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Important: Protocol superseded July 2009 - see new version here at www.edren.co.uk.
That website is in development - you can ignore the 'This website is not ready' signs ONLY for the Transplant protocols. Others are not updated or fully transferred. |
This page describes the Edinburgh regimen for the use of the immunosuppressant Mycophenolate Mofetil.
As a substitute for azathioprine in alternative triple therapy regimen for patients at high risk of rejection and following resistant rejection in patients treated with standard triple therapy.
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(500 mg to) 1g twice daily, depending on concomitant immunosuppression and renal function. |
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MMF is best absorbed on an empty stomach, either one hour before or two hours after a meal, but gastrointestinal side-effects may be alleviated by taking MMF with food and further splitting the daily dose. |
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Monitoring of MMF blood levels is not needed. |
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MMF is rapidly hydrolysed following absorption to mycophenolic acid (MPA), the active metabolite. |
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MPA is a potent inhibitor of inosine monophosphate dehydrogenase (IMPDH) and therefore inhibits the denovo pathway of guanosine nucleotide synthesis. |
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B and T lymphocytes are critically dependant on the de novo pathway and so MPA inhibits B and T lymphocyte proliferation and also B-cell antibody formation. |
MMF is available as 250 mg capsules (blue-brown) and 500 mg tablets (lavender). The brand name is CELLCEPT.
Pregnancy
- neutropenia
- gastro-intestinal bloating
- cramps
- diarrhoea
- vomiting
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Tacrolimus increases the AUC of MPA, the active metabolite of MMF. By 3 months past transplant the increase is such that the dose of MMF may need to be reduced with time post-transplant to maintain stable systemic exposure to MPA. |
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Cholestyramine and antacids - may bind MMF and significantly reduce its absorption. |
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Drugs which undergo tubular secretion e.g., Aciclovir, theoretically may impair secretion of MMF and have raised blood levels themselves during concurrent administration. |
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Drugs which interfere with enterohepatic recirculation potentially may reduce the efficacy of MMF. |
Transplant protocols developed on the Edinburgh Transplant Unit. This page first published March 2002 by Amit Adlakha, reviewed November 2006 and last modified
NOTE that the accuracy of any statements in this information CANNOT be guaranteed. It is published in the belief that it is correct, and we endeavour to keep it so - but we do make mistakes. Furthermore, over some subjects there are differing opinions, or differing degrees of certainty. We have usually not attempted to discuss these here because the aim has been to provide an immediate and brief guide. In all areas, prior medical knowledge is assumed. The EdRenHANDBOOK is not suitable for use by those without such a background. Contact us by email or at the address given at the foot of the contents page with any comments or corrections.