Missed immunosuppressant dose

[mikeeboy723]

Hi all!

I'm hoping you can put my mind at ease. I was blessed with a kidney transplant 2 months ago, and for the first time forgot to take one of my 12hr doses of tacrolimus and Myfortic last night. I took my meds as usual this morning however. I'm terrified of an acute rejection episode. What is the likelyhood of something bad happening? Does anyone have experience with this? Thanks in advance.

[Googoodoll]

Hi mikeeboy73,

1st of all don't panic!!! Call your transplant team and they will direct what you should do.

My husband had his kidney transplant 2 years ago. In that time, he has forgotten to take the evening dose twice. In the morning he took the regular dose. I called the doctor and he said to monitor my husband's temperature and if he had a fever over 100.4, to call the transplant team. Fortunately, he did not get a fever on either occasion.

I am sending good thoughts your way. Let me know how you feel tomorrow.

🙂

[Transplant314 in reply to Googoodoll]

I am 2 1/2 years out and have missed a couple of doses. When I was in the hospital for my transplant the nurses said I can take a dose up to four hours past the designated time and otherwise just skip it and get back to my schedule at the next 12 hour mark. Missing a dose is unlikely to have a harmful effect.

I set a timer on my phone which is enormously helpful . Bring your medicine in a small pill box if you are going to be out at the time you are supposed to take your meds.

[Redbone55 in reply to Transplant314]

I agree with your comments because it is exactly what I do indeed it is very helpful setting timers on your phone, staff healthy!😊

[Davidkidney]

It's unlikely to affect the transplant, nurses told me they get patients missing the odd dose quite often. I've done it a few times over the last 3 years. Just try not to make a habit of it, I set alarms on my phone. The immunosuppressants effects gradually wane, so there would have still been some in your body. You may however want to inform the transplant nurses that you missed a dose.

[alanteague]

Phone the dialysis clinic or hospital where you got transplant

[Eyak1971]

Thanks for asking the question. I have automatic alarms set on my phone just for that reason. Haven't had the problem yet but thankful for the responses you received. Take care. We are on this journey together.

[larrymontague826]

I am 2+years post transplant. I know 4 other kidney recipients, and we have all missed doses. I would not panic, but watch your temperature and try not to miss anymore.

[Okiksaints1955]

1. I have created a routine. - Before dinner, I will put the evening and morning doses into 2 small plastic cases. (I prepare my meds 1 week in advance - in bigger meds case).

2. I put both on my table where I also put my eyeglasses before I go go sleep (easy to see)

3. My fitbit has an alarm set at 8:55 am and pm.It vibrates.

4. My phone also has alarm set at 8:58 am and pm.

5. If I have to go out, I put both doses in my pocket.

I have never missed my meds.

Maintenance meds stays in our system for at least 3 days. But with less potency. Remember that they asked us to stop drinking whatever meds we were taking 5 days before surgery.

But don't I don't use that as an excuse to not be extra careful not to miss meds - thus the routine I created.

Hope this helps.

[Hidden in reply to Okiksaints1955]

Howdy...I take my meds at 9 and 9. Similar to you, I set an alarm, on my iPhone, for 8:45 and 9:15. If I miss the first alarm, the second will always do the trick. I've only missed my TAC once in the first year after transplant. Unfortunately, it was bad timing since it was the day before a lab draw. Ya know, missed TAC the morning before. On top of that, one doesn't take TAC before right before one's labs. So my TAC was artificially low. Didn't realize I forgot until a week later when I found my TAC still in the pill case. It screwed up everything — as far as blood levels go — as they raised my TAC (Envarsus) by 1mg. Good news, it only cost me another trip to the lab. TAC is back to its therapeutic range.

[LavenderRabbit]

First off, I’m not a doctor, but I know that it takes 3 months for the large amount of drugs that are typically given at the time of transplant to wear off. So you should have some of that left in your system as well.

[DexterLab]

First, congratulations on your new kidney. I am 2 and a half years in on my transplant. I have missed a dose twice. No consequences yet. Docs would rather not have you miss a dose, but say to just take the next scheduled dose instead of doubling up. We all need to develop a process that works for us as individuals to ensure we take our meds. Since you are only two months in, you are still getting frequent blood tests, and the docs would see any issues. So it will be okay. Good luck going forward.

[Alimesoda234]

I have Alexa tell me t take and an hour later to stand up and actually look at pill box to verify

[shash8363]

Congratulations on your new kidney.

I agree with what others have said. One odd dose is not likely to trigger rejection. But do not make it a habit. The reason doctors/transplant teams stress on not missing is because they do not want to patients to take this lightly. Non-compliance for immunosuppressive medication is a big cause of early rejection.

I have multiple alarms set as reminder - 10 min prior to the dose, one at medication time and one 10 mins after - helps me when i am busy or engrossed in something.

Take care!

[Darlenia]

Great advice from everyone on this thread. If you're overwhelmed with the number of medications you take, maybe it would help to switch your tac to the timed-release version which you take once a day in the morning. The occasional missed med for my transplanted hubby occurs more often in the evening after a day with lots of activity. If you're on Medicare, Part D will cover the cost of the generic version. Not all pharmacies are aware of that.

[horsie63 in reply to Darlenia]

Does Part D cover the period between when Part B no longer covers the meds (36 months) and full retirement Medicare (67 for me so 9 more years)

[Darlenia in reply to horsie63]

Part B does not cover medicine except for extremely limited meds such as certain transplant rejection meds. For most all other meds. you will need part D or an advantage plan with pharmacy coverage. Since you're employed, it's likely your company insurance plan will cover pharmaceuticals. If you retire, some companies will also continue to offer their retirees a retirement plan. In my hubby's case, he has standard medicare (plans A and B) plus plan D (Medicine) and a UnitedHealth Care supplement plan. Generally speaking, transplant centers check out your situation in advance and there aren't big surprises.

[March-31-09]

Please don’t panic. I’m 12& 1/2 years post & I certainly don’t make it a practice of missing my meds, but I can’t say it’s never happened. Give yourself some grace. Call your transplant team if it will put your mind at ease. All the best to you. Enjoy the rest of the week - it’s getting 🥶 where we live. Not too overjoyed about that. God Bless 🌷

[littlelinda50]

Don't panic but get a watch you can set alarms so you don't miss. Breath and relax. Let your doctor know. I have done that myself and I know that panic feeling.

[Traned]

I agree that you should notify your transplant team since your kidney is so new, however, I have had my transplant for 19 years and have missed on occasion. Your immunosuppressant medication creates a level in your system of the drug, it does not disappear overnight so missing one dose should not be an issue, avoid missing multiple doses in a row.