What is the recommended dose of Cellcept (mycophenolate mofetil) for a patient weighing 69.8 kg?

Mycophenolate Mofetil (CellCept) Dosing for a 69.8 kg Patient

For a patient weighing 69.8 kg, the recommended dose of CellCept (mycophenolate mofetil) is 1 g administered orally twice daily for a total daily dose of 2 g for renal transplantation, or 1.5 g twice daily for a total daily dose of 3 g for cardiac or hepatic transplantation. 1

Dosing Based on Transplant Type

Renal Transplantation

• Adult dose: 1 g orally twice daily (2 g total daily dose)
• Although 1.5 g twice daily (3 g total daily dose) was used in clinical trials, no efficacy advantage was established, and the 2 g daily dose demonstrated a better overall safety profile 1

Cardiac Transplantation

• Adult dose: 1.5 g orally twice daily (3 g total daily dose) 1

Hepatic Transplantation

• Adult dose: 1.5 g orally twice daily (3 g total daily dose) 1

Dosing for Autoimmune Conditions

For autoimmune hepatitis, when used as second-line therapy (usually after azathioprine failure or intolerance):

• Initial dose: 500 mg twice daily
• Titrate up to 1 g twice daily (2 g total daily dose) 2

Administration Considerations

• CellCept should be administered on an empty stomach as food decreases maximum concentration (Cmax) by 40% 1
• However, in stable renal transplant patients, it may be administered with food if necessary 1
• For missed doses, patients should take the dose as soon as remembered, unless it is near the next scheduled dose 1

Dose Adjustments

Renal Impairment

• For severe chronic renal impairment (GFR < 25 mL/min/1.73 m²) outside the immediate post-transplant period, doses greater than 1 g twice daily should be avoided 1
• Careful observation is required for these patients

Neutropenia

• If neutropenia develops (ANC < 1.3 × 10³/μL), dosing should be interrupted or reduced 1

Hepatic Impairment

• No dose adjustments are recommended for renal transplant patients with severe hepatic parenchymal disease 1

Monitoring

• Regular monitoring of complete blood count is essential due to potential bone marrow suppression
• Liver function tests should be performed intermittently throughout treatment
• For autoimmune hepatitis, aim to normalize both ALT and IgG levels 2

Common Side Effects

• Gastrointestinal: abdominal pain, diarrhea, nausea, vomiting
• Hematologic: leukopenia, anemia
• Increased risk of infections, particularly cytomegalovirus
• Hair loss may occur in some patients 3

Clinical Efficacy

Mycophenolate mofetil has demonstrated superior efficacy compared to azathioprine in preventing acute rejection in renal transplant recipients, with biopsy-proven rejection occurring in only 15.9-19.7% of patients on MMF compared to 35.5% on azathioprine 4.

By inhibiting inosine monophosphate dehydrogenase, MMF selectively suppresses T and B lymphocyte proliferation, providing effective immunosuppression with a different mechanism of action than calcineurin inhibitors 5.

Practical Considerations

• For this 69.8 kg patient, no weight-based adjustment is needed as they fall within the standard adult dosing range
• The medication should be started as soon as possible following transplantation 1
• When used for autoimmune conditions, dosing may need to be individualized based on response and tolerability

Remember that the choice between the 2 g and 3 g daily dose depends primarily on the type of transplant, with renal transplant patients typically receiving the lower dose due to its better safety profile.