From the Guidelines
Mycophenolate mofetil is generally well tolerated, but patients should be aware of potential side effects, including nausea, vomiting, abdominal cramping, headaches, and fatigue, as well as rare hematologic and genitourinary symptoms 1. The most common side effects of mycophenolate mofetil include:
- Gastrointestinal symptoms such as nausea, vomiting, and abdominal cramping, which may improve with the use of the enteric-coated formulation
- Headaches and fatigue, which are not dose-dependent and do not tend to negatively impact compliance Some rare but significant side effects include:
- Hematologic symptoms such as anemia, leukopenia, and thrombocytopenia
- Genitourinary symptoms such as urgency, frequency, and dysuria There is also a theoretical risk of increased susceptibility to viral and bacterial infections, as well as a potential risk of cutaneous malignancy and lymphoma, although the applicability of these risks to patients with atopic dermatitis is unknown 1. It is essential to monitor patients taking mycophenolate mofetil for these potential side effects and to report any unusual symptoms to their healthcare provider. Key points to consider when prescribing mycophenolate mofetil include:
- The use of the enteric-coated formulation to minimize gastrointestinal symptoms
- Regular monitoring for hematologic and genitourinary symptoms
- Patient education on the potential risks and benefits of the medication, including the importance of reporting unusual symptoms to their healthcare provider 1.
From the FDA Drug Label
Mycophenolate mofetil for injection can cause serious side effects, including: Increased risk of loss of a pregnancy (miscarriage) and higher risk of birth defects. Increased risk of getting certain cancers. People who take mycophenolate mofetil for injection have a higher risk of getting lymphoma, and other cancers, especially skin cancer Increased risk of getting serious infections.
The side effects of Mycophenolate include:
- Increased risk of loss of a pregnancy (miscarriage) and higher risk of birth defects
- Increased risk of getting certain cancers, especially skin cancer and lymphoma
- Increased risk of getting serious infections 2
From the Research
Mycophenolate Side Effects
- Gastrointestinal adverse effects are a major concern with mycophenolate mofetil (MMF) use, including diarrhea, abdominal pain, vomiting, and nausea 3, 4, 5, 6, 7
- The mechanism of diarrhea induced by MMF is unknown, but it may be related to the inhibition of inosine monophosphate dehydrogenase (IMPDH) 4
- Histopathologic examination of patients with MMF-induced diarrhea has shown villous atrophy 4
- The incidence of diarrhea with MMF is higher than with azathioprine, especially at higher doses 5
- CMV infection incidence is also higher with MMF compared to azathioprine 5
- Leukopenia incidence is higher with MMF, especially at higher doses 5
- Enteric-coated mycophenolate sodium (EC-MPS) was developed to reduce upper-gastrointestinal effects of MMF, but it has not significantly improved GI side effects 6
- Conversion to EC-MPS may be an effective option for patients experiencing GI complications with MMF 7
- Maintaining adequate mycophenolic acid exposure is essential to maximize short- and long-term outcomes in renal transplant patients, and monitoring of GI complications is crucial 7