prostate cancer.              Goserelin acetate should be administered by subcutaneous injection as an implant every 28 days for the duration of treatment. 

• Cabazitaxel: Cabazitaxel (Jevtana) is a semi-synthetic derivative of a natural taxoid. Jevtana together with the prednisone is recommended for treating hormone-refractory prostate cancer after treatment with docetaxel.

• Leuprolide Acetate: Leuprorelin (leuprolide acetate), is a manufactured version of a hormone used in order to treat prostate cancer. This drug should be given by injection into a muscle or under the skin. 

• Mitoxantrone Hydrochloride: Mitoxantrone (Novantrone) is basically an anthracenedione antineoplastic agent. Mitoxantrone together with the prednisone is approved as a second-line treatment for metastatic hormone-refractory prostate cancer.

• Nilutamide: Nilutamide, a NSAA drug (nonsteroidal antiandrogen drug) recommended for treating male patients with prostate cancer.                                                                      Nilutamide acts as the selective antagonist of the androgen receptor, in order to prevent the effects of androgens like testosterone and DHT (dihydrotestosterone) in the body. Because maximum prostate cancer cells rely on these hormones for growth and survival, nilutamide has the potential to slow down the progression of prostate cancer and extend the life in men with this disease. 

• Darolutamide: Darolutamide, an antiandrogen drug recommended for the treatment of male patients with the nmCRPC (non-metastatic castration-resistant prostate cancer). It is primarily approved in order to treat the non-metastatic castration-resistant prostate cancer (nmCRPC) in conjunction with the surgical or medical castration.

Note:- All the information given above is only for information purposes. Before taking any medication please consult with your Doctor.

Read:- Detailed on Prostate cancer medication 

How Tacrolimus is helpful in both Rheumatoid Arthritis and in Organ Transplant

Indication for Organ Transplant: 

Tacrolimus is a prescription medicine used with other medicines in order to help prevent organ rejection in people who have had a kidney, liver, or heart transplant and Tacrolimus shouldn't be used with medicines called cyclosporine.
It is not for use with a drug called sirolimus in people who have had a liver or heart transplants.
It is not known if it is safe and effective when used with sirolimus in people who have had kidney transplants.
It is not specified if this drug is safe and effective in children who have had a kidney or heart transplants.

It has identical immunosuppressive properties to the drug named ciclosporin, but it is kind of much more potent medication. Immunosuppression with the tacrolimus was associated with the significantly decreased rate of acute rejection compared with the ciclosporin based immunosuppression (30.7% vs 46.4%) according to the study. Clinical outcomes are better with the tacrolimus than with the ciclosporin during the initial year of the liver transplantation. It is generally prescribed as a part of the post-transplant cocktail including mycophenolate, steroids, and IL-2 receptor inhibitors such as basiliximab. Dosages are titrated in order to target blood levels.

How Does Tacrolimus be effective in Protecting the New Organ: 

The body’s immune system protects the body against anything that it does not recognize as part of the body.
For instance, when the immune system detects a virus or bacteria it tries to get rid of it to prevent infection.
When anyone has a kidney, liver, or heart transplant, their immune system is not able to identify the new organ as the part of their body and tries to get rid of it, too. This is known as rejection. It protect as well as prevents new organs by slowing down their body’s immune system.

Prevention of the organ rejection in the transplant recipients: 

In beginning the postoperative doses of tacrolimus should begin no sooner than the six hours after the liver as well as heart transplant and within 1 day of kidney transplant (but can be delayed until the renal function has recovered); titrate to target trough concentrations. Adjunctive therapy with the corticosteroids should be recommended in early post-transplant. I.V. route can only be used in those patients who are not able to receive oral medicines and continued till the oral medicines can be tolerated. In I.V. administration anaphylaxis has been reported. If switching from I.V. to oral, the oral dose must be initiated 8-12 hours after the stopping of infusion.


Dosage for Liver transplant:

Oral: Immediate release: Initial: 0.1 to 0.15 mg/kg per day in a couple of separated doses, should be given every 12 hours (titrate in order to target the concentrations)

I.V.: Initial: 0.03 to 0.05 mg/kg per day as the continuous infusion.

