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MMF GI Side Effects Management — SCE Rheumatology MCQ

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ModerateRheumatology PharmacologyMMF GI Side Effects ManagementSCE Rheumatology

A 50-year-old woman with SLE on Mycophenolate develops persistent diarrhoea. Her rheumatologist suspects Mycophenolate-related GI toxicity. What options exist if GI side effects limit Mycophenolate use?

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Correct answer: A — Switching from Mycophenolate mofetil to Mycophenolate sodium (enteric-coated formulation) may reduce upper GI symptoms; alternatively dose splitting taking with food or switching to an alternative immunosuppressant can be considered

GI side effects (diarrhoea nausea abdominal pain) are the most common dose-limiting adverse effects of Mycophenolate mofetil occurring in up to 30% of patients. Management options include: switching to enteric-coated Mycophenolate sodium (Myfortic) which may reduce upper GI symptoms (though lower GI symptoms may persist) dose splitting (taking smaller doses more frequently) taking with food (reduces absorption slightly but improves tolerance) and dose reduction. If these strategies fail alternative immunosuppressants (Azathioprine Tacrolimus Ciclosporin) should be considered depending on the indication. GI symptoms should prompt exclusion of infection (CMV C difficile) before attributing to the drug.

Reference: BNF Mycophenolate; EULAR 2023 SLE recommendations