Mycophenolate Mofetil interactions

Conditions

Conditions in which Mycophenolate Mofetil needs care, as documented in this source.

• Neutropenia

  Major

  Severe neutropenia has occurred in up to 2% of patients administered mycophenolate. Therapy with mycophenolate should be administered cautiously in patients with or predisposed to neutropenia. Mycophenolate should be discontinued or the dose reduced in patients who develop neutropenia (absolute neutrophil count <1300/mm3). Clinical monitoring of hematopoietic function is recommended. Complete blood counts should be performed weekly during the first month, two times a month during the second and third months, and monthly for the remainder of the first year of treatment.

  5 sources

  1. Deierhoi MH, Kauffman RS, Hudson SL, Barber WH, Curtis JJ, Julian BA, Gaston RS, Laskow DA, Diethelm AG "Experience with mycophenolate mofetil (RS61443) in renal transplantation at a single center." Ann Surg 217 (1993): 476-82;disc. 482-4
  2. Sollinger HW, Belzer FO, Deierhoi MH, Diethelm AG, Gonwa TA, Kauffman RS, Klintmalm GB, McDiarmid SV, Roberts J, Rosenthal JT, et al. "RS-61443 (mycophenolate mofetil). A multicenter study for refractory kidney transplant rejection." Ann Surg 216 (1992): 513-8;disc. 518-9
  3. Taylor DO, Ensley RD, Olsen SL, Dunn D, Renlund DG "Mycophenolate mofetil (RS-61443): preclinical, clinical, and three- year experience in heart transplantation." J Heart Lung Transplant 13 (1994): 571-82
  4. "Product Information. CellCept (mycophenolate mofetil)." Roche Laboratories (2001):
  5. Mrozek-Orlowski M, Christie J, Flamme C, Novak J "Pain associated with peripheral infusion of carmustine." Oncol Nurs Forum 18 (1991): 942

• Gastrointestinal Hemorrhage

  Moderate

  Gastrointestinal, rectal, and duodenal hemorrhage, hemorrhagic pancreatitis and rarely, large-intestine perforation have occurred in patients receiving mycophenolate. These events occurred primarily at dosages of mycophenolate >2 grams per day. Therapy with mycophenolate should be administered cautiously in patients with active gastrointestinal disease.

  5 sources

  1. Deierhoi MH, Kauffman RS, Hudson SL, Barber WH, Curtis JJ, Julian BA, Gaston RS, Laskow DA, Diethelm AG "Experience with mycophenolate mofetil (RS61443) in renal transplantation at a single center." Ann Surg 217 (1993): 476-82;disc. 482-4
  2. "Placebo-controlled study of mycophenolate mofetil combined with cyclosporin and corticosteroids for prevention of acute rejection. European Mycophenolate Mofetil Cooperative Study Group." Lancet 345 (1995): 1321-5
  3. Taylor DO, Ensley RD, Olsen SL, Dunn D, Renlund DG "Mycophenolate mofetil (RS-61443): preclinical, clinical, and three- year experience in heart transplantation." J Heart Lung Transplant 13 (1994): 571-82
  4. Kirklin JK, Bourge RC, Naftel DC, Morrow WR, Deierhoi MH, Kauffman RS, White-Williams C, Nomberg RI, Holman WL, Smith DC Jr "Treatment of recurrent heart rejection with mycophenolate mofetil (RS- 61443): initial clinical experience." J Heart Lung Transplant 13 (1994): 444-50
  5. "Product Information. CellCept (mycophenolate mofetil)." Roche Laboratories (2001):

• Kidney Diseases

  Moderate

  Mycophenolate undergoes complete presystemic metabolism to its active form, MPA . Less than 1% of MPA is excreted in the urine. In a single-dose study, the area under the curve (AUC) for MPA in patients with severe chronic renal impairment (creatinine clearance <25 mL/min) was approximately 75% greater than those of healthy volunteers (creatinine clearance >80 mL/min). The AUC for the inactive metabolite was 3 to 6 times higher. Multiple dose studies have not been performed. No data are available for cardiac transplant patients with severe renal impairment and when benefit outweighs risk, therapy with mycophenolate should be administered with extreme caution.

