mycophenolate mofetil: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
mycophenolate mofetil: clinical details
Prescribing considerations
- Transplant treatment should be initiated and maintained by appropriately qualified specialists.
- Exclude pregnancy and document contraception counselling before initiation where relevant.
- Review vaccination status before treatment; avoid live vaccines during clinically significant immunosuppression.
- Assess infection history, active serious gastrointestinal disease, malignancy risk and sun-protection measures.
- Consider mycophenolic-acid exposure monitoring when changing interacting immunosuppressants or in high immunological-risk situations.
- Patients should not donate blood during treatment or for six weeks afterwards; semen donation should be avoided during treatment and for 90 days afterwards.
Contraindications and cautions
- Hypersensitivity to mycophenolate mofetil, mycophenolic acid or product excipients
- A person of childbearing potential who is not using highly effective contraception
- Initiation without an appropriate negative pregnancy test in a person of childbearing potential
- Pregnancy, unless no suitable alternative can prevent transplant rejection
- Breastfeeding
- For relevant suspensions, product-specific excipient contraindications such as hereditary fructose intolerance
Monitoring
- Before treatment: pregnancy testing where applicable, full blood count, renal and liver function, albumin, blood pressure and vaccination status.
- After initiation or a treatment change: monitor full blood count, renal function, liver enzymes and albumin closely.
- Once stable: continue regular haematological, renal and hepatic monitoring.
- Investigate infection, unexplained cytopenia, bruising, bleeding, gastrointestinal symptoms, weight loss or new respiratory symptoms promptly.
Clinical pharmacology
Mycophenolate mofetil is a prodrug of mycophenolic acid, a selective, reversible inhibitor of inosine monophosphate dehydrogenase. It preferentially restricts T- and B-lymphocyte proliferation. Enterohepatic recirculation contributes materially to exposure and explains several interactions.
Formulation and product differences
- Selected products include hard capsules, film-coated tablets and powders for oral suspension.
- Tablets must not be crushed and capsules must not be opened because of teratogenic handling risk.
- Oral suspensions require reconstitution, shaking and an appropriate oral dispenser; excipients and tube-administration instructions differ between products.
- Solid and liquid formulations should not be substituted without clinical supervision.
mycophenolate mofetil preparations and strengths
Capsule
Route: Oral
Strengths: 250 mg
Oral suspension
Route: Oral
Strengths: 1 g, 1 g/5 mL
Tablet
Route: Oral
Strengths: 500 mg
mycophenolate mofetil interactions
Check all prescribed, over-the-counter and herbal products with the transplant or specialist team. Important interactions include:
Cholestyramine
Can substantially reduce mycophenolic acid exposure and effectiveness.
Rifampicin
Can markedly reduce mycophenolic acid exposure, requiring specialist monitoring and review.
Certain antibiotics
May temporarily reduce mycophenolic acid exposure.
Sevelamer and other phosphate binders
May reduce absorption; administration may need separating under pharmacist or specialist direction.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.