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                  Medication & COVID-19

                  Key points for patients with kidney disease

                  COVID-19 is a new virus, and therefore research on it has only just begun. Some hypotheses — ideas based on very little evidence — have been made about the effects of certain drugs on COVID-19, but nothing has been proven. In fact, leading health organizations such as the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have not recommended that patients stop any particular drug in order to decrease the chance of getting COVID-19 or to make it less severe. Some common drugs that have been highlighted in the news are discussed below.

                  Blood pressure medications called angiotensin converting enzyme inhibitors (ACEs) and angiotensin receptor blockers (ARBs) should NOT be stopped, unless recommended by a healthcare professional. These drugs are key to controlling blood pressure in patients with kidney disease. Stopping them could lead to a heart attack, stroke, or decreased kidney function. Learn more from the American College of Cardiology.

                  Patients with kidney transplants should not stop taking their immunosuppressants or lower their dose, unless their healthcare team tells them to. Stopping your immunosuppressants will most likely lead to the loss of your donated kidney. Contact your transplant team for any questions or concerns. Follow precautions as recommended by the American Society for Transplant located here.

                  Patients with kidney disease are usually told to avoid non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. In general, kidney experts recommend acetaminophen for pain relief and reducing fever. But if you’re told by your healthcare team to take an NSAID for a specific reason, then you shouldn’t stop taking it because of COVID-19. Always talk with your healthcare team before making any changes in the drugs you take. Find the WHO's statement here.

                  Do immunosuppressive medications increase the risk of complications from COVID-19?

                  Yes – according to the CDC, taking immunosuppressive drugs does increase your risk for developing severe disease from the coronavirus due to an underlying medical condition.

                  Kidney transplant recipients

                  Doctors at a New York City hospital have reported that kidney transplant recipients are at significantly higher risk for developing serious, life-threatening COVID-19 illness due to taking chronic immunosuppression drugs and having co-existing medical conditions. While their sample size was small (36 transplant recipients), their results showed that kidney transplant recipients had a COVID-19 mortality rate of close to 30% as compared to 1% to 5% mortality in the general population and 8% to 15% mortality in patients with COVID-19 who are 70 years of age or older.

                  Continue taking your medication

                  Kidney transplant recipients should not stop taking immunosuppressant medication or lower their dose, unless instructed by their kidney doctor or transplant team. Stopping your immunosuppressants will most likely lead to the loss of your donated kidney. Contact your transplant team for any questions or concerns.

                  Follow precautions as recommended by the American Society for Transplant located here.

                  What about other underlying medical conditions?

                  There are other underlying medical conditions that people may have in addition to having undergone a kidney transplant recipient or dialysis treatment.

                  Some of these conditions are:

                  • Chronic lung disease or moderate-to-severe asthma
                  • Serious heart conditions
                  • Immunocompromised due to cancer treatment, smoking, bone marrow transplantation, immune deficiencies, HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications
                  • Severe obesity (body mass index [BMI] of 40 or higher)
                  • Diabetes
                  • Liver disease

                  Who is at high risk for COVID-19?

                  People over the age of 65 and those living in a nursing home or long-term care facility are also at increased risk for severe illness from COVID-19.

                  Are transplant recipients at higher risk of getting COVID-19?

                  Because transplant recipients take immunosuppressive drugs, they have a higher risk of infection from viruses such as cold or flu. To lower the chance of getting the coronavirus that causes COVID-19, transplant patients should follow the CDC’s guidance on how to avoid catching or spreading germs, and contact their health care professional if they develop symptoms of COVID-19.

                  Statement from the American Society of Transplantation (AST):
                  We do not have specific information on whether COVID-19 infection will be more severe in transplant recipients compared to healthy people; however, other viruses often cause more severe disease in people whose immune system is low, such as transplant recipients.

                  Will there be drug shortages?

                  Since people with kidney disease depend on medicine to stay healthy it is important to understand issues related to potential drug shortages due to COVID-19. It’s hard to know which drugs will be affected, but it’s best not to panic. Hoarding and stockpiling drugs will only cause drug shortages to happen faster. Call your healthcare provider if you have a problem getting any of your medicines.

                  • Only take medicines that are prescribed by your healthcare provider
                  • Do NOT change the medicines you’re taking without speaking to your healthcare provider

                  The Food and Drug Administration (FDA) keeps a close watch on the drug supply chain.

                  This includes the availability of active pharmaceutical ingredients (API) which are often made in other countries, and any other parts of the supply chain that may be impacted by COVID-19. You can find more information about drug shortages related to COVID-19 on the Food and Drug Administration (FDA) website.

                  Is there a shortage of tacrolimus?

                  Tacrolimus is on national shortage but we should have enough medication for everyone; however, we can avoid emergencies if we plan refills accordingly.