Dosage for heart transplant: 

Should be recommended in combination with the azathioprine or mycophenolate mofetil.

Oral: Immediate release: Initial: 0.075 mg/kg per day in a couple of separated doses, should be given every 12 hours.

I.V.: Initial: 0.01 mg/kg per day as the continuous infusion.

Dosage for a Kidney transplant: 

Should be used in combination with the azathioprine or mycophenolate mofetil:

Note: African-American patients may require larger doses in order to attain trough concentration.

Oral: Immediate release: Initial: 0.2-0.3 mg/kg/day in 2 divided doses, given every 12 hours in combination with corticosteroids and other immunosuppressive agents; titrate to target trough concentrations.

I.V.: Initial: 0.03 to 0.05 mg/kg per day as the continuous infusion.

Indication for Rheumatoid Arthritis:

Tacrolimus is indicated for the treatment of active rheumatoid arthritis in adult patients non-responsive to a disease-modifying antirheumatic drug (DMARD) therapy or when DMARD therapy is inappropriate.
"There are various medications of rheumatoid arthritis tacrolimus is one of them"

Dosage for Rheumatoid arthritis: (Canadian labeling) 

Oral: Immediate release: 3 mg once on the daily basis; patients must be carefully monitored for serum creatinine while on therapy.

Strength of Tacrolimus:
This medication comes as the strength of:

• Capsules: Tacrolimus 0.5 mg, Tacrolimus 1 mg and Tacrolimus 5 mg
• Tacrolimus Injection: 5 mg/mL
• Oral suspension: 1 mg, 0.2 mg unit-dose (granules). 

Important Information Regarding Tacrolimus:

• Instruct patients to take tacrolimus at the same time each day, as directed. 
• Never skip or take double doses in order to make up for the missed doses.
• Do not discontinue medication without the advice of health care professionals.
• Review symptoms of rejection for transplanted organs and stress need to notify your doctor immediately if they occur.
• Advise patients in order to avoid grapefruit or grapefruit juice and eating raw oysters or other shellfish; make sure they are fully cooked before eating.
• Patients should be instructed to wear protective clothing and sunscreen to avoid photosensitivity reactions.
• Patients must be advised to avoid exposure to chickenpox, measles, mumps, and rubella. If exposed, contact your healthcare provider for prophylactic therapy.
• Advise patients of the risk of taking tacrolimus 1 mg capsules during pregnancy.
• Patients must be informed about the risk of lymphoma with tacrolimus capsules therapy.
• Emphasize the importance of repeated lab tests while on the therapy of tacrolimus tablets. 

Read:- How capecitabine is helpful in breast cancer treatment

List of Effective medications for breast cancer treatment

Breast cancer is basically a cancer that arises in the tissues of the breast usually in the tubes that help in carrying milk to the nipple known as ducts or glands that make milk known as lobules. It occurs in both males and females, although in males it is rare. The main cause of breast cancer is unknown however it is believed to have a sudden mutation in the DNA of breast cells leading to abnormal division. 

Symptoms of breast cancer: 

Below mentioned are a few symptoms of breast cancer:

• Change in shape  of the breast
• Change in size of the breast
• A lump in the breast
• Dimpling of the skin
• Thickening in the breast tissue
• An inverted nipple
• Discharge from the nipple
• Rash on the nipple
• Swelling or a lump in the armpit
• Pain in the breast 
• Skin redness or thickening

You should meet your healthcare provider if you have any of the above mentioned symptoms. However, it is quite necessary to remember that such signs can also be caused by other conditions.

Breast Cancer Medication:

The treatment mainly depends on the tumour size, subtype, grade, and existence of the biomarkers, as well as your age and your general health. Several most effective breast cancer drugs are elaborated as follows:

1. Palbociclib: 

Palbociclib is an anticancer medicine. It works by blocking proteins called cyclin-dependent kinase 4 and 6, which regulate cell growth and division. Blocking or resisting these proteins may interrupt the growth of cancerous cells and delay the progression of cancer. Palbociclib 125 mg is used to treat women with certain types of breast cancer (hormone receptor-positive, human epidermal growth factor receptor 2-negative) which have spread beyond the original tumour and/or to other organs. Palbociclib capsules should be given together with aromatase inhibitors or fulvestrant, which are used as hormonal anticancer therapies.

