Mycophenolate Mofetil (MMF) Dosing According to BNFC
According to the British National Formulary for Children (BNFC), the recommended dose of mycophenolate mofetil (MMF) for pediatric patients is 600 mg/m² administered twice daily (up to a maximum daily dose of 2 g/10 mL oral suspension). 1
Pediatric Dosing Based on Body Surface Area
- For children with body surface area (BSA) of 1.25-1.5 m²: 750 mg twice daily (1.5 g daily dose) using MMF capsules 1
- For children with BSA >1.5 m²: 1 g twice daily (2 g daily dose) using MMF capsules or tablets 1
- For younger children with smaller BSA: 600 mg/m² twice daily using oral suspension 1
Age-Dependent Considerations
Research indicates that MMF dosing requirements vary with age in pediatric patients:
- Younger children (around 2 years old) may require higher doses of approximately 500 mg/m² twice daily 2
- Adolescents typically require lower doses of around 250 mg/m² twice daily 2
- This age-dependent dosing pattern shows substantial interpatient variability of approximately 44% 2
Formulations and Administration
MMF is available in multiple formulations:
- Oral suspension (for younger children)
- Capsules (for children with appropriate BSA)
- Tablets (for older children with BSA >1.5 m²)
The medication should be administered twice daily, ideally on an empty stomach, as food has been shown to decrease maximum concentration (Cmax) by 40% 1.
Concomitant Medication Considerations
The dosage of MMF should be adjusted based on concomitant immunosuppressive therapy:
- When used with tacrolimus: Lower doses may be required (approximately 300 mg/m² twice daily) 3
- When used with cyclosporine: Standard dose of 600 mg/m² twice daily 3
- When used without calcineurin inhibitors: Intermediate dose of approximately 500 mg/m² twice daily 3
Monitoring and Safety
Regular monitoring is essential when administering MMF to pediatric patients:
- Complete blood count weekly for the first month, then monthly
- Liver function tests monthly
- Monitoring for signs of infection and gastrointestinal side effects
Common Adverse Effects
- Gastrointestinal: nausea, vomiting, abdominal cramping (most common)
- Hematologic: anemia, leukopenia, thrombocytopenia (rare)
- Genitourinary: urgency, frequency, dysuria (rare)
- Increased susceptibility to viral and bacterial infections
Important Precautions
- MMF is contraindicated in pregnancy due to risk of severe congenital malformations
- Adolescent females of childbearing potential should use two reliable forms of contraception
- Therapeutic drug monitoring may be beneficial due to substantial interpatient variability
This dosing information aligns with the FDA-approved pediatric dosing recommendations for renal transplantation, which is the primary indication for MMF use in children.