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Mycophenolate mofetil 💊
⚠️ Specialist use only. Mycophenolate is an immunosuppressive agent widely used in transplantation and autoimmune disease management. It has a relatively favourable side effect profile compared with other agents but requires careful monitoring. Always check the BNF for prescribing details.
💊 About
- Blocks de novo purine synthesis → suppresses lymphocyte proliferation.
- Used in solid organ transplant regimens and autoimmune diseases.
- Available in oral and IV formulations.
⚙️ Mechanism
- Converted to mycophenolic acid.
- Inhibits inosine monophosphate dehydrogenase (IMPDH) → specific inhibition of T and B lymphocytes.
- Spares other rapidly dividing cells compared to older immunosuppressants.
🎯 Indications & Typical Doses
- Transplantation: Used with steroids + calcineurin inhibitor (e.g. tacrolimus, ciclosporin). Dose: 2–3 g/day in divided doses.
- Autoimmune disease (off-label): Lupus nephritis, myasthenia gravis, vasculitis, rheumatoid arthritis. Dose: 1–2 g/day.
- Monitoring: Weekly FBC for 4 weeks → fortnightly for 2 months → monthly thereafter.
⚠️ Cautions
- Close blood monitoring due to risk of bone marrow suppression.
- Monitor LFTs and renal function in long-term therapy.
- Vaccinations may be less effective while on treatment.
🚫 Contraindications
- Pregnancy (teratogenic; reliable contraception required).
- Active serious infection.
💥 Side Effects
- Bone marrow suppression (anaemia, leukopenia, thrombocytopenia).
- GI upset: nausea, vomiting, diarrhoea.
- Hepatotoxicity: jaundice, hepatitis.
- ↑ Opportunistic infections (CMV, EBV, fungal).
- ↑ Risk of malignancy with long-term use (especially skin cancers, lymphoma).
🔄 Interactions
- Allopurinol: safe (unlike azathioprine).
- Clozapine: risk of agranulocytosis (avoid combination).
- Rifampicin: ↓ mycophenolate levels (enzyme induction).
📚 References
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