BRAND NAMES
 MECHANISM OF ACTION
Two forms are available. Mycophenolate mofetil (Cellcept®) is a prodrug, which is converted to mycophenolic acid in the body, which is the active form. Myfortic® is delayed-release tablets of mycophenolic acid, for oral use. Myfortic delayed release tablets and mycophenolate mofetil tablets and capsules should not be used interchangeably
In the body, mycophenolic acid inhibits de novo purine synthesis pathway by inhibiting inosine dehydrogenase, an enzyme needed for the growth of T cells and B cells. As a result, it inhibits DNA and RNA synthesis in the immune cells such as lymphocytes.
Mycophenolic acid is an immunosuppressant drug used to prevent rejection in organ transplantation.
- CellCept® (mycophenolate mofetil) is indicated for the prophylaxis of organ rejection in patients receiving allogeneic renal, cardiac, or hepatic transplants. CellCept should be used concomitantly with cyclosporine and corticosteroids. CellCept Intravenous is an alternative dosage form to CellCept capsules, tablets, and oral suspension. CellCept Intravenous should be administered within 24 hours following transplantation. CellCept Intravenous can be administered for up to 14 days; patients should be switched to oral CellCept as soon as they can tolerate oral medication.
- Myfortic is an antimetabolite immunosuppressant indicated for prophylaxis of organ rejection in adult patients receiving kidney
transplants and in pediatric patients at least 5 years of age and older who are at least 6 months post kidney transplant. Use in combination with cyclosporine and corticosteroids.
- Mycophenolate mofetil (Cellcept®): 1 g twice daily
- Mycophenolic acid sodium (Myfortic®): 720 mg twice daily
 WARNINGS AND PRECAUTIONS
- Use during pregnancy is associated with increased risks of first trimester pregnancy loss and congenital malformations. Females of reproductive potential (FRP) must be counseled regarding pregnancy prevention and planning.
- Increased risk of development of lymphoma and other malignancies, particularly of the skin, due to immunosuppression.
- Increased susceptibility to bacterial, viral, fungal, and protozoal infections, including opportunistic infections.
- Only physicians experienced in immunosuppressive therapy and management of renal, cardiac, or hepatic transplant patients should prescribe Mycophenolic acid. Patients receiving the drug should be managed in facilities equipped and staffed with adequate laboratory and supportive medical resources. The physician responsible for maintenance therapy should have complete information requisite for the follow-up of the patient.
 PREGNANCY AND LACTATION
Pregnancy Category D (US): Mycophenolic acid can cause fetal harm when administered to a pregnant female. Use of Mycophenolic acid during pregnancy is associated with an increased risk of first trimester pregnancy loss and an increased risk of congenital malformations, especially external ear and other facial abnormalities including cleft lip and palate, and anomalies of the distal limbs, heart, esophagus, kidney, and nervous system. Females of reproductive potential must be made aware of the increased risk of first trimester pregnancy loss and congenital malformations and must be counseled regarding pregnancy prevention and planning.
 SIDE EFFECTS
The principal adverse reactions include diarrhea, leukopenia, sepsis, vomiting, and there is evidence of a higher frequency of certain types of infections, eg, opportunistic infections. Phlebitis and thrombosis have been reported with intravenous administration.