Mycophenolate Mofetil (CellCept) and Mycophenolate Sodium (Myfortic)

Pill Bottle with Pills

Fast Facts

  • Mycophenolate can affect the immune system and requires careful laboratory monitoring. Notify your doctor if you bruise or bleed easily, or if you experience persistent or bloody diarrhea, shortness of breath, fevers or other signs of an infection. Mycophenolate usage should halt if there are signs of an infection.
  • It can cause serious birth defects and should not be taken while pregnant, attempting to become pregnant or while breastfeeding.
  • Caregivers administering mycophenolate should wear gloves when handling it due to concern with pregnancy risks and effects on the immune system.
  • Regular blood tests may be necessary for people taking mycophenolate. Such tests may be performed more frequently during the first several months, and then less often with time.
  • Women should avoid pregnancy and breast-feeding while taking any form of mycophenolate and use an effective form of birth control while taking this medication and for up to six weeks after you stop taking it.

Mycophenolate Mofetil (CellCept) and Mycophenolate Sodium (Myfortic) are immunosuppressant drugs (a class of drugs that reduce the strength of the body’s immune system) used in the treatment of several autoimmune diseases. Mycophenolate was used originally in the management of patients with organ transplants, but is now recommended in the treatment of some autoimmune diseases.

Uses

Mycophenolate has been used to treat people with lupus (especially those with symptoms of kidney disease), rheumatoid arthritis (RA), vasculitis, inflammatory bowel disease such as Crohn's disease, inflammatory eye disease (such as uveitis (iritis) and scleritis) and some other kidney or skin disorders.

How it works

Mycophenolate targets an enzyme in the body called inosine monophosphate dehydrogenase that is important for the formation of deoxyribonucleic acid (DNA) in cells. By interfering with DNA, the medication impairs the function of cells in the immune system that become overactive in autoimmune diseases such as lupus.

Dosing

In adults, mycophenolate is typically taken twice daily for a total dose of 2 to 3 grams (2000 to 3000 mg) a day, although this dosage may be reduced in people with underlying kidney problems. The dose usually is lower than 2 grams a day for children.

Taking mycophenolate with food often helps to prevent side effects such as nausea or stomach pain. Mycophenolate comes in 250 mg and 500 mg capsules or tablets as well as in an intravenous form through a needle placed in the vein. Patients who prefer to take medication in the liquid form can ask a pharmacist to prepare it as an oral suspension, but should not try to open the capsules or crush the tablets on their own.

Because mycophenolate can affect the immune system and cause birth defects, the tablets or capsules should only be handled with gloves by caregivers.

Time to effect

Usually the first benefits of this medication are noticed in several weeks, but it may take several months or even longer to achieve maximum results.

Side effects

The most common side effects with mycophenolate include upset stomach, nausea, vomiting or diarrhea. The frequency of these side effects may depend on the form of mycophenolate (e.g. mycophenolate mofetil (CellCept) or the delayed release mycophenolate sodium preparation, Myfortic) being used. Other possible side effects include headache, dizziness, difficulty sleeping, tremor and, occasionally, rash. These side effects usually go away with time, but tell a doctor if they persist.

Less common but more serious side effects include swelling in legs or face, elevated blood pressure, a reduction of white blood cells (increasing the chances of infections, including viral infections such as herpes zoster (“shingles”), red blood cells that bring oxygen to tissues (which may lead to anemia), and platelets that aid clotting (which can lead to gastrointestinal bleeding or dark tarry stools)). Periodic blood tests can detect reduced blood counts early on to avoid these problems.

Serious infections can occur while taking mycophenolate, such as bacterial infections (e.g. endocarditis or meningitis), tuberculosis, fungal infections, viral infections and reactivation of certain kinds of viral infection such as herpes zoster (shingles), hepatitis B or C reactivation, or a rare life threatening neurologic condition called progressive multifocal leukoencephalopathy (PML) as a result of reactivation of past viral exposure.

Patients older than 65 may be at increased risk for some side effects, especially infections and gastrointestinal bleeding. People who have had ulcers or other serious gastrointestinal conditions should talk with their doctors before taking this medication.

Studies of transplant patients taking mycophenolate have found it may increase risk of some cancers such as lymphomas and skin cancers. Because there may be a similar risk in people with rheumatic conditions who take mycophenolate for long periods of time, discuss this issue with a physician before starting the medication. When on mycophenolate, it is important to see a physician regularly, use a sunscreen and avoid prolonged sun exposure.

Drug interactions

Tell your doctor about all of the medications you are taking, including over-the-counter drugs and natural remedies. Because many antacids interfere with the absorption of mycophenolate, they should not be taken at the same time. Instead, you should either take antacids at least 1 hour before mycophenolate or wait at least 2 hours after taking mycophenolate before taking an antacid. A partial list of medications that may interfere with mycophenolate includes:

  • cholestyramine (Questran)
  • acyclovir (Zovirax)
  • gancyclovir (Cytovene)
  • azathioprine (Imuran)
  • antacids containing magnesium or aluminum hydroxide (such as Maalox, Rolaids, or Mylanta)
  • proton pump inhibitors (omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), dexlansoprazole (Dexilant))
  • norfloxacin (Noroxin)
  • metronidazole (Flagyl)
  • rifampin
  • oral contraceptives
  • trimethoprim/sulfamethoxazole (Bactrim)
  • theophylline (Theo-Dur)
  • phenytoin (Dilantin)
  • probenecid (Benemid)
  • aspirin and other salicylates

Information to discuss with health care providers

The effects of mycophenolate during pregnancy have not been well studied and it appears mycophenolate may increase the risk of pregnancy loss and birth defects. For women, a pregnancy test should be performed before starting mycophenolate and regularly while on this medication by your doctor. Do not breast-feed while taking mycophenolate, because the drug may be passed into the breast milk.

Use an effective form of birth control while taking this medication and for up to six weeks after you stop taking it. It appears that mycophenolate reduces the blood levels of some oral contraceptives (although it is not known if that means it decreases their effectiveness), so other forms of birth control are recommended.

Some vaccinations should be avoided while taking this medication. Be sure to discuss with your doctor before receiving any vaccines. You should discuss your vaccine history with your doctor as there may be reason to update some vaccines (such as pneumonia (Pneumovax), Hepatitis B, or the Herpes Zoster vaccine (Zostavax) in some cases) before starting this medication. Also, be sure to notify your doctor before any surgeries while taking this medication.

Because mycophenolate may increase the risk for infections, notify your doctor if you have a history of Hepatitis B or C, tuberculosis exposure, HIV infection or if you have a condition called phenylketonuria (PKU), because the CellCept liquid preparation contains aspartame.

Updated March 2015 by Michael Cannon, MD, and reviewed by the American College of Rheumatology Committee on Communications and Marketing. This information is provided for general education only.

Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.

© 2015 American College of Rheumatology