Recommended Dosage of Mycophenolate Mofetil (MMF) for Sjögren's Disease with Parkinsonism
The recommended dose of mycophenolate mofetil (MMF) for a patient with Sjögren's disease and Parkinsonism is to start at 500 mg twice daily and gradually increase to a therapeutic dose of 1,000-1,500 mg twice daily. 1
Dosing Protocol
Initial Dosing
- Start at 500 mg PO twice daily
- Gradually increase the dose to minimize gastrointestinal side effects
- Target therapeutic dose: 1,000-1,500 mg twice daily (2-3 g total daily dose)
Dose Adjustments
- Adjust based on:
- Clinical response
- Tolerability
- Laboratory monitoring
- For patients experiencing significant side effects, consider:
- Dividing the total daily dose into more than two administrations
- Temporary dose reduction until side effects resolve
Monitoring Recommendations
Baseline Testing (Before Starting MMF)
- Complete blood count (CBC) with differential
- Comprehensive metabolic panel (CMP)
- Hepatitis B and C screening
- Tuberculosis screening
Ongoing Monitoring
- CBC with differential and CMP:
- 2-3 weeks after starting
- 2-3 weeks after any dose increase
- Every 3 months once on stable dose 1
- Annual full body skin examination (preferably by a dermatologist)
Special Considerations for Sjögren's with Parkinsonism
For patients with Sjögren's disease and associated Parkinsonism:
- Monitor neurological symptoms closely during treatment
- Consider that Parkinsonism associated with Sjögren's syndrome may respond to immunosuppressive therapy 2
- Assess for improvement in both Sjögren's symptoms and Parkinsonism features
Potential Side Effects
Common Side Effects
- Gastrointestinal symptoms (diarrhea, nausea, abdominal pain)
- Increased risk of infections
- Bone marrow suppression (leukopenia, anemia)
- Hepatotoxicity
Management of Side Effects
- For GI side effects: Consider dividing the total daily dose into more than two administrations 3
- For hair loss: Check thyroid function, iron stores, vitamin D, and zinc levels 4
- For severe side effects: Dose reduction may be necessary
Precautions and Contraindications
- Black box warning regarding pregnancy - contraindicated during pregnancy
- Use caution in patients with renal impairment
- Increased risk of opportunistic infections
Efficacy Considerations
- MMF has shown efficacy in various autoimmune conditions including Sjögren's disease with interstitial lung disease 1
- Allow adequate time (at least 3-6 months) to assess clinical response before determining efficacy
By following this dosing protocol and monitoring schedule, the therapeutic benefits of MMF can be maximized while minimizing potential adverse effects in patients with Sjögren's disease and Parkinsonism.