mycophenolate mofetil (CellCept)

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

What is the dosage for mycophenolate mofetil-oral?

Mycophenolate mofetil should be given to patients as soon as possible following organ transplantation. Mycophenolate mofetil is recommended to be administered on an empty stomach, except in stable renal transplant patients in whom it can be administered with food if necessary.

Kidney transplantation

  • Adults: The recommended dose is 1 g administered orally or intravenously (over no less than 2 hours) twice a day.
  • Pediatrics (3 months to 18 years of age): The recommended dose of the oral suspension is 600 mg/m2 administered twice daily (maximum daily dose of 2 g/10 ml). Patients with a body surface area of 1.25 m2 to 1.5 m2 may be administered capsules at a dose of 750 mg twice daily. Patients with a body surface area >1.5 m2 may be dosed with capsules or tablets at a dose of 1 g twice daily.

Heart transplantation

  • Adults: The recommended dose is 1.5 g twice daily administered intravenously over no less than 2 hours or 1.5 g orally twice daily.

Liver Transplantation

  • Adults: The recommended dose is 1 g twice daily administered intravenously over no less than 2 hours or 1.5 g orally twice daily.
  • Geriatrics (elderly patients): The recommended oral dose is 1 g twice daily for kidney transplant patients, 1.5 g twice daily for heart transplant patients, and 1 g twice daily administered intravenously or 1.5 g twice daily administered orally in liver transplant patients.

Which drugs or supplements interact with mycophenolate mofetil-oral?

Co-administration of acyclovir (Zovirax) or ganciclovir (Cytovene, Vitrasert, Zirgan) and mycophenolate mofetil may cause an increase in blood levels of mycophenolate mofetil and the interacting drug since these drugs compete with each other for elimination via the kidneys.

Antacids containing magnesium or aluminum hydroxide may decrease MPA blood levels. If combination use is necessary, administration of the two medications must be separated by several hours.

Proton pump inhibitors (PPIs) such as lansoprazole (Prevacid), pantoprazole (Protonix), and omeprazole (Prilosec) have been shown to reduce MPA blood levels. This effect may be due to a decrease in mycophenolate mofetil solubility caused by reduced acid secretion in the stomach caused by PPIs.

Cholestyramine (Questran, Questran Light) may cause a decrease in MPA blood levels by binding to it in the intestine and preventing its absorption.

Cyclosporine (Sandimmune) may decrease MPA blood levels. Cyclosporine inhibits multidrug-resistant-associated protein 2 (MRP-2) transporter in the biliary tract, and this prevents the excretion of MPA into bile and elimination from the body.

Mycophenolate mofetil may decrease the effectiveness of some oral contraceptives (birth control pills). Combining mycophenolate mofetil with birth control pills should be done cautiously, and additional contraceptive barriers (such as condoms) should be used.

Sevelamer (Renvela) may decrease MPA blood levels. Sevelamer and other calcium free phosphate binders that are used for treating patients with kidney disease should not be administered with mycophenolate mofetil. If combination treatment is necessary, sevelamer and other calcium free phosphate binders must be given two hours after mycophenolic acid administration.

Norfloxacin (Noroxin) and metronidazole (Flagyl), two antibiotics, may decrease MPA blood levels. Use of these antibiotics with mycophenolate mofetil is not recommended. Other antibiotics that may also decrease MPA levels in the blood are ciprofloxacin (Cipro), amoxicillin plus clavulanic acid (Augmentin), and rifampin (Rifadin, Rimactane).

Probenecid may cause an increase in MPA blood levels by inhibiting its excretion via renal tubular secretion.

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