Drug Index

Mycophenolate Mofetil

Synonym :


Mechanism :

Mycophenolate mofetil is a potent, selective, uncompetitive, and reversible inhibitor of inosine monophosphate dehydrogenase (IMPDH), and therefore inhibits the de novo pathway of guanosine nucleotide synthesis without incorporation into DNA. Because T- and B-lymphocytes are critically dependent for their proliferation on de novo synthesis of purines, whereas other cell types can utilize salvage pathways, it has potent cytostatic effects on lymphocytes.

Indication :

  • Cardiac transplant
  • Renal transplant
  • Liver transplant
  • Steroid resistant nephrotic syndrome

Contraindications :

Contraindicated in patients with a hypersensitivity to mycophenolate mofetil, mycophenolic acid or any component of the drug product. With other immunosuppressive treatments, patients treated with mycophenolate are at increased risk of developing lymphomas, and other malignancies, particularly of the skin. Patients should avoid exposure to strong sunlight. Administer with caution in patients with active gastrointestinal disease. Gastrointestinal perforation has been reported.

Dosing :

Organ transplant:
Given along with cyclosporine or tacrolimus.
600 mg/m²/dose 2 times daily. First dose within 72 hours after transplant. Max: 2 gm/day.

Adverse Effect :

Leukopenia, sepsis, opportunistic infection, fever, back pain, abdominal and generalized pain, headache, asthenia, peripheral oedema, anemia, hypochromic anemia, leukopenia, leucocytosis, thrombocytopenia, renal tubular necrosis, haematuria, hypertension, hypo and hyperkalemia, hyperglycemia, hypophosphatemia, hypercholesterolemia, hypomagnesemia, peripheral edema, diarrhea, nausea, vomiting, bleeding, constipation, dyspepsia, melanoma, acne, dizziness, insomnia, tremor.

Interaction :

Food: Reduces the peak plasma level but does not reduce total absorption.
Cholestyramine: Significantly impairs the absorption of mycophenolate.
Antacids: Absorption is impaired if given at the same time as antacids containing magnesium or aluminium hydroxides. A sufficient Interval should be allowed between giving each drug.
Acyclovir, Ganciclovir: Concurrent administration with acyclovir, ganciclovir can result in higher plasma concentrations of all three drugs.

Renal Dose :

Dose in Renal Impairment GFR (mL/min)
20-50Dose as in normal renal function
10-20Mycophenolate mofetil: 1 g twice a day; mycophenolate sodium: dose as in normal renal function
<10Mycophenolate mofetil: 1 g twice a day; mycophenolate sodium: dose as in normal renal function

Dose in Patients undergoing Renal Replacement Therapies
CAPDNot dialysed. Dose as in GFR<10 mL/min
HDNot dialysed. Dose as in GFR<10 mL/min
HDF/High fluxUnknown dialysability. Dose as in GFR<10 mL/min
CAV/VVHDNot dialysed. Dose as in normal renal function

Hepatic Dose :

No dose adjustments are recommended.
Mycophenolic acid (MPA) is highly bound to albumin, and patients with severe hepatic impairment or with any other condition leading to hypoalbuminemia may have increased free MPA concentrations. Use with caution.
03/18/2024 23:03:57 Mycophenolate Mofetil
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