Home Drug Guide Mycophenolate Mofetil

Drug Guide

Generic Name

Mycophenolate Mofetil

Brand Names Cellcept, Myhibbin

Classification

Therapeutic: Immunosuppressant

Pharmacological: Antimetabolite

FDA Approved Indications

Prevention of organ rejection in kidney, heart, and liver transplantation

Mechanism of Action

Inhibits inosine monophosphate dehydrogenase, leading to suppression of de novo guanine nucleotide synthesis, which impairs lymphocyte proliferation.

Dosage and Administration

Adult: Varies based on condition and protocol, typically 1g twice daily; dosage may be adjusted based on response and tolerability.

Pediatric: Dosing based on body surface area or weight; specific regimens should be guided by a transplant specialist.

Geriatric: Dose adjustments may be needed due to increased risk of infection and malignancy; careful monitoring required.

Renal Impairment: Requires dosage adjustment; consult specific guidelines.

Hepatic Impairment: Use with caution; no specific dosage adjustment provided.

Pharmacokinetics

Absorption: Orally well absorbed, with bioavailability around 94%.

Distribution: Extensively protein-bound (~97%).

Metabolism: Converted to active metabolite mycophenolic acid by hydrolysis.

Excretion: Primarily via urine as metabolites; small amount via feces.

Half Life: Approximately 16-18 hours for active metabolite.

Contraindications

Hypersensitivity to mycophenolate mofetil or its components.
Pregnancy — teratogenic risk.

Precautions

Use with caution in patients with active infections, hematologic abnormalities, or malignancies. Monitor blood counts and renal function regularly.

Adverse Reactions - Common

Gastrointestinal upset (nausea, vomiting, diarrhea) (Common)
Leukopenia (Common)
Increased risk of infections (Common)

Adverse Reactions - Serious

Pancytopenia (Serious)
Progressive multifocal leukoencephalopathy (PML) (Rare)
Lymphoma or other malignancies (Rare)

Drug-Drug Interactions

Azathioprine, tacrolimus, cyclosporine (increased immunosuppression, risk of infection)
Live vaccines (contraindicated)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor complete blood count, renal function, liver enzymes, and for signs of infection.

Diagnoses:

Risk for infection
Risk for bleeding due to hematologic effects

Implementation: Administer with food to minimize gastrointestinal upset. Monitor for adverse effects.

Evaluation: Assess response to therapy, transplant rejection status, and adverse effects regularly.

Patient/Family Teaching

Take medication exactly as prescribed.
Report signs of infection, bleeding, or unusual symptoms.
Avoid live vaccines during therapy.
Use effective contraception—risk of fetal harm.

Special Considerations

Black Box Warnings:

Increased risk of infectious complications and lymphoma. Risks during pregnancy—teratogenic and abortifacient effects. Use contraception during treatment and for some time after discontinuation.
Immunosuppressants may increase susceptibility to infections and malignancies.

Genetic Factors: No specific genetic testing recommended yet.

Lab Test Interference: May affect monitoring of blood cell counts and immune function.

Overdose Management

Signs/Symptoms: Severe diarrhea, infections, hematologic abnormalities.

Treatment: Supportive care; no specific antidote. Hemodialysis may be considered, but efficacy is uncertain.

Storage and Handling

Storage: Store at room temperature, away from moisture, heat, and light.

Stability: Stable in original container for up to 30 days after opening.