Cellcept 500mg Roche prevent acute transplantation (5 blisters x 10 tablets)
Dosage form Box of 5 blisters x 10 tablets
Specifications Mycophenolic acid
Ingredient Kidney transplant, heart transplant
Ingredient
| Composition information | Content |
| Mycophenolic acid | 500mg |
Uses
Indications
cellcept is indicated to prevent acute transplant waste and to treat first -time or poorly responding graft waste in non -systemic kidney transplant patients.
Cellcept is indicated to prevent acute transplantation in heart transplant patients with the same blood. In patients treated, NMF helps to improve the ability to live in the first year of money after heart transplant.
Cellcept is indicated to prevent acute transplantation in non -blood liver transplant patients.
Cellcept should be used simultaneously with cyclosporin and corticosteroids.
Pharmacokological
Mycophenolate Mofetil (MMF) is the form of ester 2-MorphoLinethyl of mycophenolic acid (MPA). MPA is a Inosine monophosphate dehydrogenase inhibitor (IMPDH) with strong, selective, non -competitive and recovery inhibitors, so the De Novo road inhibitors of Guanosine Nucleotide synthesis. The MPA mechanism inhibits the enzyme activity of IMPDH that seems to be the ability to imitate the structure of both nicotinamide adenine dinucleotide and a catalytic water molecule. This will prevent the IMP oxidation into xanthose -5 -monophosphate is the main step in the Denovo path of Guanosine Nucleotide synthesis.
MPa has a stronger effect on lymphocytes for other cell lines because T -lymphocytes and B lymphocytes are dependent on their proliferation in the De Novo path of the Purines synthesis, while other cell lines can take advantage of other regenerative paths.
pharmacokinetic
pharmacokinetics of MyCophenolate Mofetil (MMF) has been studied in patients with kidney, heart and liver.
Overall, the pharmacokinetics of MPA in heart transplant and kidney transplant patients are the same. During the right stage before grafting, patients with liver transplantation take a dose of 1.5g MMF or intravenously a dose of MMF1G with an equivalent MPA concentration compared to patients with kidney transplantation using 1G MMF oral or intravenous sugar.
absorption
After being used by oral and transmission line, Mycophenolate Mofetil is absorbed quickly and widely and completely transferred into active metabolites, which is MPA. The average bioavailability of Mycophenolate Mofetil is taken orally, based on the AUC of MPA, 94% compared to mycophenolate mofetil used by vein. Mycophenolate mofetil can be systematically evaluated after intravenous infusion. However, after drinking, the drug concentration is lower than the specified limit (0.4 ng/ml).
The first time after transplantation (
Food does not affect the absorption level (AUC of MPa) of Mycophenolate Mofetil when used at a dose of 1.5g used twice a day for kidney transplant patients. However, the peak concentration of MPa decreased by about 40% when preserving food. The equivalent of the biological oral dosage form of the oral cellcept is evaluated. Two 500 mg tablets are shown to be equivalent to 4 250 mg capsules.
Distribution
Thanks to the reabsorption through the cyclic cycle, the plasma mpa concentration usually increases about 6-12 hours after taking the drug. The AUC of MPA decreases nearly 40% when using Cholestyramine simultaneously (4g three times a day) suitable for the interruption of the re-circulating round. At clinical concentration, 97% MPa is attached to plasma albumin.
transformation
MPa is metabolized by Glucuronyl Transferase (ISOFOFform isomer UGT1A9) into an inactive form of mpa's phenolic glucuronide (MPAG). On Vivo, MPAG is converted into a free mpa through the re-circulating cycle. A small amount of acylglucuronide (ampag) is also formed. Ampag is a pharmacological activity and is thought to be a number of unwanted effects of MMF (diarrhea, leukopenia).
Elimination
Use Mycophenolate Mofetil oral radioactive canal can completely obtain the amount of drugs used, with 93% of the drug found in pepper water and 6% found in feces. The majority (about 87%) of the drug dose is eliminated through the pepper water as MPAG. A negligible number ( 100kg/ml), a small amount of MPAG is also removed. Due to the medication through the intestinal circulation, the drugs remove bile acid, such as cholestyramine, reducing MPA (see section 2.7 overdose).
Elimination of MPa depends on many shipping substances. Transport of Polypeptide organic anion (OATPS) and protein 2 related to drug resistance (MRP2) also related to the elimination of MPa; CATP, MRP2 and Breast Cancer Protein (BCRP) are shipping related to the secretion of Glucuronides. Protein 1 has been resistant to drugs (MDR1) can also transport MPA, but the role of this substance seems to be limited during the absorption process. In MPA kidneys and metabolites can interact with organic anions in the kidney,
pharmacokinetics in special subjects
Patients with severe renal failure
In a single dose study (each group of 6 objects), the average concentration of MPA is observed after oral use in patients with chronic renal failure (glomerular filtration level
Dynamic pharmacokinetics when using multiple doses of mycophenolate mofetil in patients with chronic kidney failure has not been studied.
Patients with slow recovery kidney function after transplantation
In patients with slow recovery kidney function after grafting, the average AUC0-12 in the plasma of MPa is equivalent to the concentration in patients with normal recovery organ transplant function.
