Page 37 - Heart Transplant Protocol

Heart Function Service: Heart Transplant Protocols

Dosing
1-3 months of age and >24 months of age: 30 mg/kg/day once daily (maximum dose: 1500 mg/day)

4-24 months of age: 45 mg/kg/day once daily (maximum dose: 1500 mg/day) Adolescents 13-16 years
and Adults: 1500 mg once daily

Drug interactions
Rifampin may decrease plasma Atovaquone concentration

Food interactions
Food increases bioavailability of Atovaquone suspension 1.4-fold over that achieved in a fasting state or
up to 3-fold with a high fat meal.

Pentamidine is indicated in patients for the treatment and prevention of pneumonia caused by
Pneumocystis jiroveci (formerly carinii) in patients who cannot tolerate or who fail to respond to
Sulfamethoxazole/Trimethoprim or Dapsone

Dosing
300mg inhaled every month for 12 months
I.M., I.V.: 4 mg/kg/dose every 2-4 weeks

Dosing adjustment in renal impairment:
Clcr 10-30 mL/min: Administer normal dose once every 36 hours
Clcr <10 mL/min: Administer normal dose once every 48 hours

Drug interactions
Aminoglycosides, Amphotericin, Cisplatin and Vancomycin (additive nephrotoxicity) Didanosine (additive
toxicity)

Immunization Protocol

 Document immunizations at the time of assessment for transplant with ID consult
 Assess IgG response to immunization with serology during assessment for transplant
 Provide direction for updating immunizations following transplant assessment if needed
 Recommend update of immunizations for siblings and other household family members
 Consider accelerated immunization schedules if appropriate
o eg: MMR as early as 4-6 months
o DTaP-IPV, Hib as early as 6 weeks and next 2 doses given at 4 week intervals
 No routine live virus vaccine(s) once listed for transplantation unless discussed with Transplant
team

Updated November 9, 2017 37