Antiproliferative Immunosuppressant Pregnancy: Contraindicated (Pregnancy Prevention Programme mandatory)

Mycophenolate Mofetil

Brand names: CellCept, Myfenax (generic)

Adult dose

Dose: Renal transplant: 1–1.5 g BD. Lupus nephritis/vasculitis: 1–2 g BD (as per protocol).

Route: Oral

Frequency: Twice daily

Max: 3 g/day (transplant); 3.6 g/day for mycophenolate sodium

MMF is prodrug — converted to mycophenolic acid (MPA). Mycophenolate sodium (Myfortic) is enteric-coated MPA — NOT equivalent to MMF on mg-per-mg basis. Women of childbearing age: mandatory contraception (MHRA PPP).

Paediatric dose

Route: Oral

Frequency: BD

Max: 2 g/day

Concentration: 200 mg/mL oral suspension mg/m²/dose/ml

Paediatric dosing: 600 mg/m² BD (maximum 2 g/day). Oral suspension available for children unable to swallow capsules.

Dose adjustments

Renal

Maximum 1 g BD if eGFR <25 in transplant patients

Hepatic

No adjustment required for renal indications; caution in severe hepatic impairment

Clinical pearls

Pregnancy Prevention Programme: two forms of contraception required; teratogenic (limb/ear malformations)
CMV prophylaxis (valganciclovir) commonly prescribed alongside MMF in post-transplant period
Diarrhoea often managed by dose reduction or switching to enteric-coated mycophenolate sodium (Myfortic)
ASPREVA trial: MMF non-inferior to cyclophosphamide for induction of lupus nephritis — now first-line

Contraindications

Pregnancy (Category D — Pregnancy Prevention Programme mandatory)
Hypoxanthine-guanine phosphoribosyltransferase deficiency (rare)

Side effects

Diarrhoea (most common — dose-dependent)
Nausea/vomiting
Leucopenia and neutropenia
Anaemia
Opportunistic infections (CMV especially)
PML (rare)
GI haemorrhage
Lymphoma risk (long-term)

Interactions

Antacids/PPIs — reduce MMF absorption (separate by 2h)
Ciclosporin vs tacrolimus — ciclosporin reduces MPA levels; tacrolimus does not
Cholestyramine — reduces enterohepatic recirculation of MPA
Live vaccines — contraindicated
Azathioprine — avoid combination (additive myelosuppression)

Monitoring

FBC (weekly × 4 weeks, then monthly)
CMV PCR monitoring post-transplant
Renal function
GI symptoms
Pregnancy test (WOCBP before and during treatment)

Reference: BNFc; BNF; KDIGO Transplant Guidelines; ASPREVA Lupus Management Study (Appel et al, JASN 2009); MHRA PPP. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Pathways