Anti-Rejection Medications
The daily medicines that protect your new kidney — what they do, how to take them right, the foods and medicines that interact with them, and the side effects to watch for.
Key Points
- Take your medicines at the same time every day — within thirty minutes of the same hour, morning and evening. The trough level we measure depends on you being on a steady schedule.
- Never stop or change a dose on your own, even if you feel perfect or if a side effect is bothering you — call the transplant team and they will adjust the plan with you.
- Tell every doctor, dentist, and pharmacist who treats you that you are on Prograf or Neoral before they prescribe anything new — especially antifungals (fluconazole), certain antibiotics (clarithromycin, erythromycin), and some heart medicines (diltiazem). These raise the level and can damage the kidney.
- Grapefruit, Seville orange, and pomegranate juice raise the level of Prograf and Neoral dangerously, even from a small amount. Star fruit is toxic to the transplanted kidney. Avoid all four completely.
- Avoid Brufen, Voltaren, and Cataflam (the anti-inflammatory painkillers) — they damage the kidney. Plain Panadol (paracetamol) at normal doses is safe.
- Never take St John's Wort, and ask the team before any herbal medicine, supplement, or traditional remedy — many of them interact with the transplant medicines in unsafe ways.
- A small daily dose of prednisolone is the standard in our centres for life — withdrawing the cortisone is not routinely done in our part of the world because the rate of rejection is higher.
- If you miss a dose and remember within four hours of the usual time, take it. If more than four hours have passed and the next dose is close, skip the missed one and call the clinic. Never double up.
Clinical review
Reviewed by Dr Osama Ashry Gheith, Consultant Transplant Nephrologist. Kuwait Center for Nephrology and Kidney Transplantation (KCNKT). Mansoura Urology and Nephrology Center, Egypt. Reviewed 1 August 2026.
About the Transplant Patient Portal
This chapter is part of ASNRT's bilingual (Arabic / English) transplant patient-education portal — 14 clinical chapters covering kidney transplantation from preparation through long-term follow-up, plus decision-aid tools for Ramadan fasting, drug-food interactions, and red-flag symptom triage.
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