From the Guidelines
Mycophenolate is primarily used as an immunosuppressant medication to prevent rejection in solid-organ transplants and to treat autoimmune disorders, such as systemic lupus erythematosus and immune thrombocytopenia (ITP) 1. The use of mycophenolate involves its conversion to its active form, mycophenolic acid, which inhibits inosine monophosphate dehydrogenase, an enzyme necessary for purine synthesis primarily in lymphocytes, thereby inhibiting DNA synthesis of T and B cells. Some key points to consider when using mycophenolate include:
- Administration: orally at a dose of 500 to 2000 mg per day in adults and doses of 1300 mg/m2 per day (maximum of 2000 mg) in children 1
- Side effects: common side effects include diarrhea, neutropenia, anemia, and viral infections, with a small increased risk of malignancy and progressive multifocal leukoencephalopathy with prolonged use 1
- Contraindications: mycophenolate is a teratogen and should not be used during pregnancy or lactation 1
- Monitoring: regular blood monitoring is essential to check for leukopenia, anemia, and thrombocytopenia In the context of lupus nephritis, mycophenolate has been shown to be effective, but the benefit of any immunosuppression should be carefully weighed against the likelihood of harm, particularly in patients with advanced chronic kidney disease 1. Overall, mycophenolate is a valuable treatment option for autoimmune disorders and solid-organ transplants, but its use requires careful consideration of the potential benefits and risks, as well as regular monitoring for side effects 1.
From the FDA Drug Label
Mycophenolate mofetil is an antimetabolite immunosuppressant indicated for the prophylaxis of organ rejection in recipients of allogeneic kidney, heart or liver transplants, in combination with other immunosuppressants. (1) Mycophenolate mofetil is indicated for the prophylaxis of organ rejection, in adult and pediatric recipients 3 months of age and older of allogeneic kidney [see Clinical Studies (14.1)], heart [see Clinical Studies (14.2)] or liver transplants [see Clinical Studies (14.3)] , in combination with other immunosuppressants.
The use of Mycophenolate is for the prophylaxis of organ rejection in recipients of allogeneic kidney, heart, or liver transplants, in combination with other immunosuppressants 2, 2, 2.
- Key indications include:
- Kidney transplants
- Heart transplants
- Liver transplants
- Important consideration: Mycophenolate should be used in combination with other immunosuppressants.
From the Research
Use of Mycophenolate
- Mycophenolate is an immunosuppressant medication used to prevent rejection in organ transplant patients, including kidney and heart transplant recipients 3, 4, 5, 6.
- It is often used in combination with other immunosuppressants, such as prednisone and tacrolimus, to achieve optimal immunosuppressive effects 3, 4, 6.
- Mycophenolate has been shown to be effective in reducing the risk of biopsy-proven rejection, graft loss, and mortality in heart transplant patients 5.
- The medication works by inhibiting the proliferation of T and B lymphocytes, which are involved in the immune response 7.
Dosage and Administration
- The dosage of mycophenolate varies depending on the patient's age, weight, and other factors, and is often adjusted based on the patient's response to treatment and the presence of adverse effects 5, 7.
- Mycophenolate can be administered orally or intravenously, and is available in several formulations, including mycophenolate mofetil and mycophenolate sodium 7.
- The use of a risk-stratified approach to dosing mycophenolate has been shown to be safe and effective in heart transplant patients 5.
Potential Side Effects
- Mycophenolate can cause a range of side effects, including hepatotoxicity, nephrotoxicity, and increased risk of infection 4, 7.
- The medication can also cause hematological toxicity, gastrointestinal symptoms, and other adverse effects 7.
- The risk of side effects can be minimized by careful monitoring of the patient's response to treatment and adjustment of the dosage as needed 7.