Mycophenolate-Mofetil

Indications

Mycophenolate Mofetil is an immunosuppressant, a medicine that lowers the activity of the immune system. It is used together with other medicines such as Ciclosporin or Tacrolimus and steroids to prevent the body from rejecting a transplanted kidney, heart or liver. Specialists also use it for some autoimmune diseases, such as lupus nephritis (kidney inflammation caused by lupus).

How It Works

In the body, mycophenolate mofetil is changed to mycophenolic acid. This blocks an enzyme called IMPDH that white blood cells (lymphocytes) need to make DNA and multiply. With fewer active lymphocytes, the immune system is less able to attack the new organ or the body's own tissues.

Dosage and Administration

Mycophenolate is a specialist medicine and must be taken exactly as prescribed by the transplant or specialist team; the dose depends on the organ, the other medicines used and blood test results. Tablets or capsules are usually taken twice a day, about 12 hours apart, on an empty stomach or as directed. Swallow them whole; do not crush, chew or open them. The injection is given into a vein by a doctor or nurse. Never stop or change the dose without talking to your specialist.

Interactions

Antacids containing magnesium or aluminium, Colestyramine, iron and some proton pump inhibitors can reduce absorption. Aciclovir, Ganciclovir and Valganciclovir levels can rise. Rifampicin and some antibiotics can lower mycophenolate levels. Live vaccines (such as oral polio, BCG, yellow fever, MMR) should be avoided. It may make hormonal contraceptives less reliable. Azathioprine should not be used with it.

Contraindications

Do not use mycophenolate if you are allergic to it, are pregnant (unless no other suitable treatment exists), are a woman able to have children who is not using highly effective contraception, or are breastfeeding.

Side Effects

Common side effects include diarrhoea, nausea, vomiting, stomach pain, low white blood cell or platelet counts, anaemia, infections (including viral infections like CMV and shingles), high blood pressure, headache, tremor and swelling. Long-term use increases the risk of skin cancer and lymphoma. Rare problems include a serious brain infection (PML) and pure red cell aplasia.

Get urgent medical help if you have fever, chills, sore throat or other signs of infection, unusual bruising or bleeding, severe diarrhoea, black stools or vomiting blood, new confusion, weakness or problems with vision or speech, or signs of a serious allergic reaction.

Pregnancy and Lactation

Mycophenolate can cause miscarriage and serious birth defects. Women must have a negative pregnancy test before starting and use effective contraception during treatment and for 6 weeks after stopping. Men should use condoms during treatment and for 90 days after, and their partners should also use contraception. It must not be used while breastfeeding.

Precautions and Warnings

Regular blood tests are needed. Avoid crowds and people with infections where possible, and report any infection quickly. Limit sun exposure and use high-factor sunscreen because of the skin cancer risk. Do not donate blood during treatment and for 6 weeks after, and men should not donate semen for 90 days after. Handle tablets carefully and do not let other people, especially pregnant women, touch broken tablets.

Overdose

Overdose may increase the risk of infections and low blood counts, along with diarrhoea and vomiting. Contact your doctor or go to hospital straight away.

Therapeutic Class

Immunosuppressant, antiproliferative agent (IMPDH inhibitor).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children. Injections are stored as directed on the pack.