Mycophenolate Mofetil Dosage

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Usual Adult Dose for:

Usual Geriatric Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Organ Transplant - Rejection Prophylaxis

Renal Transplantation: 1 g orally or intravenously twice a day. Orally: 1 hour before or 2 hours after a meal.
Intravenously: administered over 2 hours.

Cardiac Transplantation: 1.5 g intravenously twice a day administered over no less than 2 hours or 1.5 g orally twice a day

Hepatic Transplantation: 1 g intravenously twice a day administered over no less than 2 hours or 1.5 g orally twice a day

Usual Geriatric Dose for Organ Transplant - Rejection Prophylaxis

Renal Transplantation: 1 g orally or intravenously twice a day. Orally: 1 hour before or 2 hours after a meal.
Intravenously: administered over 2 hours.

Cardiac Transplantation: 1.5 g intravenously twice a day administered over no less than 2 hours or 1.5 g orally twice a day

Hepatic Transplantation: 1 g intravenously twice a day administered over no less than 2 hours or 1.5 g orally twice a day

Usual Pediatric Dose for Organ Transplant - Rejection Prophylaxis

Renal transplantation:
3 months or younger: Data not available

3 months or older:
Initial dose: 600 mg/m2/dose twice daily up to a maximum of 2 grams/day.

Usual Pediatric Dose for Nephrotic Syndrome

Frequently relapsing:
Initial dose: 12.5 to 18 mg/kg orally twice daily for 1 to 2 years with a tapering dose of prednisone.
Maximum dose: 2 grams per day.

Steroid-dependent:
Initial dose: 12 to 18 mg/kg or 600 mg/m2 orally twice daily.
Maximum dose: 2 grams per day.

Renal Dose Adjustments

CrCl less than 25 mL/min: Doses greater than 1 gram twice a day should be avoided.

Liver Dose Adjustments

Data not available

Precautions

If a patient develops neutropenia (absolute neutrophil count <1300/mm³), dosing with mycophenolate should be stopped or the dose reduced, and the patient should be managed appropriately. Close clinical monitoring is recommended if mycophenolate is used in patients with liver disease. Doses > 2 g/day (especially in renal dysfunction) are not recommended. Higher doses may lead to more severe gastrointestinal adverse reactions and enhanced immunosuppression.

Dialysis

Mycophenolic acid (the active metabolite) and the inactive glucuronide metabolite are not removed in significant amounts by hemodialysis.

Other Comments

The US FDA requires a Risk Evaluation and Mitigation Strategy (REMS) for mycophenolate. It includes a medication guide and elements to assure safe use. Additional information is available at www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm111350.htm

The intravenous form should be administered within 24 hours following transplantation. The intravenous form can be administered for up to 14 days. Patients should be switched to the oral form as soon as they can tolerate oral medication.

The initial oral dose should be given as soon as possible following renal, cardiac, or hepatic transplantation. It is recommended that the oral form of the drug be administered on an empty stomach. However, in stable renal transplantation patients, the drug may be administered with food if necessary.

Patients should be monitored for the development of neutropenia. CBCs should be performed weekly during the first month, then twice a month during the second and third month, and then monthly for the remainder of the first year of treatment.

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