Indications
Mycophenolic Acid (as mycophenolate sodium delayed-release tablets) is an immunosuppressant used together with other medicines, such as Cyclosporine or Tacrolimus and corticosteroids, to prevent the body from rejecting a transplanted kidney. Specialists sometimes use it for certain autoimmune diseases, such as lupus nephritis.
How It Works
Mycophenolic Acid blocks an enzyme (IMPDH) that white blood cells called lymphocytes need to make the building blocks of DNA. Because T and B lymphocytes depend heavily on this pathway, they cannot multiply, so the immune attack on the transplanted organ is reduced.
Dosage and Administration
The dose is set by your transplant specialist, as prescribed, and is usually taken twice a day. Swallow the tablets whole on an empty stomach (1 hour before or 2 hours after food), at the same times each day. Do not crush, chew or cut them. Delayed-release mycophenolate sodium tablets and mycophenolate mofetil are not interchangeable milligram for milligram, so never switch between them without your doctor’s advice. Do not stop taking it unless your doctor tells you to.
Interactions
- Antacids containing Magnesium or Aluminium, and Cholestyramine or Sevelamer: reduce absorption; separate doses.
- Azathioprine: should not be used together (both suppress the bone marrow).
- Live vaccines (such as MMR, oral polio, BCG, yellow fever): avoid while taking it.
- Aciclovir, Ganciclovir and Valganciclovir: levels of both may rise, especially with kidney problems.
- Rifampicin, Proton pump inhibitors and some antibiotics: may reduce its levels.
- Hormonal contraceptives: may be less effective; use an additional method.
Contraindications
- Allergy to Mycophenolic Acid, mycophenolate mofetil or any ingredient.
- Pregnancy, unless no suitable alternative exists to prevent transplant rejection.
- Women who could become pregnant and are not using highly effective contraception.
- Breastfeeding.
- Rare hereditary HGPRT deficiency (Lesch-Nyhan or Kelley-Seegmiller syndrome).
Side Effects
Common effects include diarrhoea, nausea, vomiting, stomach pain, low white blood cell counts, anaemia, infections (such as urinary, chest, cold sores or shingles) and high blood pressure. Long-term use raises the risk of skin cancer and lymphoma.
Get urgent medical help if you have fever, chills, sore throat or other signs of infection; unusual bruising or bleeding; black or bloody stools or vomiting blood; severe or persistent diarrhoea; new confusion, weakness on one side or problems with vision or speech (a rare brain infection called PML); or signs of a severe allergic reaction.
Pregnancy and Lactation
Mycophenolic Acid can cause miscarriage and serious birth defects. Women of childbearing potential need a negative pregnancy test before starting and must use effective contraception during treatment and for 6 weeks after stopping. Men should use condoms during treatment and for at least 90 days after stopping. Do not breastfeed while taking it.
Precautions and Warnings
Regular blood counts and kidney and liver tests are needed. Limit sun exposure and use sunscreen because of skin cancer risk. Avoid contact with people who have infections, and report any infection early. Do not donate blood during treatment and for 6 weeks after, and men should not donate sperm for 90 days after.
Overdose
An overdose may increase the risk of severe bone marrow suppression, infections and stomach problems. Contact a doctor or go to hospital at once.
Therapeutic Class
Immunosuppressant (antimetabolite, IMPDH inhibitor).
Storage
Store below 30°C in a dry place, away from light and out of the reach of children. Keep tablets in their original pack. Pregnant women should avoid handling broken tablets.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.