From the Guidelines
Mycophenolate mofetil (MMF) rarely causes significant hepatotoxicity, but if drug-induced liver injury (DILI) is suspected, the offending medication should be discontinued immediately. The management of DILI from MMF requires prompt recognition and monitoring of liver function tests. According to the study published in the American Journal of Transplantation 1, MMF and mycophenolic acid (MPA) do not exhibit the rare side effect of cholestatic hepatitis, which is associated with azathioprine (AZA). However, frequent side effects of MMF include gastrointestinal issues, such as gastritis, nausea, diarrhea, and abdominal pain.
In terms of adverse effects and monitoring, a study published in the Journal of the American Academy of Dermatology 1 notes that MMF is generally well tolerated, with nausea, vomiting, and abdominal cramping being the most common side effects. While the study does not specifically address DILI, it highlights the importance of monitoring for potential adverse effects, including hematologic and genitourinary symptoms.
Key considerations in the management of DILI from MMF include:
- Prompt discontinuation of the offending medication if DILI is suspected
- Regular monitoring of liver function tests
- Avoiding alcohol and other hepatotoxic medications
- Potential use of N-acetylcysteine in severe cases
- Consideration of hepatology consultation in severe cases.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Mycophenolate Mofetil (MMF) and Liver Transplantation
- MMF is used as an immunosuppressant in liver transplantation to prevent rejection 2.
- The combination of MMF and tacrolimus has been shown to be effective in preventing acute cellular rejection compared to tacrolimus alone 2.
- However, MMF can cause gastrointestinal side effects, which may limit its use in some patients 3, 4.
MMF-Induced Hepatotoxicity
- MMF-induced hepatotoxicity can occur, although it is not common 5.
- In one case report, a patient developed hepatotoxicity while taking MMF, which led to tacrolimus nephrotoxicity 5.
- The patient's liver function improved after MMF was withdrawn, but the reintroduction of MMF worsened liver function and led to nephrotoxicity 5.
Treatment of Immune Checkpoint Inhibitor-Related Liver Injury with MMF
- MMF has been used to treat immune checkpoint inhibitor-related liver injury that relapses during corticosteroid tapering 6.
- In two case reports, MMF was effective in treating liver injury and allowed for the discontinuation or reduction of corticosteroids 6.
Comparison of MMF and Enteric-Coated Mycophenolate Sodium (EC-MPS)
- EC-MPS may be associated with less severe gastrointestinal side effects compared to MMF 4.
- However, one study found no significant difference in gastrointestinal symptoms between patients taking EC-MPS and those taking MMF 4.
- Another study found that gastrointestinal symptoms improved significantly when patients were converted from MMF to EC-MPS 4.