Immunosuppressants: Uses, Types & Side Effects

Immunosuppressants are medications that reduce or suppress immune system activity. They can prevent the immune system from attacking healthy cells and reduce immune responses involved in autoimmune diseases.

These medications are commonly used to prevent organ rejection after a transplant and to treat autoimmune diseases such as rheumatoid arthritis, lupus, and psoriasis. Some immunosuppressants are also used as part of the treatment for certain types of cancer.

Immunosuppressants should only be used under the supervision of a healthcare provider. Regular medical appointments are important for monitoring treatment and detecting possible side effects, as these medications can increase the risk of infection.

When they're recommended

Immunosuppressants may be recommended for:

• Rheumatoid arthritis or lupus

• Aplastic anemia

• Psoriasis or alopecia areata

• Ankylosing spondylitis

• Crohn’s disease or ulcerative colitis

• Sjögren syndrome

• Multiple sclerosis

• Certain inflammatory lung diseases, such as bronchiolitis obliterans

• Gestational trophoblastic disease

• Head and neck cancer or osteosarcoma

• Non-Hodgkin lymphoma, multiple myeloma, or leukemia

Immunosuppressants are also used to prevent rejection after an organ transplant, such as a kidney, liver, heart, lung, or pancreas transplant.

According to the National Cancer Institute, immunosuppressive medications may also be used after an allogeneic bone marrow transplant or hematopoietic stem cell transplant to help prevent or treat graft-versus-host disease.

Main types

The main types of immunosuppressants include:

1. Corticosteroids

Corticosteroids, such as prednisone, dexamethasone, and prednisolone, are among the most commonly used immunosuppressants. They reduce the production of inflammatory substances and suppress immune system activity.

These medications are commonly prescribed to treat autoimmune diseases or help prevent rejection after a transplant. They may also be used as part of the treatment for certain cancers, such as multiple myeloma, lymphoma, or chronic lymphocytic leukemia.

2. Janus kinase inhibitors

Janus kinase inhibitors, also called JAK inhibitors, include medications such as tofacitinib and ruxolitinib. They block signaling pathways used by cytokines and other substances involved in inflammation and immune responses.

Tofacitinib may be prescribed for certain autoimmune or inflammatory conditions, such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, ulcerative colitis, or polyarticular-course juvenile idiopathic arthritis. Ruxolitinib may be used to treat myelofibrosis or polycythemia vera.

Ruxolitinib may also be prescribed for acute or chronic graft-versus-host disease. This complication can develop after a bone marrow or hematopoietic stem cell transplant and may be treated with ruxolitinib when corticosteroids or certain other treatments have not been effective.

3. Calcineurin inhibitors

Calcineurin inhibitors, such as cyclosporine and tacrolimus, reduce the activation of T cells and the production of substances such as interleukin-2. These substances normally help increase immune system activity.

Calcineurin inhibitors are mainly prescribed to prevent or treat organ transplant rejection. Depending on the medication and formulation, they may also be used to treat rheumatoid arthritis, severe psoriasis, or atopic dermatitis.

4. Monoclonal antibodies

Monoclonal antibodies, such as rituximab, tocilizumab, and adalimumab, act on specific targets in the body. They may block proteins or immune cells involved in inflammation or target cells involved in the growth of certain cancers.

Depending on the medication, monoclonal antibodies may be prescribed to treat rheumatoid arthritis, Crohn’s disease, ulcerative colitis, psoriasis, ankylosing spondylitis, or non-Hodgkin lymphoma.

5. Biologic agents

Biologic agents, such as etanercept and anakinra, are immunosuppressant or immunomodulatory medications made from proteins. They help reduce immune system activity and block substances involved in inflammation.

Depending on the medication, these biologic agents may be prescribed to treat rheumatoid arthritis in adults or certain forms of juvenile idiopathic arthritis. They can help relieve symptoms such as joint pain and swelling.

Possible side effects

According to the U.S. Food and Drug Administration (FDA), immunosuppressive medications can increase the risk of bacterial, viral, fungal, and opportunistic infections because they reduce the body’s immune defenses.

Possible signs of an infection or another serious adverse effect include:

• Extreme tiredness

• Weakness

• Fever

• Chills

• Pale skin

• Cough

• Difficulty breathing

• Pain in the lower back or side

• Difficulty urinating

• Pain or a burning sensation when urinating

• Sore throat or mouth sores

• Abdominal pain

Contact a healthcare provider promptly if any of these symptoms occur. If the symptoms are severe, seek urgent medical care or go to the nearest emergency room for evaluation and treatment.

Other side effects vary depending on the specific immunosuppressant. They may include nausea, vomiting, diarrhea, constipation, gas, dizziness, weight changes, diabetes, acne, high blood pressure, stomach pain, or osteoporosis.

Important precautions

Important precautions to follow while taking immunosuppressants include:

• Take the immunosuppressant at the correct times and exactly as prescribed.
• Attend regular medical appointments to monitor how well the treatment is working and check for side effects.
• Check with a healthcare provider before taking new prescription medications, over-the-counter medications, or supplements.
• Do not increase or decrease the immunosuppressant dose unless instructed by a healthcare provider.
• Do not stop taking the immunosuppressant without consulting a healthcare provider.
• Check with a healthcare provider before receiving any vaccine, as some live vaccines may be contraindicated during certain immunosuppressive treatments.
• Wash your hands frequently with soap and water, especially before eating or preparing food and after using the bathroom, touching animals, gardening, or changing a child’s diaper.
• Use an alcohol-based hand sanitizer when soap and water are not available.
• Wash fruits and vegetables thoroughly before eating them.
• Avoid close contact with people who have the flu, a cold, or another contagious infection.
• Avoid touching your eyes, mouth, or nose with unwashed hands.
• Consider limiting time in crowded, poorly ventilated indoor spaces when the risk of infection is high or when advised by a healthcare provider.

It is also important to get adequate sleep, exercise regularly as advised by a healthcare provider, and maintain a balanced diet.

Contraindications for use

Contraindications vary depending on the specific immunosuppressant. These medications should not be used by anyone who is allergic to the active ingredient or another component of the product.

Many immunosuppressants should not be started while a person has an active serious infection. Before treatment begins, a doctor should review the person’s overall health, medical history, and current medications.

Safety during pregnancy

The safety of immunosuppressants during pregnancy depends on the specific medication. Some may be used during pregnancy when the benefits outweigh the potential risks, while others can harm the developing baby and should be avoided.

People who are pregnant or breastfeeding should only use immunosuppressants under the supervision of an obstetrician and the healthcare provider managing their condition. Together, they can determine whether the expected benefits of treatment outweigh the potential risks to the parent and baby.