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Mycophenolate mofetil Disease Interactions

There are 6 disease interactions with mycophenolate mofetil:

Major

Mycophenolate (applies to mycophenolate mofetil) neutropenia

Major Potential Hazard, Moderate plausibility.

Severe neutropenia has occurred in up to 2% of patients administered mycophenolate. Therapy with mycophenolate should be administered cautiously in patients with or predisposed to neutropenia. Mycophenolate should be discontinued or the dose reduced in patients who develop neutropenia (absolute neutrophil count <1300/mm3). Clinical monitoring of hematopoietic function is recommended. Complete blood counts should be performed weekly during the first month, two times a month during the second and third months, and monthly for the remainder of the first year of treatment.

References

  1. Taylor DO, Ensley RD, Olsen SL, Dunn D, Renlund DG "Mycophenolate mofetil (RS-61443): preclinical, clinical, and three- year experience in heart transplantation." J Heart Lung Transplant 13 (1994): 571-82
  2. "Product Information. CellCept (mycophenolate mofetil)." Roche Laboratories, Nutley, NJ.
  3. Mrozek-Orlowski M, Christie J, Flamme C, Novak J "Pain associated with peripheral infusion of carmustine." Oncol Nurs Forum 18 (1991): 942
  4. Sollinger HW, Belzer FO, Deierhoi MH, Diethelm AG, Gonwa TA, Kauffman RS, Klintmalm GB, McDiarmid SV, Roberts J, Rosenthal JT, et al "RS-61443 (mycophenolate mofetil). A multicenter study for refractory kidney transplant rejection." Ann Surg 216 (1992): 513-8;disc. 518-9
  5. Deierhoi MH, Kauffman RS, Hudson SL, Barber WH, Curtis JJ, Julian BA, Gaston RS, Laskow DA, Diethelm AG "Experience with mycophenolate mofetil (RS61443) in renal transplantation at a single center." Ann Surg 217 (1993): 476-82;disc. 482-4
View all 5 references
Moderate

Mycophenolate (applies to mycophenolate mofetil) GI hemorrhage

Moderate Potential Hazard, High plausibility. Applicable conditions: Gastrointestinal Hemorrhage, Inflammatory Bowel Disease, Peptic Ulcer

Gastrointestinal, rectal, and duodenal hemorrhage, hemorrhagic pancreatitis and rarely, large-intestine perforation have occurred in patients receiving mycophenolate. These events occurred primarily at dosages of mycophenolate >2 grams per day. Therapy with mycophenolate should be administered cautiously in patients with active gastrointestinal disease.

References

  1. "Product Information. CellCept (mycophenolate mofetil)." Roche Laboratories, Nutley, NJ.
  2. "Placebo-controlled study of mycophenolate mofetil combined with cyclosporin and corticosteroids for prevention of acute rejection. European Mycophenolate Mofetil Cooperative Study Group." Lancet 345 (1995): 1321-5
  3. Kirklin JK, Bourge RC, Naftel DC, Morrow WR, Deierhoi MH, Kauffman RS, White-Williams C, Nomberg RI, Holman WL, Smith DC Jr "Treatment of recurrent heart rejection with mycophenolate mofetil (RS- 61443): initial clinical experience." J Heart Lung Transplant 13 (1994): 444-50
  4. Taylor DO, Ensley RD, Olsen SL, Dunn D, Renlund DG "Mycophenolate mofetil (RS-61443): preclinical, clinical, and three- year experience in heart transplantation." J Heart Lung Transplant 13 (1994): 571-82
  5. Deierhoi MH, Kauffman RS, Hudson SL, Barber WH, Curtis JJ, Julian BA, Gaston RS, Laskow DA, Diethelm AG "Experience with mycophenolate mofetil (RS61443) in renal transplantation at a single center." Ann Surg 217 (1993): 476-82;disc. 482-4
View all 5 references
Moderate

Mycophenolate (applies to mycophenolate mofetil) hepatic dysfunction

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Liver Disease

Mycophenolate mofetil (inactive) undergoes complete presystemic metabolism to active MPA , further metabolism to inactive forms, some of which undergo enterohepatic circulation producing a second peak of MPA. Alcoholic cirrhosis (parenchymal cell damage) does not appear to affect the metabolism of MPA to inactive forms. Hepatic disease/dysfunction due to other etiologies may induce different effects.

