Mycophenolate mofetil

Generic name: Mycophenolate Mofetil
Drug class: Selective immunosuppressants

Usage of Mycophenolate mofetil

Mycophenolate belongs to a group of medicines known as immunosuppressive agents. It is used with other medicines (eg, cyclosporine, steroid medicine) to lower the body's natural immunity in patients who receive organ transplants (eg, kidney, heart, or liver).

When a patient receives an organ transplant, the body's white blood cells will try to get rid of (reject) the transplanted organ. Mycophenolate prevents the white blood cells from rejecting the transplanted organ.

This medicine is available only with your doctor's prescription.

Mycophenolate mofetil side effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

Black, tarry stools

bladder pain

bleeding gums

bloating or swelling of the face, arms, hands, lower legs, or feet

blood in the urine or stools

bloody or cloudy urine

blurred vision

burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings

chest pain or tightness

confusion

cough or hoarseness

decreased urine

difficult or labored breathing

difficult, burning, or painful urination

difficulty in moving

dizziness

dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

drowsiness

dry mouth

fainting

fast, slow, pounding, or irregular heartbeat or pulse

fever or chills

flushed, dry skin

frequent urge to urinate

fruit-like breath odor

headache

heartburn

increased hunger

increased thirst

increased urination

irregular heartbeats

irregular pulse

irritability

lightheadedness

loss of appetite

loss of strength or energy

lower back or side pain

muscle cramps in the hands, arms, feet, legs, or face

muscle pain, stiffness, cramps, or weakness

muscle spasms (tetany) or twitching

nausea or vomiting

nervousness

numbness or tingling in the hands, feet, or lips

pain in the joints

painful or difficult urination

pale skin

pinpoint red spots on the skin

pounding in the ears

rapid weight gain

rapid, shallow breathing

seizures

sore throat

sores, ulcers, or white spots on the lips or in the mouth

stomach cramps, pain, and bloating

sweating

swollen glands

tingling of the hands or feet

trembling

tremor

trouble breathing

unusual bleeding or bruising

unusual tiredness or weakness

unusual weight gain or loss

weakness or heaviness of the legs

Incidence not known

Back pain

bloody, black, tarry stools

constipation

coughing or spitting up blood

darkened urine

general feeling of illness

indigestion

night sweats

pain

pains in the stomach, side, or abdomen, possibly radiating to the back

severe headache

sudden high fever or low-grade fever for months

tenderness

watery or bloody diarrhea

yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Acid or sour stomach

belching

fear

heartburn

lack or loss of strength

rash

trouble sleeping

weight loss

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Before taking Mycophenolate mofetil

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of mycophenolate capsules, suspension, or tablets in children receiving kidney transplants. However, safety and efficacy have not been established in infants younger than 3 months of age.

Appropriate studies have not been performed on the relationship of age to the effects of mycophenolate capsules, suspension, or tabletsin children receiving heart or liver transplants. Safety and efficacy have not been established.

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of mycophenolate delayed-release tablets in children receiving kidney transplants. However, safety and efficacy have not been established in children younger than 5 years of age.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of mycophenolate in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving mycophenolate.

Breast Feeding

Studies in women breastfeeding have demonstrated harmful infant effects. An alternative to this medication should be prescribed or you should stop breastfeeding while using this medicine.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Adenovirus Vaccine Type 4, Live

Adenovirus Vaccine Type 7, Live

Aluminum Carbonate, Basic

Aluminum Hydroxide

Aluminum Phosphate

Amoxicillin

Azathioprine

Bacillus of Calmette and Guerin Vaccine, Live

Cholestyramine

Ciprofloxacin

Clavulanic Acid

Colesevelam

Colestipol

Cyclosporine

Dengue Tetravalent Vaccine, Live

Desogestrel

Dexlansoprazole

Dienogest

Dihydroxyaluminum Aminoacetate

Dihydroxyaluminum Sodium Carbonate

Drospirenone

Esomeprazole

Estradiol

Ethinyl Estradiol

Ethynodiol

Etonogestrel

Gestodene

Influenza Virus Vaccine, Live

Isavuconazonium Sulfate

Lansoprazole

Levonorgestrel

Magaldrate

Magnesium Carbonate

Magnesium Hydroxide

Magnesium Oxide

Measles Virus Vaccine, Live

Medroxyprogesterone

Mercaptopurine

Mestranol

Metronidazole

Mumps Virus Vaccine, Live

Nomegestrol

Norelgestromin

Norethindrone

Norfloxacin

Norgestimate

Norgestrel

Omeprazole

Pantoprazole

Poliovirus Vaccine, Live

Rabeprazole

Rifampin

Rotavirus Vaccine, Live

Rubella Virus Vaccine, Live

Segesterone

Smallpox Vaccine

Tacrolimus

Telmisartan

Typhoid Vaccine, Live

Ulipristal

Varicella Virus Vaccine, Live

Yellow Fever Vaccine

Zoster Vaccine, Live

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Iron

Lanthanum Carbonate

Sevelamer

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Relate drugs

How to use Mycophenolate mofetil

Take this medicine exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. Taking too much may increase the chance of side effects, while taking too little may lead to rejection of your transplanted organ.

This medicine should come with a Medication Guide and patient instructions. Read and follow these instructions carefully. Ask your doctor if you have any questions.

It is best to take this medicine on an empty stomach, either 1 hour before or 2 hours after meals, unless your doctor tells you otherwise.

Mycophenolate capsules, delayed-release tablets, and tablets should be swallowed whole. Do not break, crush, cut, open, or chew them.

It is important that you handle this medicine with care. Avoid inhaling the powder from the capsule or allowing the powder or the oral liquid to touch your skin or eyes. If the medicine gets on your skin, wash it thoroughly with soap and water. If the medicine gets in your eyes, wash them with plain water. Should a spill occur, wipe it up using paper towels wetted with water to remove the powder or liquid.