Patients should avoid grapefruit and grapefruit juice while on this drug as it could increase the side effects of Ibrance.

It comes as the strength of 125 mg, 100 mg, and 75 mg capsule.

The most common side effects include neutropenia, fatigue, nausea, stomatitis, anemia, diarrhea, thrombocytopenia, rash, decreased appetite, asthenia, vomiting, infections, pyrexia, alopecia, and leukopenia.

2. Capecitabine:

It is basically a chemotherapy drug used for the treatment of breast cancer. For breast cancer treatment it is mainly used together with the docetaxel.
It can also be used in the treatment of colorectal cancer (either as neoadjuvant therapy with radiation, adjuvant therapy or for metastatic cases.

The common adverse effects include abdominal pain, vomiting, diarrhea, weakness, and rashes. Other severe side effects may occur such as blood clotting problems, allergic reactions, heart problems such as cardiomyopathy, and low blood cell counts.

It comes in the strength of:

• Capecitabine 150 mg
• Capecitabine 500 mg

Take Capecitabine 500 mg tablets exactly as your doctor tells you to take it. Your doctor will tell you how much Xeloda to consume and when to consume it. You should take this drug within 30 minutes after finishing a meal. Swallow tablets whole with water. Do not break or crush Capecitabine tablets.

3. Trastuzumab:

It is a monoclonal antibody recommended for the treatment of breast cancer (Adjuvant Breast Cancer and Metastatic Breast Cancer) and also stomach cancer. It is mainly used for cancer that is HER2 receptor positive. It can be used by itself or together with the other chemotherapy drugs. Trastuzumab Injection should be given by slow injection into a vein and injection just under the skin.

The usual dose of this drug depends on patient body weight. Your healthcare provider will calculate the dose for you.

How long you need to take Trastuzumab 440 mg will depend on a patient response to the treatment. Your doctor will check your response at the regular basis and decide how many treatments you will receive.
A Registered Nurse in the hospital or outpatient clinic will give you Hertraz 440 mg at regular intervals (usually every 3 weeks) determined by your physician.

The most common adverse effects may appear such as fever, cough, headache, infection, trouble sleeping, and rash. Some other adverse effects include allergic reactions, lung disease and heart failure.

4. Thiotepa:

Thiotepa is an alkylating medication indicated for the treatment of adenocarcinoma of the breast or ovary.
The most common adverse effects include anemia, thrombocytopenia, elevated aspartate aminotransferase, elevated bilirubin, mucositis, cytomegalovirus infection, diarrhea, hematuria, rash, neutropenia, elevated alanine aminotransferase, and hemorrhage.

Note: It can also be used for treating superficial papillary carcinoma of the urinary bladder.
Additionally, it is also recommended to use in order to reduce the risk of graft rejection when used in conjunction with the high-dose of cyclophosphamide and busulfan as a preparative regimen for the allogeneic HSCT (hematopoietic progenitor cell transplantation) for the patients who are pediatric with the beta-thalassemia class 3.

5. Ribociclib:

This medication is recommended to use together with the aromatase inhibitor as an endocrine-based therapy for treating postmenopausal women with the HR-positive (hormone receptor-positive), human epidermal growth factor receptor-2 negative metastatic or advanced breast cancer.
Consume this medication exactly as your healthcare provider instructs you. Never change Or interrupt your dose unless your healthcare provider suggests you.

Ribociclib should be taken every day at about the identical time, preferably in the morning.
You should consume it with or without food. Swallow Ribociclib 200 mg tablets whole. Do not chew, crush, or split tablets prior swallowing them.

The most common side effects include nausea, fatigue, diarrhea, alopecia, vomiting, back pain, headache, neutropenia, leukopenia and constipation.

6. Everolimus: 

Everolimus approved for breast cancer in post-menopausal women with the advanced hormone-receptor-positive, HER2-negative type cancer, in conjunction with exemestane.
This drug comes as the strength of 2.5 mg, 5 mg, and 10 mg tablets.

