Why you should stay away from grapefruit and schisandra after lung transplant surgery

Patients should stay away from “two foods” after lung transplant surgery, a treatment for end-stage lung diseases such as pulmonary fibrosis, pulmonary hypertension, and pneumoconiosis.

The two are grapefruit and schisandra.

After lung transplant surgery, many medications, including immunosuppressants, which patients must take for the rest of their lives to protect their transplanted lungs, interact with grapefruit and schisandra extracts to affect patients adversely.

"Grapefruit and schisandra extracts have many interactions with immunosuppressants as well as other drugs, so they should not be consumed," said Ryu Ha-bin, a pharmacist at Severance Hospital's Pharmacy Department, on the YouTube channel “Severance.” "Folk remedies, herbal medicines, and dietary supplements should not be taken arbitrarily because they may directly affect the effectiveness of immunosuppressants or cause unexpected side effects, such as toxicity to the liver and kidneys with untested treatments."

According to Ryu, lung transplant patients must take immunosuppressants for life after surgery to prevent their immune systems from rejecting the transplanted lungs. They must also take infection-prevention medications, including antibiotics, antifungals, and antivirals, to minimize the risk of infection caused by immunosuppressants.

That shows why it is important to know the precautions of lifelong medications, which will help lung transplant patients get the most out of their medications and minimize side effects.

First, lung transplant patients must take their immunosuppressant medications at the correct time and dose.

Immunosuppressants should be stored at room temperature in their original packaging and swallowed whole, without cutting or crushing, unless there are special circumstances, like an inability to swallow. Also, don't "vaccinate" yourself without your doctor's consent.

"It is also recommended to wear sunscreen and long clothes when going out for a long time," Ryu advised.

-- Immunosuppressants: Three types of immunosuppressants need to be taken after lung transplant surgery: primary immunosuppressants, supplementary immunosuppressants, and steroids. The primary immunosuppressants are Tacrobell and Prograf, which contain tacrolimus, abbreviated as FK506. However, the dosage and usage vary from person to person and are often changed depending on the test results.

"Because the dosage varies, it is recommended that you familiarize yourself with the name, shape, color, and dosage of your medication to ensure that you take it correctly," Ryu said. "You should be careful not to take more than the prescribed dose of immunosuppressants because it can cause kidney damage."

The primary immunosuppressant is taken at 9 a.m. and 9 p.m. with the supplementary immunosuppressant, and antacids containing aluminum or magnesium should be taken not simultaneously but one to two hours apart from the immunosuppressant.

It's also a good idea to familiarize yourself with the side effects of your primary immunosuppressant. Generally, the first time you take an immunosuppressant, you may experience numbness or tremors, and your blood pressure, blood sugar, and cholesterol may increase, according to Ryu.

"Because the main immunosuppressive drugs can be affected by food, it is always better to have a consistent diet," Ryu said. "Avoid eating too fatty meals and take immunosuppressive drugs on an empty stomach as much as possible."

In addition to the main immunosuppressive medication, the supplementary immunosuppressive medication used after lung transplantation is mycophenolate mofetil, abbreviated MMF. Cellcept Capsule is the most commonly prescribed of these drugs, but it also has side effects to watch out for.

"One of the side effects is a decrease in blood levels, and the most common discomfort patients experience is bruising," the Severance Hospital pharmacist said. "This drug can also cause loose stools and abdominal pain. You can tell your healthcare provider at your appointment if you have any symptoms."

If a patient plans to become pregnant after lung transplantation, she should consult with her doctor, as mycophenolate mofetil is contraindicated.

"Women of childbearing age or pregnant women should avoid using mycophenolate mofetil due to its teratogenic effects on the fetus," Ryu advised.

Steroids used as immunosuppressants in lung transplant patients include Solondo Tablet, which contains prednisolone, and Prandin and Calcoat, which contain deflazacort. They are usually taken once or twice daily, but the individual's dosage can vary.

"Typically, patients start with a high number of pills and take them frequently, and then taper down to fewer pills and less frequent doses over time," Ryu said. "Side effects can include rounding of the face and osteoporosis, which is a weakening of the bones."

Steroids, in particular, have ophthalmic side effects, including the risk of glaucoma and cataracts, so patients should tell their doctor if they notice a significant decrease in vision while taking the drug.

"Regular eye examinations are recommended, and patients with pre-existing high blood sugar may require additional dietary and medication management," Ryu noted.

-- Infection prevention medications: Long-term use of immunosuppressive medications can lead to the development of so-called opportunistic infections, which would not be a problem with a normal immune system. Opportunistic infections are caused by a decrease in the body's ability to fight off pathogens.

There are medications that lung transplant patients take to manage these opportunistic infections, the longest of which are the sulfa antibiotics sulfamethoxazole and Septrin with trimethoprim.

"These antibiotics are used to prevent or treat pneumonia, urinary tract infections, and other infections that may occur after transplantation," Ryu said, adding that patients should tell their healthcare providers if they are allergic to sulfa antibiotics or if they experience any skin problems after taking them.

Infection prevention medications can make your skin more sensitive to sunlight. "It's a good idea to wear sunscreen when you go out for a long time," she advised.

In addition to sulfa antibiotics, a drug to prevent infection by cytomegalovirus (CMV) called Valcyte or Vigavir, which contains valganciclovir, is also required for some time after lung transplantation.

"It is recommended to take these medicines with meals whenever possible to enhance their efficacy, and should not be crushed or tampered with, and pregnant women should not handle these medicines due to the risk of fetal malformations," Ryu explained.

The itraconazole-based medicine to prevent the fungus Sporanox, also needs to be taken after lung transplantation. Still, the dosage instructions for the liquid and capsule versions are slightly different.

"Sporanox Solution should be taken on an empty stomach, while Sporanox Capsules are better absorbed when taken immediately after a meal," Ryu said, adding that patients should notify their doctor if they experience persistent nausea, vomiting, yellowing of the skin under the eyes or severe swelling.

-- Electrolyte correction medications: Depending on their individual characteristics, lung transplant patients may need to take additional electrolyte correction medications, such as magnesium, potassium, calcium, and iron, in addition to immunosuppressants and infection prevention medications.

"When taking commonly prescribed electrolyte correction medications, including Bolgre Solution and Feroba-You SR Tab, it is recommended to take them at least two hours apart from tannin-containing teas, such as green and black tea, milk and dairy products, and antacids containing aluminum or magnesium, as these can interfere with the absorption of iron," Ryu said.