References

  1. Yatscoff RW, Keenan R, LeGatt DF "Single-dose pharmacokinetics of the new immunosuppressant RS-61443 in the rabbit." Ther Drug Monit 15 (1993): 400-4
  2. Bullingham R, Monroe S, Nicholls A, Hale M "Pharmacokinetics and bioavailability of mycophenolate mofetil in healthy subjects after single-dose oral and intravenous administration." J Clin Pharmacol 36 (1996): 315-24
  3. Hood KA, Zarembski DG "Mycophenolate mofetil: a unique immunosuppressive agent." Am J Health Syst Pharm 54 (1997): 285-94
  4. Bullingham RES, Nicholls A, Hale M "Pharmacokinetics of mycophenolate mofetil (RS61443): a short review." Transplant Proc 28 (1996): 925-9
  5. Kirklin JK, Bourge RC, Naftel DC, Morrow WR, Deierhoi MH, Kauffman RS, White-Williams C, Nomberg RI, Holman WL, Smith DC Jr "Treatment of recurrent heart rejection with mycophenolate mofetil (RS- 61443): initial clinical experience." J Heart Lung Transplant 13 (1994): 444-50
  6. Sollinger HW, Deierhoi MH, Belzer FO, Diethelm AG, Kauffman RS "RS-61443--a phase I clinical trial and pilot rescue study." Transplantation 53 (1992): 428-32
  7. "Product Information. CellCept (mycophenolate mofetil)." Roche Laboratories, Nutley, NJ.
View all 7 references
Moderate

Mycophenolate (applies to mycophenolate mofetil) renal dysfunction

Moderate Potential Hazard, High plausibility.

Mycophenolate undergoes complete presystemic metabolism to its active form, MPA . Less than 1% of MPA is excreted in the urine. In a single-dose study, the area under the curve (AUC) for MPA in patients with severe chronic renal impairment (creatinine clearance <25 mL/min) was approximately 75% greater than those of healthy volunteers (creatinine clearance >80 mL/min). The AUC for the inactive metabolite was 3 to 6 times higher. Multiple dose studies have not been performed. No data are available for cardiac transplant patients with severe renal impairment and when benefit outweighs risk, therapy with mycophenolate should be administered with extreme caution.

References

  1. Deierhoi MH, Kauffman RS, Hudson SL, Barber WH, Curtis JJ, Julian BA, Gaston RS, Laskow DA, Diethelm AG "Experience with mycophenolate mofetil (RS61443) in renal transplantation at a single center." Ann Surg 217 (1993): 476-82;disc. 482-4
  2. Bullingham R, Monroe S, Nicholls A, Hale M "Pharmacokinetics and bioavailability of mycophenolate mofetil in healthy subjects after single-dose oral and intravenous administration." J Clin Pharmacol 36 (1996): 315-24
  3. Sollinger HW, Belzer FO, Deierhoi MH, Diethelm AG, Gonwa TA, Kauffman RS, Klintmalm GB, McDiarmid SV, Roberts J, Rosenthal JT, et al "RS-61443 (mycophenolate mofetil). A multicenter study for refractory kidney transplant rejection." Ann Surg 216 (1992): 513-8;disc. 518-9
  4. Bullingham RES, Nicholls A, Hale M "Pharmacokinetics of mycophenolate mofetil (RS61443): a short review." Transplant Proc 28 (1996): 925-9
  5. "Product Information. CellCept (mycophenolate mofetil)." Roche Laboratories, Nutley, NJ.
  6. Keown P, Hayry P, Mathew T, Morris P, Stiller C, Barker C, Carr L, Landsberg D, Hardie I, Rigby R, Isoniemi H, Gray D, Belitsk "A blinded, randomized clinical trial of mycophenolate mofetil for the prevention of acute rejection in cadaveric renal transplantation, by the tricontinental mycophenolate mofetil renal transplantation study group." Transplantation 61 (1996): 1029-37
View all 6 references
Moderate

Mycophenolate mofetil (applies to mycophenolate mofetil) HGPRT deficiency

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Lesch-Nyhan Syndrome

Mycophenolate mofetil is an inosine monophosphate dehydrogenase (IMPDH) inhibitor; therefore it should be avoided in patients with hereditary deficiencies of hypoxanthine-guanine phosphoribosyl-transferase (HGPRT) such as Lesch-Nyhan and Kelley-Seegmiller syndromes because it may cause an exacerbation of disease symptoms characterized by the overproduction and accumulation of uric acid leading to symptoms associated with gout such as acute arthritis, tophi, nephrolithiasis or urolithiasis and renal disease including renal failure.

Moderate

Mycophenolate mofetil (applies to mycophenolate mofetil) vaccination

Moderate Potential Hazard, Moderate plausibility.

During treatment with mycophenolate mofetil, the use of live attenuated vaccines should be avoided and patients should be advised that vaccinations may be less effective. Advise patients to discuss with the physician before seeking any immunizations.

Mycophenolate mofetil drug interactions

There are 285 drug interactions with mycophenolate mofetil

Mycophenolate mofetil alcohol/food interactions

There is 1 alcohol/food interaction with mycophenolate mofetil

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.