The most common side effects include stomatitis, infections, fatigue, cough, asthenia, and diarrhea.

Note: Everolimus is also approved for several other conditions include:

• Advanced kidney cancer
• Prevention of organ rejection after the renal transplant
•  SEGA stands for Subependymal giant cell astrocytoma associated with the tuberous sclerosis (TS) in those patients who are unsuitable for the surgical intervention. 
• Progressive or metastatic pancreatic neuroendocrine tumors surgically removable. 
• Prevention of organ rejection after the liver transplant. 
• Well-differentiated non-functional, Progressive, NET (neuroendocrine tumors) of gastrointestinal (GI) or lung origin with an unresectable, locally advanced or metastatic disease. 
• Tuberous sclerosis complex-associated with the partial-onset seizures for the adult and pediatric patients who are aged of 2 years or older. 

7. Paclitaxel:

Paclitaxel is an anti-cancer drug used in the treatment of a patient suffering from breast cancer. It is also effective in lung,  prostate, ovarian, bladder, esophageal, Melanoma cancer.

Paclitaxel is available in an injection form that is injected intravenously. The dosage of the drug depends upon several factors such as general health, weight, and height, type of cancer, and response rate of the patient.

Some common side effects of paclitaxel 100 mg injection include diarrhea, nausea, hair loss, hypersensitivity, peripheral neuropathy, low blood count, and mouth sores.

8. Anastrozole:

Anastrozole is a medication prescribed for the treatment of breast cancer in women who have gone through the menopause. Your healthcare providers may also be prescribed this medicine by Arimidex, which is its well-known brand name. Men with breast cancer may be recommended anastrozole, although another medicine named tamoxifen is more commonly prefered. Sometimes this drug is recommended to be given together with goserelin (Zoladex) to those women who haven’t yet been through the menopause. In case hormone receptor negative cancer, anastrozole is not useful. The drug is given in order to reduce the risk of breast cancer in women who haven’t had breast cancer but have a higher risk of developing due to their family history. It is usually recommended to be given following surgery in order to reduce the risk of breast cancer coming back or spreading.

If you’re having chemo or radiotherapy, your healthcare professionals will tell you when it’s best to start the medicine anastrozole.

Occasionally, this medicine may be prescribed as the first treatment for breast cancer, for instance when surgery is inappropriate or requires to be delayed. It is sometimes prescribed prior to surgery to shrink breast cancer (larger).

Anastrozole can also be prescribed for the treatment of breast cancer that has come back (recurrence). It can also be recommended for the treatment of breast cancer that has spread to another part of the body (secondary breast cancer)                                                             when it is often prescribed together with another drug. Anastrozole is consumed as a tablet once a day, either with or without food. It is best to consume it at the same time each day. Adverse Reactions: Like any medicine, anastrozole 1 mg may cause adverse reactions. Each individual reacts differently to medicines and some people have more adverse reactions than others. Common adverse reactions may include:

• Nausea
• Vomiting
• Headaches
• Loss of appetite
• High cholesterol
• Hot flushes
• Sweating
• Constipation
• Hair and skin changes
• Sleep Disturbance
• Vaginal Irritation
• Reduced Libido (sex drive)
• Low mood and depression
• Difficulty sleeping
• Fatigue (extreme tiredness)
• Pain in the joints and muscles

9. Atezolizumab:

Atezolizumab also named Tecentriq, specifically is a monoclonal antibody medication used in order to treat TNBC (triple negative breast cancer). 

In patients taking treatment with this medication, certain side effects may occur, which are as: tiredness, nausea (feeling sick), reduced appetite, vomiting, rash, difficulty breathing, cough, diarrhea, fever, pain in the back, joints, muscles and bones, itching, weakness and urinary tract infection. 

10. Abemaciclib: 

Abemaciclib also named Verzenio, is a medication used in order to treat patients with advanced/metastatic breast cancers. This agent was originated by Eli Lilly and it is believed to work as a CDK inhibitor selective for the CDK4/CDK6.

Some commonly reported side effects of abemaciclib are diarrhea, nausea, vomiting, low white blood cell count including low red blood cell count, low platelet count, stomach pain, fatigue, infections, headache and decreased appetite. 

11. Lapatinib Ditosylate:

Lapatinib also named Tykerb, specifically is an orally active medicine in order to treat breast cancer and other solid tumours. Lapatinib is a dual TKI, interrupts the HER2/neu and EGFR pathways. It is mainly prescribed in combination therapy in order to HER2+Ve breast cancer. It is prescribed in order to treat patients with the advanced or metastatic breast cancer whose tumors overexpress HER2 (ErbB2).

The most commonly reported side effects of Lapatinib include: diarrhea, nausea, fatigue and rashes. 

12. Tucatinib: 

Tucatinib, also named Tukysa, specifically is a small molecule inhibitor of HER2 in order to treat HER2+Ve breast cancer. This medication was originated by Array BioPharma and licensed to Cascadian Therapeutics.

Some commonly reported side effects of Tucatinib include: vomiting, diarrhea, nausea, palmar-plantar erythrodysesthesia, fatigue, hepatotoxicity (liver damage), rash, decreased appetite, stomatitis, abdominal pain, anemia and headache. Pregnant or breastfeeding women must avoid taking Tucatinib because it may be responsible for causing harm to a developing fetus or newborn baby. 

13. Phesgo: 

Pertuzumab/trastuzumab/hyaluronidase (Phesgo), specifically is a fixed-dose combination drug, used for the treatment of adult patients with HER2+Ve breast cancer that has spread to other organs of the body, and for treating adult patients with the early HER2+Ve breast cancer. Phesgo contains pertuzumab, trastuzumab, and hyaluronidase–zzxf, and is available in order to be injected under the skin via subcutaneous injection in the thigh.

Some most commonly reported side effects of Phesgo include hair loss, nausea, diarrhea, reduced red blood cells and lack of energy. 

NOTE: The piece of information mentioned about "List of Effective medications for breast cancer treatment" in this article is just for the informational purposes and is not served as a substitute for medical treatment, consultation, diagnosis of a qualified doctor.

Read:-  Important things to be kept in mind during and after Breast Cancer treatment

Why is “Ikris Pharma Network” one of the best Pharmaceutical Wholesaler in exporting Indian Generic Medicines?

Pharma companies in any country are as important as oxygen. For many years people used to avoid medications and use natural remedies. Many people were not able to afford treatment as the cost involved was very high. Now with the time there is more awareness of Generic Drugs. India is the largest manufacturer and supplier of generic medicines to the world. India takes care of more than 50% of the World's requirements. More than 80% of the ARVs ( Anti HIV) are being supplied by Indian pharmaceutical companies.  In this scenario, it is very important to know the importance of the best generic medication supplier from India. Ikris is one of the most popular Pharma networks which supplies medications to 150+ countries. It is listed as one of the best MNC companies across the globe.

At Ikris Pharma we provide a wide range of pharmaceutical products to patients, distributors, and the healthcare sector at the best price. Since the year 2020 has started the world is facing a situation that has affected every industry badly but we are ready to help doctors, patients, hospitals, and even NGOs. Many hospitals and other healthcare industries are taking measures to provide a better system for the patients as well as for the front line doctors which are making COVID 19 easy for all.
In this pandemic, the Ikris Pharma network has proven to be an outclass pharmaceutical wholesaler with its exceptional services and treatments for its patients, hospitals, and distributors.  Our branded generic medication suppliers are always on toes to provide you the best of its services.

Let’s have a look at Why Ikris Pharma Network is the best Pharmaceutical Wholesaler?

Lower cost:

We provide products to the hospitals and other distributors in bulk which not only lower the cost but also guarantee the economy of scale. It is a reality that if you buy products from a retailer it will cost you more than buying it from a pharmaceutical wholesaler which automatically gives an advantage to the buyers. So in order to save your money and buy the best products possible, make the right choice for you. Ikris Pharma network provides you with the best price possible so you can trust us and trust our experts for the best pharmaceutical wholesaler service.

