When can Cellcept (mycophenolate mofetil) be resumed after an infection?

When to Resume CellCept (Mycophenolate Mofetil) After Infection

CellCept should be resumed once the infection has completely resolved, which typically means at least 3 days since resolution of fever without antipyretics, significant improvement in respiratory or other infection symptoms, and at least 10 days since symptoms first appeared.

General Guidelines for Resuming CellCept After Infection

The decision to restart CellCept after an infection requires balancing the risk of immunosuppression against the risk of disease flare. The following approach is recommended:

Symptom-Based Strategy (Preferred Approach)

• Wait until ALL of the following criteria are met:
  • At least 3 days (72 hours) since recovery defined as resolution of fever without fever-reducing medications 1
  • Clinically meaningful improvement in infection symptoms (e.g., cough, shortness of breath, drainage) 1
  • At least 10 days have passed since symptoms first appeared 1

Test-Based Strategy (Alternative Approach)

• For severe infections or in high-risk patients, consider:
  • Meeting all clinical criteria above PLUS
  • Two consecutive negative tests for the infectious agent (if applicable) collected ≥24 hours apart 1

Special Considerations Based on Infection Type and Severity

Mild Infections

• For uncomplicated infections that have been treated with antibiotics, CellCept can typically be restarted after completion of the antibiotic course and full resolution of symptoms 1
• Ensure no significant swelling, erythema, or drainage at infection site before restarting 1

Moderate to Severe Infections

• For more severe infections, consider a longer waiting period (up to 14 days) after symptom resolution 1
• The FDA label for mycophenolate notes that dose reduction or discontinuation should be considered in patients who develop new infections, weighing the risk of reduced immunosuppression against the risk of infection complications 2

COVID-19 Specific Guidance

• For patients with COVID-19, follow the symptom-based strategy above
• For severe COVID-19, consider extending the waiting period before resuming CellCept 1

Monitoring After Resuming CellCept

• Once CellCept is restarted, monitor closely for:
  • Signs of infection recurrence
  • Complete blood counts to check for neutropenia, which may be exacerbated by both infection and CellCept 2
  • If neutropenia develops (ANC < 1.3 x 10³/μL), consider interrupting or reducing the CellCept dose 2

Common Pitfalls to Avoid

1. Restarting too early: Resuming CellCept before complete resolution of infection can lead to prolonged or worsened infection 3

2. Waiting too long: Excessive delay in restarting may lead to disease flares in conditions like lupus or transplant rejection 1

3. Ignoring drug interactions: Some antibiotics (penicillins, sulfonamides, trimethoprim) may increase mycophenolate levels by decreasing its binding to albumin or reducing renal elimination 3

4. Failing to monitor for opportunistic infections: Patients on CellCept are at increased risk for opportunistic infections that may occur after restarting therapy 2

By following these guidelines, you can safely resume CellCept after infection while minimizing both infection complications and disease flares.