Mycophenolate Mofetil (MMF) Dosing for a 69.8 kg Patient
For a patient weighing 69.8 kg, the recommended dose of Mycophenolate Mofetil (MMF) is 600 mg/m² administered twice daily, which calculates to approximately 1000 mg twice daily (2 g total daily dose).
Calculating the Appropriate Dose
To determine the correct MMF dose for this patient, we need to:
- Calculate the body surface area (BSA)
- Apply the recommended dosing formula
Body Surface Area Calculation
For a 69.8 kg adult, the BSA is approximately 1.8 m² (using standard BSA calculation formulas).
Dose Determination
According to the FDA label, for pediatric patients, the recommended dose is 600 mg/m² twice daily (up to a maximum of 2 g daily) 1. For adults, this translates to:
- 600 mg/m² × 1.8 m² = 1080 mg per dose
- Rounded to a practical dose: 1000 mg twice daily
This aligns with the FDA-approved adult dosing for renal transplant patients, which is 1 g twice daily (2 g total daily dose) 1.
Dosing Considerations by Indication
The appropriate dose may vary depending on the specific indication:
- Renal transplantation: 1 g twice daily (2 g total daily) 1
- Cardiac or hepatic transplantation: 1.5 g twice daily (3 g total daily) 1
- Autoimmune conditions: Starting at 500 mg twice daily, titrating up to 1 g twice daily 2
- Inflammatory myopathy: Start at 500 mg twice daily, titrate up to 1 g twice daily 3, 4
- Primary immune thrombocytopenia: Progressive dosing from 250 mg up to 1000 mg twice daily 3
Administration Guidelines
- Administer on an empty stomach for optimal absorption (food decreases maximum concentration by 40%) 1
- If gastrointestinal side effects occur, may be taken with food if necessary 1
- For patients with severe chronic renal impairment (GFR < 25 mL/min/1.73 m²), doses greater than 1 g twice daily should be avoided 1
Monitoring Recommendations
- Complete blood count: Monitor regularly for leukopenia or neutropenia
- Liver function tests: Monitor for hepatotoxicity
- If neutropenia develops (ANC < 1.3 × 10³/μL), interrupt dosing or reduce dose 1
Common Adverse Effects
- Gastrointestinal: Abdominal pain, diarrhea, nausea, vomiting
- Hematologic: Leukopenia, anemia
- Infectious: Increased risk of opportunistic infections, particularly cytomegalovirus
- Other: Headache, fatigue
Important Considerations
- Women of childbearing potential should use reliable contraception as MMF is teratogenic 3
- Compliance may be an issue at higher doses due to gastrointestinal side effects 3
- For patients with severe gastrointestinal side effects, consider splitting the total daily dose into three or four smaller doses
In conclusion, for a 69.8 kg patient, the standard dose of 1000 mg twice daily is appropriate for most indications, with adjustments based on the specific condition being treated and patient tolerance.