Measure the oral liquid medicine with the oral dispenser. Do not mix with any other medicine. Ask your doctor or pharmacist if you have any questions about this.

Use only the brand of this medicine that your doctor prescribed. Different brands may not work the same way.

If you are also using antacids that contain aluminum or magnesium (eg, Maalox® or Mylanta®), do not use them at the same time as mycophenolate. Use them 2 hours after your dose. If you have questions, talk with your doctor about the best times to use your medicines.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage forms (capsules, suspension, or tablets):

To prevent heart transplant rejection:

Adults—1.5 grams (g) 2 times a day.

Children—Use and dose must be determined by your doctor.

To prevent kidney transplant rejection:

Adults—1 gram (g) 2 times a day.

Children 3 months of age and older—Dose is based on body surface area (BSA) and must be determined by the doctor. The suspension dose is 600 milligrams (mg) per square meter [m(2)] 2 times a day. The capsules and tablets are given as 750 mg to 1 gram two times a day.

Children younger than 3 months of age—Use and dose must be determined by your doctor.

To prevent liver transplant rejection:

Adults—1.5 grams (g) 2 times a day.

Children—Use and dose must be determined by your doctor.

For oral dosage forms (delayed-release tablets):

To prevent kidney transplant rejection:

Adults—720 milligrams (mg) 2 times a day.

Children 5 years of age and older (at least 6 months after the transplant)—Dose is based on body surface area (BSA) and must be determined by the doctor. The dose is 400 mg per square meter [m(2)] 2 times a day. Dose is usually not more than 720 mg 2 times a day.

Children younger than 5 years of age—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

If you miss a dose and it is less than 2 hours from your next scheduled dose, skip the missed dose and return to your regular schedule.

Storage

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

The oral suspension can also be kept in the refrigerator. Throw away any unused suspension after 60 days.

Warnings

It is very important that your doctor check your progress at regular visits. Your doctor will do blood tests to make sure that mycophenolate is working properly and to check for unwanted effects.

Using this medicine while you are pregnant can harm your unborn baby or cause a miscarriage during the first 3 months. If you are a woman who can bear children, your doctor may give you a pregnancy test before you start using this medicine to make sure you are not pregnant. Your birth control pills may not work as well while you are using this medicine. You must use two forms of birth control together for 1 month before starting this medicine, for the entire time that you are being treated, and for 6 weeks after you receive your last dose of this medicine. Use birth control pills together with another form of birth control, including a condom, diaphragm, or contraceptive foam or jelly. Male patients with female partners should use an effective form of birth control during treatment and for at least 90 days after the last dose. If you think you have become pregnant while using the medicine, tell your doctor right away.

Do not donate sperm during treatment and for at least 90 days after the last dose.

Using this medicine may increase your risk of getting skin cancer or cancer of the lymph system (lymphoma). Talk to your doctor if you have concerns about this risk.

Use sunscreen or sunblock lotions with a sun protection factor (SPF) of at least 30 on a regular basis when you are outdoors. Wear protective clothing and hats and stay out of direct sunlight, especially between the hours of 10 am. and 3 pm. Avoid sunlamps and tanning beds.

Mycophenolate can temporarily lower the number of white blood cells in your blood, which increases the chance of getting an infection. If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you have a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.

Mycophenolate may cause pure red cell aplasia (PRCA). This is a very rare condition where the body no longer makes red blood cells and the patient has severe anemia. Check with your doctor right away if you have a fever and sore throat, pale skin, unusual bleeding or bruising, or unusual tiredness or weakness.

This medicine may increase your risk of developing a serious and rare brain infection called progressive multifocal leukoencephalopathy (PML). Check with your doctor right away if you have vision changes, loss of coordination, clumsiness, memory loss, difficulty speaking or understanding what others say, and weakness in the legs.

This medicine may increase your risk of developing rare and serious virus infections, including shingles, herpes, cytomegalovirus (CMV) infection, polyomavirus associated nephropathy (PVAN), BK virus-associated nephropathy (BKVAN), or SARS-CoV-2 (COVID-19) infection. The BK virus may affect how your kidneys work and cause a transplanted kidney to fail. Check with your doctor right away if you have bloody urine, a decreased frequency or amount of urine, increased thirst, loss of appetite, lower back or side pain, nausea, swelling of the face, fingers, or lower legs, trouble breathing, unusual tiredness or weakness, vomiting, or weight gain.

This medicine may cause reactivation of hepatitis B or C infection. Check with your doctor right away if you have dark-colored urine or pale stools, nausea, vomiting, loss of appetite, pain in your upper stomach, or yellow skin or eyes.

Check with your doctor right away if you have difficulty in moving, fever, muscle pain or stiffness, or pain, swelling, or redness in the joints. These may be symptoms of acute inflammatory (swelling) syndrome.

While you are using mycophenolate, and after you stop, do not have any immunizations (vaccinations) without your doctor's approval. Mycophenolate will lower your body's resistance and there is a chance you might get the infection the immunization is meant to prevent.

This medicine may cause serious stomach or bowel problems (eg, ulcers, bleeding). Check with your doctor right away if you have black, tarry stools, constipation, diarrhea, heartburn, indigestion, nausea, stomach pain, cramping, or burning, trouble breathing, or vomiting of blood or material that looks like coffee grounds.

This medicine may inhibit the ability to drive and use machines. Avoid driving or using machines if confusion, dizziness, fainting, lightheadedness, sleepiness, or trembling or shaking of the hands or feet occur during treatment.

Do not stop taking this medicine without checking first with your doctor. Doing so may cause rejection of your transplanted organ. Your doctor will decide how long you should take this medicine.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

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