Mycophenolate mofetil: Difference between revisions
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==Administration== | ==Administration== | ||
*Type: Immunosuppressant | *Type: Immunosuppressant | ||
*Dosage Forms: 250,500; | *Dosage Forms: 250,500; 200mg/mL; IV | ||
*Routes of Administration: PO, IV | *Routes of Administration: PO, IV | ||
*Common Trade Names: CellCept | *Common Trade Names: CellCept | ||
| Line 15: | Line 15: | ||
===Liver transplant rejection prophylaxis=== | ===Liver transplant rejection prophylaxis=== | ||
*1.5 g PO | *1.5 g PO BID or 1 g IV bid | ||
*Info: start IV with in 24h post transplant, continue up to 14 days, switch to PO ASAP; Info: give on empty stomach | *Info: start IV with in 24h post transplant, continue up to 14 days, switch to PO ASAP; Info: give on empty stomach | ||
===Lupus nephritis=== | ===Lupus nephritis=== | ||
*1 g PO bid | *1 g PO bid | ||
*Info: use with prednisone, consider decease dose 50% after 6mo | *Info: use with [[prednisone]], consider decease dose 50% after 6mo treatment | ||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
===Kidney transplant rejection prophylaxis=== | ===Kidney transplant rejection prophylaxis=== | ||
*3 mo-18 yo: Dose: | *3 mo-18 yo: Dose: 600mg/m^2 PO bid; Alt: 750mg PO BID for body surf. area = 1.25-1.5 m^2; 1 g PO BID for body surf. area >1.5 m^2; Max: 1 g/dose | ||
==Special Populations== | ==Special Populations== | ||
| Line 36: | Line 36: | ||
*Pediatric: | *Pediatric: | ||
**kidney transplant patients, delayed graft function immediate postop: no adjustment | **kidney transplant patients, delayed graft function immediate postop: no adjustment | ||
**kidney transplant patients, outside immediate post-transplant period: CrCl <30: max | **kidney transplant patients, outside immediate post-transplant period: CrCl <30: max 600mg/m^2/day; HD/PD: no supplement | ||
===Hepatic Dosing=== | ===Hepatic Dosing=== | ||
| Line 72: | Line 72: | ||
*colitis | *colitis | ||
*acute renal failure | *acute renal failure | ||
*interstitial lung | *interstitial lung disease | ||
*pregnancy loss, 1st trimester | *pregnancy loss, 1st trimester | ||
*congenital malformations | *congenital malformations | ||
===Common=== | ===Common=== | ||
* | *hypertension | ||
*infection | *infection | ||
*diarrhea | *diarrhea | ||
Latest revision as of 07:17, 7 July 2017
Administration
- Type: Immunosuppressant
- Dosage Forms: 250,500; 200mg/mL; IV
- Routes of Administration: PO, IV
- Common Trade Names: CellCept
Adult Dosing
Kidney transplant rejection prophylaxis
- 1 g PO/IV bid
- Start: IV with in 24h post transplant, continue up to 14 days, switch to PO ASAP; Info: give on empty stomach; stable patients may take with food
Heart transplant rejection prophylaxis
- 1.5 g PO/IV bid
- Start: IV with in 24h post transplant, continue up to 14 days, switch to PO ASAP; Info: give on empty stomach
Liver transplant rejection prophylaxis
- 1.5 g PO BID or 1 g IV bid
- Info: start IV with in 24h post transplant, continue up to 14 days, switch to PO ASAP; Info: give on empty stomach
Lupus nephritis
- 1 g PO bid
- Info: use with prednisone, consider decease dose 50% after 6mo treatment
Pediatric Dosing
Kidney transplant rejection prophylaxis
- 3 mo-18 yo: Dose: 600mg/m^2 PO bid; Alt: 750mg PO BID for body surf. area = 1.25-1.5 m^2; 1 g PO BID for body surf. area >1.5 m^2; Max: 1 g/dose
Special Populations
- Pregnancy Rating: D
- Lactation risk: possibly unsafe
Renal Dosing
- Adult:
- kidney transplant patients, delayed graft function immediate postop: no adjustment
- kidney transplant patients, outside immediate post-transplant period:CrCl <25: max 1 g bid; HD/PD: no supplement
- heart or liver transplant patients: CrCl <25: weigh risk/benefit; HD/PD: not defined
- Pediatric:
- kidney transplant patients, delayed graft function immediate postop: no adjustment
- kidney transplant patients, outside immediate post-transplant period: CrCl <30: max 600mg/m^2/day; HD/PD: no supplement
Hepatic Dosing
- Adult: renal transplant with severe hepatic parenchymal disease: no adjustment; other hepatic impairment: not defined
- Pediatric: renal transplant with severe hepatic parenchymal disease: no adjustment; other hepatic impairment: not defined
Contraindications
- Allergy to class/drug
- hypersens. to polysorbate 80 (IV form)
- Lesch-Nyhan syndrome
- Kelly-Seegmiller syndrome
- caution in elderly patients
- caution if GI disorder
- caution if renal disease, severe
- caution if bone marrow depression
- caution if PKU (phenylalanine-containing forms)
Adverse Reactions
Serious
- thrombocytopenia
- leukopenia
- neutropenia
- immunosuppression
- infection, severe
- opportunistic infection
- viral reactivation
- polyomavirus-assoc. nephropathy
- PML
- pure red cell aplasia
- lymphoma
- lymphoproliferative disorders
- malignancy
- GI bleeding
- GI perforation/ulcer
- colitis
- acute renal failure
- interstitial lung disease
- pregnancy loss, 1st trimester
- congenital malformations
Common
- hypertension
- infection
- diarrhea
- peripheral edema
- anemia
- abdominal pain
- constipation
- leukopenia
- fever
- headache
- nausea/vomiting
- dyspepsia
- hypotension (rapid IV use)
- dyspnea
- cough
- hypercholesterolemia
- hypokalemia
- tremor
- acne
- insomnia
Pharmacology
- Half-life: 17.9h (PO route), 16.6h (IV route)
- Metabolism: liver; CYP450: Info: prodrug converted to mycophenolic acid (MPA)
- Excretion: urine 93% (<1% unchanged), feces 6%
Mechanism of Action
inhibits B- and T-lymphocyte proliferation
Comments
See Also
References
epocrates