mycophenolate mofetil (CellCept) (cont.)
Omudhome Ogbru, PharmD
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:
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).
Medically Reviewed by a Doctor on 6/2/2015
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