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Last updated: Acute Kidney Injury…
on 10 Apr 2017

Mycophenolate



Indication
  • Prophylaxis of transplant rejection in liver, kidney or heart allograft recipients
  • Also used for some auto-immune diseases
Preparations
  • Anti-proliferative immunosuppressant
  • 250 mg caps, 500 mg tabs, oral suspension (1g/5ml), Injection 500mg.
  • Mycophenolate mofetil does NOT need to be prescribed by brand
  • Intravenous and oral doses are equivalent
  • Do NOT switch between mycophenolate mofetil (MMF) and mycophenolic acid (1g=720mg)
  • Mycophenolate sodium (Mycophenolic acid):180 mg or 360 mg tablets as Myfortic®
Contraindications
  • Hypersensitivity to mycophenolate or any of the excipients
  • Avoid in breasfeeding women
Cautions
  • Monitor FBC (and LFTs) regularly; daily in immediate post-transplant periodAvoid in pregnancy - congenital malformations have been reported, a negative pregnancy test is required before commencing therapy and contraception is required during therapy and for 6 weeks after stopping
  • Live vaccines should also be avoided
  • If neutropenia develops (absolute neutrophil count  <1.3) it may be appropriate to interupt or discontinue mycophenolate
Side-effects
  • Dose-related bone marrow suppression. Infection and malignancies (esp lymphoma, skin and cervical cancer).
  • Many side-effects including diarrhoea, abdominal pain, rash and gingival hyperplasia
  • Rarely pure red cell aplasia (PRCA) and interstitial lung disease
Dose
  • MMF: 1-1.5g BD. Intravenous dose is equivalent to oral dose
  • IV MMF 1g BD as an infusion over 2 hours (peripherally or centrally)
  • Mycophenolic acid = 720 mg BD. No IV preparation
Dose in renal impairment
  • Avoid doses > 1g BD or 720 mg BD. Not dialysed
Interactions
  • Separate doses
  • Levels ↓ by sevelamer, colestyramine, antacids and oral iron
  • Levels ↑ by aciclovir and ganciclovir

Note: care with tacrolimus and ciclosporin (monitor levels of these drugs)

How to Prescribe View Details
Patient comment
  • There is an increased risk of infection and certain cancers (including skin and cervical)
  • Avoid sunbathing, use high factor sun cream and women should attend for yearly cervical smears
  • Avoid live vaccines – ask your pharmacist
  • Swallow tablets whole do not crush tablets
  • Avoid in pregnancy and breastfeeding

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