Indications
Mycophenolate Mofetil or Mycophenolic acid is indicated for the prophylaxis of organ rejection in patients receiving allogeneicrenal, cardiac or hepatic transplants. This should be used concomitantly with cyclosporine and corticosteroids.
Therapeutic Class
Immunological Chemotherapy, Immunosuppressant
Pharmacology
Mycophenolate Mofetil or Mycophenolic acid acts by blocking purine synthesis of human lymphocytes through reversible inhibition of inosine monophosphate dehydrogenase. It also inhibits proliferation of both T- and B- lymphocytes.
Dosage & Administration
Renal Transplantation:
Adults: A dose of 1 gm administered orally or intravenously (over NO LESS THAN 2 HOURS) twice a day (daily dose of 2 gm) is recommended for use in renal transplant patients. Although a dose of 1.5 g administered twice daily (daily dose of 3 gm) was used in clinical trials and was shown to be safe and effective, no efficacy advantage could be established for renal transplant patients. Patients receiving 2 gm/day of Mycophenolate demonstrated an overall better safety profile than did patients receiving 3 gm/day of Mycophenolate .
Pediatrics (3 Months To 18 Years Of Age): The recommended dose of Mycophenolate oral suspension is 600 mg/m2 administered twice daily (up to a maximum daily dose of 2 gm/10 ml oral suspension). Patients with a body surface area of 1.25 m2 to 1.5 m2 may be dosed with Mycophenolate capsules at a dose of 750 mg twice daily (1.5 g daily dose). Patients with a body surface area >1.5 m2 may be dosed with Mycophenolate capsules or tablets at a dose of 1 gm twice daily (2 gm daily dose).
Cardiac Transplantation: A dose of 1.5 g bid administered intravenously (over NO LESS THAN 2 HOURS) or 1.5 g bid oral (daily dose of 3 gm) is recommended for use in adult cardiac transplantpatients.
Hepatic Transplantation: A dose of 1 gm bid administered intravenously (over NO LESS THAN 2 HOURS) or 1.5 g bid oral (daily dose of 3 gm) is recommended for use in adult hepatic transplantpatients.
Interaction
Increased plasma levels of both drugs when combined with aciclovir, valaciclovir, ganciclovir and valganciclovir. Reduced absorption with colestyramine, magnesium- and aluminium hydroxide-containing products, sevelamer and other calcium-free phosphate binders. Reduced plasma levels with ciclosporin, metronidazole, quinolones, rifamycins. May reduce plasma levels of progestins; may reduce efficacy of oral contraceptives. Increased plasma levels with probenecid. May reduce efficacy of live vaccines.
Contraindications
Pregnancy, lactation. Rare hereditary deficiency of hypoxanthine-guanine phosphoribosyltransferase (HGPRT), including Kelley-Seegmiller or Lesch-Nyhan syndrome.
Side Effects
Diarrhoea, vomiting, GI haemorrhage and perforation; leucopenia; asthenia, pain, headache, anaemia, thrombocytopenia, renal tubular necrosis, haematuria, BP changes, hyperglycaemia, disturbances of electrolytes and blood lipids, peripheral oedema, dyspnoea, cough, acne, rash, alopecia, dizziness, insomnia, paraesthesia, tremor, hypersensitivity reactions, pancreatitis, hepatitis.
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