Drug reference

Mycophenolate Mofetil

Immunosuppressant · Immunosuppressant; Prophylaxis of graft rejection in renal transplantation

Also known as Myfenax, Mycophenolate mofetil hydrochloride

ImmunosuppressantImmunosuppressant; Prophylaxis of graft rejection in renal transplantation

CDSCO approvedSchedule H

EXCRETION

—

not curated

INTERACTIONS

12 major

SEVERE in our sources

PREGNANCY

Avoid unless no suitable alternative; associated with congenital malformations and spontaneous abortions.

FDA category + note

Top interactionssee all 12 →

Activated CharcoalSevereDatabaseDDInter
AdalimumabSevereDatabaseDDInter
AmoxycillinSevereDatabase
BaricitinibSevereDatabaseDDInter

Mechanism

Mycophenolate mofetil is a prodrug that is rapidly hydrolyzed to mycophenolic acid (MPA), a selective, reversible, non-competitive inhibitor of inosine monophosphate dehydrogenase (IMPDH) type II — the rate-limiting enzyme in the de novo pathway of guanosine nucleotide synthesis. Because T and B lymphocytes depend almost exclusively on this de novo pathway (unlike most other cells that can use the salvage pathway), MPA selectively suppresses lymphocyte proliferation while relatively sparing other rapidly dividing cells. This immunological selectivity provides effective immunosuppression with less myelotoxicity than azathioprine.

Indications

Prophylaxis of organ rejection in adults undergoing kidney transplantationprophylaxis of transplant rejectionsystemic lupus erythematosus (off-label)ms (off-label)sarcoidosis (off-label)induction and maintenance of remission in difficult-to-treat IBDpatients who are intolerant of thiopurinessteroid-dependent patients

Dosing

Adult: doses should be reduced when allopurinol p. 1183 is given concurrently. Mycophenolate mofetil is metabolised to mycophenolic acid which has a more selective mode of action than azathioprine.…

Contraindications

Pregnancy (unless no suitable alternative due to reported congenital malformations and spontaneous abortions)
pregnancy

Side effects

Common

dizzinessgouthepatic disordershyperbilirubinaemiahyperuricaemianeuromuscular dysfunctiontaste alteredvasodilationgi (diarrhea and vomiting)hematological (leukopenia, pure red cell aplasia) problemscolitis (paradoxical, reported in patients using it to prevent transplant rejection)

Serious