Mycophenolate Mofetil Dosage for Transplant Patients
For renal transplant patients, the recommended dose is 1 g orally twice daily (2 g total daily dose), while cardiac and hepatic transplant patients require 1.5 g twice daily (3 g total daily dose). 1
Standard Adult Dosing by Transplant Type
Renal Transplantation
- Standard dose: 1 g twice daily (2 g/day total) 1
- A 3 g/day dose (1.5 g twice daily) was studied but showed no efficacy advantage over 2 g/day, with a worse safety profile 1
- Administer on an empty stomach for optimal absorption, though stable renal transplant patients may take with food if necessary 1
Cardiac Transplantation
- Dose: 1.5 g twice daily (3 g/day total) 1
Hepatic Transplantation
- Dose: 1.5 g twice daily (3 g/day total) 1
Pediatric Dosing (Ages 3 Months to 18 Years)
The recommended dose is 600 mg/m² twice daily using oral suspension, with a maximum daily dose of 2 g. 1
Body Surface Area-Based Adjustments:
- BSA 1.25-1.5 m²: 750 mg capsules twice daily (1.5 g/day) 1
- BSA >1.5 m²: 1 g capsules or tablets twice daily (2 g/day) 1
Important Pediatric Consideration:
When combined with tacrolimus rather than cyclosporine, significantly lower doses are required (approximately 300 mg/m² twice daily vs. 600 mg/m² twice daily) due to altered MPA clearance 2
Dose Adjustments for Special Populations
Severe Chronic Renal Impairment
- **For GFR <25 mL/min/1.73 m² outside immediate post-transplant period:** Avoid doses >1 g twice daily 1
- Carefully observe these patients for adverse effects 1
- No dose adjustment needed for delayed graft function immediately post-transplant 1
Neutropenia
- If ANC <1.3 × 10³/µL: Interrupt dosing or reduce dose 1
Hepatic Impairment
- No dose adjustment recommended for severe hepatic parenchymal disease in renal transplant patients 1
- Insufficient data for cardiac/hepatic transplant patients with severe hepatic disease 1
Elderly Patients
- Standard dosing applies (1 g twice daily for renal, 1.5 g twice daily for cardiac/hepatic transplants) 1
Alternative Formulations and Dosing
Mycophenolic Acid (Enteric-Coated)
For patients with gastrointestinal side effects, switch to mycophenolic acid at 720-1080 mg twice daily (approximately equivalent to mycophenolate mofetil 1-1.5 g twice daily). 3
Maintenance Dosing in Lupus Nephritis
- Early maintenance phase: Mycophenolate mofetil 750-1000 mg twice daily, or mycophenolic acid 540-720 mg twice daily 3
Critical Dosing Considerations
Drug Interactions Affecting Dosage
- With tacrolimus: Apparent MPA clearance is reduced; consider starting at lower doses (300 mg/m² twice daily in pediatrics) 2
- With cyclosporine: Standard dosing typically tolerated (600 mg/m² twice daily in pediatrics) 2
- Absorption inhibited by antacids (aluminum/magnesium), cholestyramine, iron, and activated charcoal 4
Therapeutic Drug Monitoring
- Target MPA AUC: 20-60 µg·h/mL for optimal efficacy and safety 5, 6
- High interindividual variability exists even with fixed dosing 5, 6
- MPA level at 2 hours post-dose correlates best with AUC (r=0.622) 6
- Consider checking MPA blood levels if gastrointestinal intolerance develops 4, 7
Common Pitfall: Geographic and Ethnic Variations
Thai patients often cannot tolerate the standard 2 g/day dose due to gastrointestinal effects, with most maintained on 0.5-2 g/day based on tolerability, yet 91% still achieve therapeutic MPA levels 6. This highlights the importance of dose individualization based on tolerance while monitoring for therapeutic adequacy.
Timing of Initial Dose
Administer the first dose as soon as possible following transplantation 1