  6 sources

  1. Deierhoi MH, Kauffman RS, Hudson SL, Barber WH, Curtis JJ, Julian BA, Gaston RS, Laskow DA, Diethelm AG "Experience with mycophenolate mofetil (RS61443) in renal transplantation at a single center." Ann Surg 217 (1993): 476-82;disc. 482-4
  2. Sollinger HW, Belzer FO, Deierhoi MH, Diethelm AG, Gonwa TA, Kauffman RS, Klintmalm GB, McDiarmid SV, Roberts J, Rosenthal JT, et al. "RS-61443 (mycophenolate mofetil). A multicenter study for refractory kidney transplant rejection." Ann Surg 216 (1992): 513-8;disc. 518-9
  3. "Product Information. CellCept (mycophenolate mofetil)." Roche Laboratories (2001):
  4. Keown P, Hayry P, Mathew T, Morris P, Stiller C, Barker C, Carr L, Landsberg D, Hardie I, Rigby R, Isoniemi H, Gray D, Belitsk "A blinded, randomized clinical trial of mycophenolate mofetil for the prevention of acute rejection in cadaveric renal transplantation, by the tricontinental mycophenolate mofetil renal transplantation study group." Transplantation 61 (1996): 1029-37
  5. Bullingham RES, Nicholls A, Hale M "Pharmacokinetics of mycophenolate mofetil (RS61443): a short review." Transplant Proc 28 (1996): 925-9
  6. Bullingham R, Monroe S, Nicholls A, Hale M "Pharmacokinetics and bioavailability of mycophenolate mofetil in healthy subjects after single-dose oral and intravenous administration." J Clin Pharmacol 36 (1996): 315-24

• Lesch-Nyhan Syndrome

  Moderate

  Mycophenolate mofetil is an inosine monophosphate dehydrogenase (IMPDH) inhibitor; therefore it should be avoided in patients with hereditary deficiencies of hypoxanthine-guanine phosphoribosyl-transferase (HGPRT) such as Lesch-Nyhan and Kelley-Seegmiller syndromes because it may cause an exacerbation of disease symptoms characterized by the overproduction and accumulation of uric acid leading to symptoms associated with gout such as acute arthritis, tophi, nephrolithiasis or urolithiasis and renal disease including renal failure.

  1 source

  1. "Product Information. CellCept (mycophenolate mofetil)." Roche Laboratories (2001):

• Liver Diseases

  Moderate

  Mycophenolate mofetil (inactive) undergoes complete presystemic metabolism to active MPA , further metabolism to inactive forms, some of which undergo enterohepatic circulation producing a second peak of MPA. Alcoholic cirrhosis (parenchymal cell damage) does not appear to affect the metabolism of MPA to inactive forms. Hepatic disease/dysfunction due to other etiologies may induce different effects.

  7 sources

  1. Kirklin JK, Bourge RC, Naftel DC, Morrow WR, Deierhoi MH, Kauffman RS, White-Williams C, Nomberg RI, Holman WL, Smith DC Jr "Treatment of recurrent heart rejection with mycophenolate mofetil (RS- 61443): initial clinical experience." J Heart Lung Transplant 13 (1994): 444-50
  2. Sollinger HW, Deierhoi MH, Belzer FO, Diethelm AG, Kauffman RS "RS-61443--a phase I clinical trial and pilot rescue study." Transplantation 53 (1992): 428-32
  3. Yatscoff RW, Keenan R, LeGatt DF "Single-dose pharmacokinetics of the new immunosuppressant RS-61443 in the rabbit." Ther Drug Monit 15 (1993): 400-4
  4. "Product Information. CellCept (mycophenolate mofetil)." Roche Laboratories (2001):
  5. Bullingham RES, Nicholls A, Hale M "Pharmacokinetics of mycophenolate mofetil (RS61443): a short review." Transplant Proc 28 (1996): 925-9
  6. Bullingham R, Monroe S, Nicholls A, Hale M "Pharmacokinetics and bioavailability of mycophenolate mofetil in healthy subjects after single-dose oral and intravenous administration." J Clin Pharmacol 36 (1996): 315-24
  7. Hood KA, Zarembski DG "Mycophenolate mofetil: a unique immunosuppressive agent." Am J Health Syst Pharm 54 (1997): 285-94