                  Pharmacies are able to mail, deliver, or provide curbside pick up of your medications.

                  Stay on top of your refills. When you are about 1-2 weeks away from needing a refill, call your pharmacy to make sure they have the medication.

                  If the pharmacy is not able to get your medication, contact your transplant center immediately for guidance.

                  Why isn't there a vaccine for COVID-19?

                  COVID-19 is a new strain of coronavirus. Because COVID-19 is different, it needs its own vaccine. Researchers are working to develop a vaccine against COVID-19. The process of research and development can take some time. When a vaccine is developed, it also needs to be tested to make sure it’s safe and effective.

                  What should I know about miracle cures and treatments?

                  " The FDA considers the sale and promotion of fraudulent COVID-19 products to be a threat to the public health"

                  Stephen H Hahn, MD, FDA Commissioner

                  Unfortunately, in times of uncertainty, there are people who look to prey upon those who are vulnerable. The US Food and Drug Administration (FDA) reports there are unscrupulous companies and individuals looking to fraudulently profit by scamming people who want to prevent and/or treat COVID-19.

                  Knowledge is power

                  The best way to avoid becoming a victim of fraud is to know the facts. According to the latest guidance from the CDC, there no vaccines or drugs approved to treat or prevent COVID-19. And, while there are investigational COVID-19 vaccines and treatments in development, these investigational products are still in the early stages of development and have not yet been fully tested for safety or effectiveness.

                  Beware of false promises

                  Products that claim to cure, mitigate, treat, or prevent disease, but are not proven safe and effective for those purposes, defraud consumers of money and can place consumers at risk for serious harm. Fraudulent COVID-19 products may come in many varieties, including dietary supplements, such as vitamins and minerals, foods (garlic), as well as questionable products purporting to be drugs, herbal remedies, immune boosters, medical devices, or vaccines. Using these products may lead to delays in getting proper diagnosis and treatment for COVID-19.

                  The FDA urges consumers and patients to talk to their healthcare providers and to follow the advice from federal public health agencies about how to prevent the spread and treatment options for people with COVID-19.

                  Take stock of your supplies

                  If you are caregiver for a family member or friend who is at an increased risk of serious disease, now’s the time to make sure you are prepared by doing the following.

                  • Know what medications your loved one is taking and see if you can help them have extra on hand.
                  • Monitor food and other medical supplies (oxygen, incontinence, dialysis, wound care) needed and create a back-up plan.
                  • Stock up on non-perishable food to have on hand in your home to minimize trips to stores.
                  • If your loved one is a resident in a care facility, check whether any residents have tested positive and know what will happen should an outbreak occur.

                  Are those on immunosuppressants at risk of a false negative COVID-19 diagnosis?

                  There have been reports of possible false negative COVID-19 test results in the general public. There is also the potential for false negative COVID-19 test results among kidney transplant recipients on immunosuppression. However, research is ongoing to confirm or determine the extent of false negative test results.

                  What is a generic drug?

                  Generic drugs are basically copies of brand-name drugs that have similar active ingredients. The FDA defines a generic drug as “a medication created to be the same as an existing approved brand-name drug in dosage form, safety, strength, route of administration, quality, and performance characteristics.”

                  You should contact your healthcare team before switching to generics, or making any other changes to your medications. 

                  You can visit the FDA’s website on generic drugs for more information: https://www.fda.gov/drugs/questions-answers/generic-drugs-questions-answers

                  Can people on anti-rejection medicines switch from brand to generic?

                  You should contact your transplant team first before making any changes to generics. Switching to generic medicines has been done safely with transplant patients, if the team is aware of the change and the drug levels stay consistent. They will probably have you do more frequent blood tests to make sure that your levels of the medicines are stable.

                  Generally, studies on certain anti-rejection medicines (immunosuppresants), such as tacrolimus, have shown that patients can be converted from brand to generic safely and feasibly. However, in addition to drug concentrations, plasma creatinine levels may also be monitored.

                  If you have any questions about your anti-rejection medicines, coverage, copays, and brand-vs-generic options, contact your transplant team and work with them to preserve your health and your transplanted organ. You should also talk to your pharmacy to make sure that they can consistently give you the same version of the medicine every month.

                  1. Tushla L, Medication Matters
                  2. González F, López R, Arriagada E, Carrasco R, Gallardo N, Lorca E. Switching Stable Kidney Transplant Recipients to a Generic Tacrolimus Is Feasible and Safe, but It Must Be Monitored. J Transplant. 2017;2017:5646858.
                  3. Rosenborg S, Nordstr?m A, Almquist T, Wennberg L, Bárány P. Systematic conversion to generic tacrolimus in stable kidney transplant recipients. Clin Kidney J. 2014;7: 151-

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