What are the side effects of Mycophenolate (Cellcept), including impaired coordination and insomnia?

From the Guidelines

Mycophenolate can cause neurologic effects, including insomnia, but coordination problems are not explicitly listed as a common side effect. According to the American College of Chest Physicians evidence-based clinical practice guidelines 1, mycophenolate is associated with various adverse reactions, including:

• Cardiovascular effects
• Dermatologic effects
• Endocrinologic effects
• Metabolic effects
• GI effects
• Hematologic effects
• Opportunistic infection
• Musculoskeletal effects
• Neurologic effects, such as headache, tremor, insomnia, dizziness, and anxiety
• Ocular changes
• Genitourinary effects
• Respiratory effects

The guidelines also mention that mycophenolate can increase the risk of infections and may interact with other medications, such as activated charcoal, aluminum or magnesium salts, and cholestyramine 1. It is essential to report any unusual symptoms, including insomnia or coordination problems, to your healthcare provider to determine if they are related to the medication or require adjustment of your treatment plan. The elimination half-life of mycophenolate and its extensive conversion to MPA glucuronide, which is cleared through renal excretion, may also impact its side effect profile 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Mycophenolate Side Effects

• The provided studies do not specifically mention insomnia or coordination as side effects of mycophenolate 2, 3, 4, 5, 6.
• However, the studies do report various side effects associated with mycophenolate, including:
  • Gastrointestinal adverse effects (31% of patients) 2
  • Cytopenia (4% of patients) 2
  • Infection (3% of patients) 2
  • Myelosuppression, which can lead to neutropenia 6
• It is essential to note that the studies focus on the effectiveness and tolerability of mycophenolate in treating various conditions, such as morphea, autoimmune diseases, and multifocal motor neuropathy, rather than specifically investigating its side effects.

Pharmacokinetics and Pharmacodynamics

• Mycophenolic acid, the active metabolite of mycophenolate, exhibits complex and erratic pharmacokinetics with substantial between-subject variability 3.
• Factors such as patient renal function, serum albumin levels, sex, ethnicity, food intake, and concurrent administration of interacting drugs can influence the pharmacokinetics of mycophenolate 3, 4.
• Monitoring mycophenolic acid plasma levels can help evaluate immunosuppressive therapy and minimize adverse effects 4.