Inosine monophosphate dehydrogenase inhibitor

Mycophenolate mofetil

Brand names: CellCept, Myfortic (mycophenolic acid)

Adult dose

Dose: Renal transplant: 1g BD. Cardiac transplant: 1.5g BD. Off-label autoimmune: 0.5–1.5g BD; specialist

Route: PO/IV

Frequency: BD

Clinical pearls

Solid organ transplant; lupus nephritis, ANCA-associated vasculitis
MHRA Pregnancy Prevention Programme: monthly pregnancy testing for women of childbearing potential, reliable contraception during and 6 weeks (women) / 90 days (men) after stopping

Contraindications

Pregnancy (highly teratogenic — Pregnancy Prevention Programme MANDATORY)
Breastfeeding
Hypersensitivity

Side effects

Severe teratogenicity (1st-trimester loss, ear/face/limb anomalies)
Myelosuppression (esp. neutropenia/anaemia)
GI upset (diarrhoea, abdominal pain)
Increased infection risk (incl. PML)
Increased malignancy risk (skin, lymphoma)
HSV/CMV reactivation

Interactions

Aciclovir/ganciclovir (raised levels)
Antacids/iron (reduced absorption)
Tacrolimus/ciclosporin (concentration effects)
Live vaccines

Monitoring

FBC
LFTs
Pregnancy testing
Infection signs
Skin checks

Reference: BNF; NICE; MHRA Drug Safety Update; https://bnf.nice.org.uk/drugs/mycophenolate-mofetil/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways