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Overview

Immune system is the fundamental part of health and safety. It comprises of complex cells, tissues and organs which collectively work together and secures the body. They have an ability to recognize the foreign agents such as viruses, bacteria, parasites and protect the body from getting infected from them. Sometimes, this natural protective mechanism can cause complications in the human body. In organ transplantation procedure, there is installation of new organs and tissues in the body. Our immune system considers them as a foreign substance and rejects the transplanted organ. So, immunosuppressive agents are given in order to reduce the efficacy of immune system and avoid the rejection of transplanted organ. First successful renal transplant was done in 1954. With advancement of science, there are number of surgeries done like kidney and bone marrow transplantation. These transplant procedures have tremendously increased the use of immunosuppressive drugs for the smooth outcomes of the surgeries.

Classification of Immunosuppressants

Classification of Immunosuppressive agents can be done into three categories such as:

Induction immunosuppressant- the drugs falling under this category are prescribed after transplant in order to prevent acute rejection. They are recommended for short span of time only as they helps in avoiding rejection of transplanted organs by the body. Methylprednisolone, Basilixamab are the commonly employed drugs.

Maintenance immunosuppressant – these are the drugs that are given to maintain the suppression effect of immune system. Prednisone, cyclosporine, Tacrolimus are the recommended drugs.

Anti rejection immunosuppressant – these are the agents that are prescribed when there is acute rejection is shown by the body after transplant surgery. It is given for 30 days and all the immunosuppressant drugs come under this category.

What are the uses of immunosuppressant?

These drugs have been employed in various conditions such as:

• Rejection of transplanted tissue or organ
• Autoimmune disease conditions such as Rheumatoid arthritis, Systemic Erythematosus and Crohn’s disease
• Curing non autoimmune conditions like controlling chronic allergic asthma 

What are the available treatments?

It is very crucial for a patient who undergoes transplant surgery to maintain the balance between the rejection and infection. There should be balanced intake of these medicines as excessive intake can result in infection and less intake can leads to acute rejection of the organ. Our body continuously produces B cells and T cells that identify foreign tissues called antigens. Prescribed drugs are used to prevent the response of immune system and prevent rejection of the transplanted tissues or organs

Immunosupression procedure involves double, Triple and Quadruple drug treatment. In double treatment, two drugs like cyclosporine or Tacrolimus is given along with Azathioprine. In triple drug treatment, three drug combinations are prescribed that involves Tacrolimus with corticosteroid and Azathioprine. In quadruple therapy, cytotoxic antibiotics are given in induction phase along with the drugs given in triple drug therapy.

What are the available agents and their action?

Drugs given in the treatment solely depends upon the organ being transplanted and is made to minimize the health hazards of the same. The prime duty of the Doctor is to recommend best treatment option for you. The drugs for the treatment are as follows:

Glucocorticoids and vitamin D analogs are the most prescribed drugs in induction as well as in maintenance phase. Methylprednisolone weakens the immune system by activating the white blood cells activity. White blood cells are the cells that plays key role in generating immune response. They are widely employed in auto immune diseases such as rheumatoid arthritis and asthma.

Cyclophosphamide is the most potent drug and is used in autoimmune disease such as systemic erthyematosus.

Methotrexate and Azathioprine are the drugs that are given in the rheumatoid arthritis and in transplant rejection reactions. These are the cell cycle inhibitors that stop the formation of B cells and T cells that cause immune response.

Cytotoxic antibiotics like Dactinomycin and Bleomycin are used in kidney transplantation

Cyclosporine is a calcineurin inhibitor that interferes in the cell mediated immune reactions. It is given in rejection of transplanted kidneys. Tacrolimus is slightly more influential than cyclosporine as it has higher potency and can be administered along with the corticosteroids

What are the side effects?

The side effects vary from person to person. The side effects encountered till date are as follows:

• Anxiety
• Loss of hair from the head and body
• Impaired digestion
• Arthritis
• Mood swings
• Increased craving for food
• Prolonged healing of wound
• High cholesterol levels
• Hypertension
• Kidney damage
• Osteoporosis
• Impaired immune system making person more prone to other infections
• Unwanted hair growth
• Swelling of feet and abdomen
• Shingles
• Depression
• Diabetes
• Cancer

How to avoid possible risks?

Immunosuppressant weakens the immune system of an individual and makes him prone to other infections. Due to impaired immune system one can experience uncontrolled bleeding also. To prevent other infections one should follow:

• Wash your hands properly especially before taking meals. Frequent hand washing really decreases the chances of getting infected
• Avoid coming in contact with people who are already sick or having contagious infections
• Stay away from crowded areas 
• Bath daily and keep your mouth clean by keeping your teeth cleaned
• Be cautious while using sharp knives and blades
• Don’t ignore even minor bleeding, try to cover that cut or wound by bandage and take first aid measures to control it
• Take medication as prescribed by your doctor
• Keep track record of your medication in a diary and take each and every dose as recommended
• Store your medication in a cool and dry place and keep them away from children
• Regular check up and refill of medicines should be done timely 
• If any adverse side effects occur, then consult your physician immediately
• Abrupt discontinuation of recommended treatement can really make you reach at life threatening condition so never ever stop the medicine without the approval of physician

 Also read: Listeria- Advice for pregnant women and anyone with weak immunity