Medication Informed Consent for CellCept (Mycophenolate Mofetil)
Purpose of Medication
CellCept (mycophenolate mofetil) is an immunosuppressant medication used to prevent organ rejection in transplant patients or to treat autoimmune conditions by suppressing your immune system.
Important Risks and Side Effects
By taking this medication, you acknowledge understanding of the following serious risks:
Pregnancy risks: CellCept has a BLACK BOX WARNING for severe birth defects and pregnancy loss. You must use two effective forms of contraception before, during, and for 6 weeks after stopping treatment if you can become pregnant 1.
Increased infection risk: This medication suppresses your immune system, making you more vulnerable to serious and potentially life-threatening infections 2.
Cancer risk: Long-term use increases your risk of developing lymphoma, skin cancer, and other malignancies 2, 1.
Blood disorders: Regular blood tests are required to monitor for leukopenia, anemia, thrombocytopenia, and neutropenia 2.
Common Side Effects
- Gastrointestinal: Diarrhea, nausea, vomiting, abdominal pain
- Hematologic: Decreased white blood cells, red blood cells, and platelets
- Other: Headache, high blood pressure, swelling, fatigue
Monitoring Requirements
- Weekly blood tests for the first month
- Twice monthly for months 2-3
- Monthly for the remainder of the first year
- Every 1-3 months thereafter 2
Special Precautions
- Do not donate blood while taking this medication and for at least 6 weeks after stopping
- Do not donate sperm while taking this medication and for at least 90 days after stopping
- Avoid live vaccines while on this medication
- This medication may impair your ability to drive or operate machinery
Drug Interactions
Avoid taking with:
- Antacids containing aluminum or magnesium
- Cholestyramine
- Activated charcoal
- Iron supplements
- Certain antivirals (acyclovir, ganciclovir)
- Azathioprine 2
I understand the risks, benefits, and monitoring requirements associated with CellCept (mycophenolate mofetil) therapy as explained above.
Patient Name: _________________________ Date: _____________
Patient Signature: ______________________
Healthcare Provider Signature: _____________________ Date: _____________