Indication |
- Prophylaxis of transplant rejection in liver, kidney or heart allograft recipients
- Also used for some auto-immune diseases
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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®
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Contraindications |
- Hypersensitivity to mycophenolate or any of the excipients
- Avoid in breasfeeding women
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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
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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
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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
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Dose in renal impairment |
- Avoid doses > 1g BD or 720 mg BD. Not dialysed
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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)
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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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