Mycophenolate

• Prophylaxis of transplant rejection in liver, kidney or heart allograft recipients
• Also used for some auto-immune diseases

• 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®

• Hypersensitivity to mycophenolate or any of the excipients
• Avoid in breasfeeding women

• 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

• 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

• 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

• Avoid doses > 1g BD or 720 mg BD. Not dialysed

• 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)

• 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