Mycophenolate – a tablet used for suppressing immune system

Mycophenolate – a tablet used for suppressing immune system

Mycophenolate is a tablet used to suppress the immune system.

Generic / trade names: Mycophenolate Mofetil (CellCept); Mycophenolate Sodium (Myfortic)
Uses: Prevent transplant organ rejection and a variety of autoimmune conditions
Dosage form: 250 mg; 500 mg
Drug class: Inosine monophosphate dehydrogenase (IMPDH) inhibitor (purine antagonist)

What is mycophenolate?

• Mycophenolate (CellCept/Myfortic) is an immunosuppressant medication, most commonly prescribed as mycophenolate mofetil (MMF) or mycophenolate sodium.
• It belongs to a class of drugs known as inosine monophosphate dehydrogenase (IMPDH) inhibitors. It specifically reduces the production of certain immune cells.

Uses

Mycophenolate is used to treat people with:

• Organ transplants: To prevent the body from rejecting a transplanted kidney, heart, lung or liver (usually used in combination with other medications like prednisolone and ciclosporin).
• Lupus Nephritis: A serious complication of Systemic Lupus Erythematosus (SLE) affecting the kidneys.
• Other autoimmune conditions: Such as refractory rheumatoid arthritis, vasculitis, or certain inflammatory skin and eye conditions (often used ‘off-label’ when other treatments are ineffective).

Dosage

• Taken twice daily (usually 12 hours apart) on an empty stomach or with food, but you must be consistent with whichever method you choose.
• The tablets or capsules should be swallowed whole; do not crush or chew them.
• The dose is individualised: For adult kidney transplant patients, a common dose is 1g twice daily (2g total per day).
• Like many immunosuppressants, it may take several weeks to reach its full therapeutic effect.

Side-effects

Common side-effects

• Digestive issues: Diarrhoea, stomach cramps, nausea, and vomiting.
• Increased risk of infection: More frequent colds, urinary tract infections (UTIs), or respiratory infections.
• Tiredness: Feeling unusually weak or fatigued.
• Headaches and dizziness.

Less common (and more serious) side-effects

• Severe Infection: Because it lowers immunity, it can cause severe, sometimes fatal infections (e.g. pneumonia, sepsis).
• Pregnancy Risk: High risk of congenital malformations and miscarriage; women must use effective contraception before, during, and 6 weeks after treatment.
• Cancer Risk: Increased risk of skin cancers and lymphatic cancers (lymphoma).
• Blood Disorders: Low white blood cell count (neutropenia), anaemia, or low platelets (unusual bleeding/bruising).
• Gastrointestinal: Severe diarrhoea, constipation, nausea, or GI bleeding.
• Liver Damage: Yellowing of the skin or eyes (jaundice).

Note: If you develop a sudden fever, persistent sore throat, or unusual bleeding, contact your doctor immediately.

How it works

• It works by reducing the activity of the body’s immune system.
• It does this by blocking the production of T and B lymphocytes (white blood cells) – by disrupting their DNA/RNA synthesis.
• By limiting the production of lymphocytes, it helps prevent the body from attacking its own healthy tissues (what happens in autoimmune disease) or rejecting a transplanted organ.
• Mycophenolate mofetil is a prodrug which is rapidly converted to mycophenolic acid (MPA).
• Mycophenolate sodium is not a prodrug. Instead, it is the active delayed-release salt formulation of MPA.

Monitoring

Your doctor should monitor:

• Frequent blood tests: You will need regular Full Blood Counts (FBC) to monitor your white cell levels, and Liver Function Tests (LFTs) to ensure your liver is processing the drug safely.
• Pregnancy prevention: For women of childbearing age, pregnancy tests are required before starting, and two forms of effective contraception must be used during treatment and for six weeks after stopping.
• Skin: Because the drug increases your sensitivity to UV light, you should be monitored for any changing moles, and wear high-SPF sunscreen.