Effects of Mycophenolate Mofetil on Serum Potassium
Mycophenolate mofetil can cause electrolyte abnormalities including alterations in serum potassium as part of its metabolic and endocrine side effect profile, though this is not among its most common or clinically significant adverse effects. 1
Electrolyte Effects
The Endocrine Society reports that mycophenolate mofetil causes metabolic and endocrine effects including electrolyte abnormalities, alongside hyperglycemia, hypercholesterolemia, Cushingoid changes, and hirsutism. 1
These electrolyte disturbances are listed as recognized adverse effects but are not characterized as frequent or severe compared to the drug's more prominent gastrointestinal, hematologic, and infectious complications. 1
Clinical Context and Monitoring
The primary adverse effects requiring vigilant monitoring are gastrointestinal toxicity (nausea, diarrhea, abdominal pain affecting 3-34% of patients), hematologic suppression (anemia, leukopenia, thrombocytopenia), and increased infection risk due to immunosuppression. 1
Standard monitoring protocols focus on CBC counts (weekly for the first month, twice monthly for months 2-3, then monthly for the first year) and comprehensive metabolic panels including renal and hepatic profiles at regular intervals. 1
The comprehensive metabolic panel monitoring would capture serum potassium levels as part of routine electrolyte assessment, though specific potassium-related toxicity is not emphasized in guideline recommendations. 1
Important Caveats
In patients with renal impairment, mycophenolate mofetil requires particular attention as the glucuronide metabolite (MPAG) accumulates significantly—approximately five times normal levels in end-stage renal disease—which may increase susceptibility to various adverse effects including metabolic disturbances. 2, 3
The accumulation of MPAG in renal dysfunction is primarily associated with gastrointestinal intolerance rather than specific electrolyte derangements, but comprehensive metabolic monitoring remains essential in this population. 3
Dose adjustments based on electrolyte abnormalities should be considered on an individual basis when toxicity manifests, though preemptive dose reduction for renal function alone is not routinely required. 4