Every day, organ transplant patients must remember to take as many as 10 to 15 different medications. Most are designed to prevent the body from rejecting the transplanted organ.

Others address concurrent medical conditions such as high blood pressure, infection, lipid disorders and diabetes.

As a member of the abdominal organ transplant team at Temple University Hospital, Nicole Sifontis, clinical assistant professor of pharmacy practice at the School of Pharmacy, helps patients negotiate this medicine maze.

Currently, not all transplant teams include pharmacists, but that could soon change.

Effective Aug. 1, 2004, the United Network for Organ Sharing amended its bylaws to state that a clinical transplant pharmacist who will be responsible for providing pharmaceutical care to solid organ transplant recipients must be identified to qualify as a designated transplant program.

Using a large medication card and a multi-compartment pill box, Sifontis lays out a specific routine, instructing patients on what medications to take, as well as when and how to take them.

“Transplant patients follow very complicated medication regimens. We spend a lot of time reviewing and explaining the appropriate use of their medicines, filling their pill boxes and educating them about how each of their medicines work,” said Sifontis, who has found that such counseling enhances medication adherence.

Pharmacy students who choose the five-week transplant rotation assist and accompany Sifontis. While she encourages students to ask the patients questions and make assessments, she is always there at their side.

A large portion of the students’ responsibilities surround educating patients on their medication regimen, including side effects and potential drug interactions. Pharmacy students also provide drug information to other healthcare providers on the team, including the transplant surgeons and transplant coordinators.

Sifontis concentrates mostly on the patients just out of surgery because they’re at the most critical stage. She also works with the transplant coordinators on medication planning for patients going home from the hospital. Typical medications include immunosuppressants (up to three different drugs), anti-virals and anti-bacterials.

While the immunosuppressants must be taken for life, the others are usually taken just for the first six months after surgery, when patients are at higher risk of infection and other complications.

Patients might also already be taking medications for high blood pressure, high cholesterol, diabetes and osteoporosis. Sometimes there are mental illnesses, like depression, that also require drug therapy. Because many of these medications have the potential to interact with the immunosuppressants, they must be monitored very closely.

During the acute phase, which occurs in the first few weeks after the transplant, the big issue related to medication is side effects including tremors, gastrointestinal upset and weight gain.

“We counsel patients to report any new side effects, many of which are dose-related,” Sifontis said. “A certain dose is required for a drug to be effective, however. Choosing the appropriate drugs and dosages while preventing harmful drug interactions and side effects is an ongoing concern that we re-evaluate at every patient visit.”

After about three to six months after transplantation, patients start to feel better, many are able to return to work and medication adherence becomes an issue. “Why do I need to take all of these pills if I feel so great?” they say.

The abdominal organ transplant team holds clinic daily. Patients arrive by 7 a.m., before they’ve taken any medications, to facilitate accurate testing of certain medication blood levels.

Patients must also report everything else they are taking, such as supplements, vitamins and even herbal therapies, to help prevent adverse interactions.

“The best part of this job is that it’s always different. You never know what’s going to happen from one day to the next or even from hour to hour due the nature of organ transplantation.

When an organ becomes available, everything moves very quickly,” Sifontis said.