Convenience:

Ikris pharma network is best because we provide all the products under one roof without any inconvenience to roam around here and there. This not only saves your time but will also provide you extreme comfort to buy everything from a single wholesaler. We are working 24X7

Range of products:

At Ikris pharma we have a wide range of products which include HIV medications, oncology medications, and other important medications for Hepatitis, rare disease, and transplant, etc

Reduced Risk:

We are one of the best generic medication suppliers. We buy products directly from manufacturers or their authorized distributors. We take 100 % guarantee of genuine and quality Medicines. We have all the required licenses to buy and export medicines. The most important thing to be taken care of is license and certification. So, before you make a purchase make sure you do not invest in the illegal wholesalers. Ikris Pharma, in this case, is highly recommended because we are licensed and all our medications are regulatory approved and in addition to this we provide all possible documentation.

Stock control:

We can supply products in any qty. We have supplied large quantities to various ministries.Our turn around time is one of the best in the industry. You will not have to worry about the shortage of stock to sell to your customers and distributors.

What makes Ikris Pharma different from other networks- 

• Generic Medication
• Easily accessible 
• 100% Compliant Company 
• Ikris Pharma has its own warehouse
• Good packaging material 

Ikris pharma network is a legally licensed pharmaceutical wholesaler. We not only deal with generic medication but also have branded generic medication. Our team is always ready to guide the patients with the proper treatments they require. The payment process is very flexible with a safe convenient bank transfer. We at the Ikris pharma network know how to provide you with the best platform to manage the systems for pharmaceuticals. If you like to know more about our resources and how to handle the distribution and suppliers, we are offering you to easily search for improved assistance through our customer support representative. We will provide you with the solutions you need based on the number of staff, divisions, and the total size of the business.

Our network is so wide that we provide medications around the world. We even have one of our offices in Belgium named Ikris Pharma International. Our 24/7 customer support can really help you know more about our pricing and services. Contact us and call at any time on
Toll-free +91 1800-889-1064  for any assistance and support.

The technologies have made the advancement easy to access more information which has also made it easy for the physicians to better understand the medical condition of the patients and treat them well. Due to the tremendous advancement in medical technology the treatments have been made easier.
So if you have finally decided to buy medications from a reliable wholesaler, Ikris Pharma network is the right place for you. We deal with all kinds of medications that will help to treat the patient correctly and without any hassle and extra cost. Our costs are reliable and our services are exceptional.
We believe in providing our clients with the most amazing service and all our products are approved by well-known organizations.

COVAXIN from Bharat Biotech get approved from DGCI for phase l and ll clinical trials

Recently the central drug standard control organization (CDSCO) has allowed Bharat Biotech India (BBIL) for conducting Phase 1 and 2 clinical trials on humans of "COVAXIN".  The trial has been started from 1st July 2020. The Drug Controller General of India (DCGI) has given approval to the company for Phase 1 and II clinical trials.

According to the report of BBIL, this vaccine has a form of killed virus that doesn't have any potential for infecting or replicating in the body. It just enhances the immune system by allowing it to produce an antibody response against the virus.

Newly developed vaccines are required to fulfill the four stages of the testing process starting from preclinical trials and ending at Phase 3 clinical trial which is conducted on thousands of infected patients. After successful trials, the company monitors the use of vaccines on patients and submits their post-marketing surveillance details which check for long term side effects.

BBIL directed human trials in July but the testing report and final authorization are doubtful. Before approving Covaxin two other medications are already approved named Favipiravir 200 mg and other as Remdesivir.

Testing stages of COVAXIN:

This injection went preclinical testing on animals such as Mice And Guinea pigs. After the healthy recovery of these infected animals from coronavirus, this vaccine is authorized for the 1st Phase trial.

In the first phase, a small group of patients will be injected by this vaccine, and the following reports are submitted mentioning whether the patient has any effective building in immunity or any side effect.

In the 2nd phase, this test will be performed on a group of thousand patients characterized on the basis of age and sex.

After successful trials, post-marketing surveillance is done to check any long-term adverse reaction of this injection on sufferers.


Read:- US Bought more than 90 percent stock of COVID Medication Remdesivir