Affording and Taking Immunosuppressive and Other Medications

1
Affording and Taking Immunosuppressive and Other
Medications

• Tracy Anderson-Haag, Pharm.D., BCPS
• Clinical Pharmacy Specialist
• Hennepin County Medical Center
• Clinical Assistant Professor
• University of Minnesota, College of Pharmacy
• Minneapolis, MN

2
Over the next few minutes I am going to talk
about

• Why it is vital to continue taking prescribed
  medications after transplant
• Repercussions of missing medications and non
  adherence
• The importance of having routine labs and seeing
  your transplant team for the life of your
  transplant
• Ideas to help improve adherence-patient and
  transplant team role

3
Importance of Adherence

• Adherence involves taking your medications and
  following advised instructions for labs and f/u
• Medication Adherence
• Taking medications as prescribed
• Having levels monitored on recommended schedule
• Rates 25 of transplant patients are
  non-adherent higher rates miss occasional doses
  of medications
• Nonadherence increases over time
• Starts increasing significantly within 6-9 months
  of transplant

4
Risk of Non-Adherence to Graft

• 3rd leading cause of graft failure
• 1/3 of graft loss in kidney tx associated with
  prior nonadherence
• Odds of graft failure 7 fold higher in
  nonadherent patients
• 53 of rejections after 6 months post tx (later
  rejections) associated with nonadherence (one
  study)
• More rejection, more graft loss, and higher SCr
  if nonadherent

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Why is this so hard?

• Life
• Many tx patients have a great QOL
• Busy schedules interfere with med regimen
• Forget, inconvenient to take
• Feel so good, do I really need the meds
  (especially when they make me feel worse!)?
• Potentially no immediate consequence felt when
  misses meds (BP, DM, Immunos, antidep, supps)
• Complex post transplant regimens (many meds,
  TID/QID dosing, many comorbidities clinic
  visits)
• Money
• Medications are often expensive
• On many meds even if low copay this adds up

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What can we ALL do to improve adherence?

• Understand your medication regimen
• If you know why youre taking the meds, more
  likely to buy into importance of adherence
• Establish routine
• Involve support system (family, friends,
  coworkers)
• Enlist help of transplant team
• Pharmacists are a part of your team-great
  resource for med information and questions
• Simplify med regimen if possible (next slides)
• Address financial needs (SW)

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Pharmacist Access

• Community Pharmacist
• Fills your prescriptions
• May or may not know all active medications if
  using gt 1 pharmacy
• Can help identify interactions and dosing issues
  with medications filled at that pharmacy
• Transplant Pharmacist
• Special training in transplant
• Intensive medication reviews
• Face to face interactions/advanced counseling
• Able to work more efficiently (directly) with
  transplant team

8
Tx Patients on complex regimens

• When your transplant pharmacist evaluates your
  medication profile they look for
• Excessive or unnecessary use of prescription or
  nonprescription medications
• Taking prescription or OTC medications that have
  no apparent indication or duplicate medications
  to treat the same disease
• Concurrent use of interacting medications
• Use of an inappropriate dosage
• Medications not optimized before adding more
• Up titration of medications to max dose/effect
• Desired result not obtained /- adverse effect
  present
• Use of drug therapy to treat side effects
• Too many doses a day QD79 adherence, BID,
  69, TID 65, QID 51.

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Tx Patients on complex regimens

• Trust your transplant team
• Be honest about your adherence
• Help identify barriers to your medical
  adherence-medications, labs and visits
• Together we may be able to find solutions to
  improve adherence and outcomes

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Summary

• Adherence isnt always easy!
• Poor adherence can lead to acute rejection, worse
  graft function and loss of graft
• Utilize resources like your transplant team to
  improve success with adherence to regimen
• Develop good medication and behavioral habits to
  support adherence