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Mycophenolate Mofetil

Immunosuppressive drug, Autoimmune disease, Anemia treatment

Brand Names

CellCept®

Drug Information

Pharmacology

Immunosuppressant

Contraindications

General
  • Do not use in patients with known sensitivity to mycophenolate.
  • Patients with severe renal dysfunction may require dosage adjustment.
  • IV mycophenolate must be given over at least 2 hours – can’t be given by IV bolus or rapid IV infusion.
  • For humans there is a black box warning regarding potential increased risk for lymphoma associated with its use.
  • It is recommended to avoid use during pregnancy if at all possible as risk to the fetus is possible.

Adverse Effects

General
  • Veterinary studies of the use of this drug are limited. Adverse event profile is unknown.
  • Adverse effects in dogs reported at the time of publishing include vomiting, diarrhea, anorexia, lethargy, lymphopenia, increased rates of dermal infections.
  • Because of the immunosuppressive actions increased systemic infection and malignancy rates are also possible.
  • In humans, the most common side effects include GI effects and headache. Hypertension and peripheral edema occur in about 30% of patients. Leukopenia occurs in 25 – 45% of patients. Other more rare effects include GI bleeding, severe neutropenia, cough, confusion, tremor, infection and malignant lymphoma.

Interactions

General Interactions
  • Probenecid may potentially increase serum levels of mycophenolic acid and the phenolic glucuronide of mycophenolic acid
Category Interactions
Antacid
  • Aluminum or magnesium containing antacids may decrease absorption of mycophenolate – separate by 2 hours.
Oral iron supplement
  • May decrease absorption of mycophenolate – separate by 2 hours.
Vaccination
  • May be less effective – avoid use.
Drug Interactions
Acyclovir
  • Increased serum concentrations of acyclovir and the phenolic glucuronide of mycophenolic acid may occur.
Aspirin / Acetylsalicylic acid
  • May potentially increase concentrations of free mycophenolic acid.
AzaTHIOprine
  • Additive risk for bone marrow suppression – use together is not advised in humans.
ESOmeprazole
  • Esomeprazole may reduce mycophenolic acid (MPA; active metabolite) levels.

Comments

Veterinary studies of the use of this drug are limited. May also be useful in cats but no information is available on safety or efficacy.
Monitor CBC, profile baseline and periodically.
Preferably give on an empty stomach. If vomit or anorexia occur give with food to see if resolves.
Because this drug can cause birth defects – the manufacturer recommends that tablets not be crushed or split and capsules not be opened.
Powder for oral solution is reconstituted with 94 mL of water and may be stored at room temperature or refrigerated. Unused portion should be discarded after 60 days.
Injectable product should be stored at 25 degrees C. Each vial should be reconstituted with 14 mL of 5% dextrose injection – gently agitate to dissolve. Further dilute with 5% dextrose to a concentration of 6 mg/mL for IV administration. This would be an additional 70 mL of dextrose 5% per vial. It is recommended to administer within 6 hours of reconstitution.
Injectable solution should not be mixed or given with any other medication or diluent.
IV injection should occur over 2 hours – do not give by bolus or rapid IV administration.

Available Forms

Human
  • Capsules – 250 mg; CellCept® Tablets – 500 mg; CellCept® Powder for oral suspension – 200 mg/mL in 225 mL bottles; CellCept® Lyophilized powder for injection – 500 mg in 20 mL vial; CellCept® Mycophenolate is also available as the sodium salt in oral delayed release tablets – Myfortic®. It does not appear that his dosage form will be useful for veterinary patients.
Veterinary – General
  • None