Transplants and Counterfeit Medicines: What You Need to Know

Receiving an organ transplant is like being given a new lease on life, but that lease comes with an exceptionally important string attached to it. Strict adherence to your prescribed medications is your best line of defense against rejection. The Cleveland Clinic says that not taking anti-rejection medicines as prescribed is the third major cause of transplant failure. Sadly, even if you go to every follow-up appointment and take every single pill, this can still happen to you. Black market medicines are something you need to stay away from. They have been found to have too little, too much, and no active ingredient whatsoever. Any of these things will compromise your chance of success. Only FDA-approved medicines guarantee you the best chances of your body accepting your new organ.

Which organ you had transplanted will affect which medications and dosages you are prescribed, but several drugs are common to organ transplants: tacrolimus, cyclosporine, mycophenolate mofetil, and azathioprine, which are all immunosuppressants, and prednisone, which is a steroid. Taking multiple medications for the rest of your life can add up quickly so being concerned about the cost of medications you need to stay alive is only natural. However, purchasing your medications from illegal online pharmacies is never a viable option.

Let’s take a look at one of the prescriptions mentioned above, azathioprine. Your doctor writes you a prescription for 60 50-milligram azathioprine pills each month. A search on lists the best cash price in the U.S. as $23.85, at Ralphss. If there isn’t a Ralphss near you, the three next best prices were at chains with locations nationwide and cost about $3.00 more. We looked at the price on an online “Canadian” pharmacy and the quote for 112 50-milligram pills was $83. (Note that these businesses are neither licensed pharmacies nor even Canadian, in most cases) You can get more FDA-approved pills (120 pills for $49.54) from a licensed U.S. pharmacy for 40 percent less than that company is selling (112 pills for $83).

And just to be sure, we called a Rexall pharmacy in Winnipeg, Manitoba, a place that is selling medicine from Canada’s official drug supply chain, and asked what the cash price would be for 60 50-milligram azathioprine. The price they quoted was $48.75 CAD, which converts to $38.70 USD. So the real pills at a real pharmacy in Canada cost 56% more than the same pills at a U.S. pharmacy, but also 88% less than whatever it is that Canadian online pharmacy is selling. Wonder where that online Canadian pharmacy is getting its pills from?

Always remember the easiest and fastest way to save money on your prescriptions is to choose the generic version of the drugs. Generics have the same active ingredient as the brand-name version, but they generally cost up to 80 percent less.

If you are struggling to afford your medications, the first place you should look for help is They have a free prescription drug discount program that can help you save up to 80 percent off the cash price for medications, as well as two very useful resources: their diagnosis-based assistance program information and their searchable list of prescription assistance programs. For cyclosporine, for example, there are six patient assistance programs available.

Making risky choices with your medications can cost you. Counterfeit drugs have managed to make their way into the U.S.’s secure drug supply chain and into the body of an organ transplant recipient before. In February 2002, 16-year-old Timothy Fagan in New York needed an emergency liver transplant. The following month his doctor prescribed him a weekly injection of Epogen to treat post-surgery anemia. Sadly, some counterfeit Epogen had made its way into the U.S.’s secure drug supply system. According to an article in, the medicine that was in this vial contained only one-twentieth the amount of active ingredient. When Fagan received the counterfeit injections, he suffered terrible cramps and he screamed so loudly at night that his seven-year-old sister covered her ears. In a second case in 2015, the U.S. Food and Drug Administration sent warning letters to over 300 medical practices in 34 states who purchased medications from Gallant Pharmaceuticals. Included in the list of 39 non-FDA approved drugs sold by Gallant was Methylprednisone, a drug by transplant patients.

Prescription adherence post-transplant is a matter of life or death. Facing taking multiple medications for the rest of your life can add up quickly, but choosing to purchase any of your medications from an illegal online pharmacy will only increase your chance of rejection.