There may be slight increase in plasma and free MPA levels in patients with slow recovery renal function after grafting. No need dosage adjustment of Cellcept (see section 2.2 Special dose instructions). The average ACO-12 of MPAG in plasma is 2-3 times higher than that patients with normal recovery kidney function after kidney transplant.
In patients after kidney transplant that the organ transplant does not recover, the plasma concentration of MPAG is accumulated; The accumulation of MPA, if any, is much smaller.
Patients with liver failure
In general, the pharmacokinetics of MPA and MPAG are not affected by liver parenchyma disease in volunteers with alcoholic cirrhosis when using oral mmf or intravenously. The effects of liver disease on this process may depend on each specific disease. Liver disease with biliary tract lesions, such as primary cholestatic cirrhosis, can cause another effect.
Children (
The pharmacokinetic parameters are evaluated on 55 kidney transplantation patients (between 1 year old to 18 years old) using 600 mg/Mo mycophenolate mofetil oral twice daily (maximum dose up to 1g twice a day). This dose achieves the AUC value of MPA similar to the adult patient with a kidney transplant using Cellception 1g twice a day in the early and late after kidney transplantation. The AUC value of MPA between age groups is similar in early and late after kidney transplantation.
Elderly (65 years old)
Pharmacokinetics in the elderly have not been officially evaluated.
Before taking Cellcept 500mg Roche prevent acute transplantation (5 blisters x 10 tablets)
How to use
oral tablets.
Dosage
Renate dosage of kidney transplantation
Adult patient:
Children (from 3 months - 18 years old):
Adult patient:
Adult patient:
Adult patient:
Pediatric:
Treatment dose for patients with neutropenia
If there is a neutropenia (absolute neutropenemia
used in the elderly
The oral dosage of 1g x twice daily in patients with kidney transplant and 1.5g x 2 times daily in patients with heart or liver transplant is suitable for old patients.
Patients with renal failure
Patients with severe renal impairment should avoid doses higher than 1g x 2 times daily for patients with kidney transplant that suffer from severe kidney failure (glomerular filtration speed
Patients with liver failure
No need to adjust the dose for patients with kidney transplant with severe liver parenchyma disease. There is no data on patients with heart transplant with severe liver parenchyma.
Note: The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.
What to do when overdose? In many cases of overdose, there are no adverse events recorded. The unfavorable events reported in the case of overdose have been known in advance in the data on the safety of the drug.
It is thought that the overdose of Mycophenolate Mofetil can inhibit the immune system excessive, increasing sensitivity to infection and bone marrow inhibitor (see items note and caution). If neutrophilic leukemia occurs, it is necessary to stop or reduce the dose of cellcept. (See the category and cautious item).
MPa is not excreted by dialysis. However, at high doses (plasma C concentrations higher than 100kg/ml), a small amount of MPAG was eliminated. Medications that increase bile acid discharge like cholestyramine can be removed by MPA by increasing the elimination of drugs (see the item of pharmacokinetic properties).
In an emergency, call the 115 emergency center immediately or go to the nearest local health station.
What to do when forgetting 1 dose? However, if the time to relax with the next dose is too short, skip the dose and continue the calendar of the drug. Do not use double dose to compensate for missed dose.
Side Effects
Notify the doctor with unwanted effects when using the drug.
Understanding events occur when using immunosuppressive drugs is often difficult to determine due to the presence of the existing disease and the use of many different drugs at the same time.
Experience from clinical trials
The main undesirable reactions are related to the use of cellcept in the prophylactic treatment for kidney, heart and liver waste combined with corticosteroids and ciclosporin including: diarrhea, leukopenia, blood infection and vomiting; And there is evidence that the frequency of some types of infections is higher, such as an opportunity infection. The adverse events occur when using intravenous road cellocpt is similar to the oral cellcept.
Cellcept safety in patients who are treated with kidney transplantation is hard to treat similarly in patients in 3 clinical trials with a control of reserve waste prophylaxis with 3G/day doses. Diarrhea and leukemia, followed by anemia, nausea, abdominal pain, blood infections, nausea and vomiting, indigestion are the most prominent adverse events or found in patients using cellcept rather than in patients treated with intravenous corticosteroids.
Malignant disease
As well as patients treated with many immunosuppressive drugs, patients who use cellcept in immunosuppressive treatment regimen are subjects that increase the risk of lymphoma and other malignant diseases, especially skin diseases. In clinical trials with control in patients with kidney, heart and liver is monitored for at least a year, it is found that lymphoma or lymphoma occurs at 0.4% to 1% of patients using Cellcept (2G or 3G per day) in combination with other immune inhibitors.
The rate of skin cancer is not a pigment tumor, accounting for about 1.6% to 3.2% of patients, other types of cancer accounts for about 0.7-2.1%. Safety data in 3 years in heart and kidney transplant patients do not show any changes that are not expected of cancer rates compared to data in 1 year. Liver transplant patients are monitored for at least one year, but less than 3 years. In the tests with a study of the state of kidney transplantation that is difficult to treat, the lymphoma ratio is 3.9% with an average tracking time of 42 months.
Opportunity infection
All organ transplant patients are at risk of chance infection, this risk increases according to the dose of immunosuppressive drugs (see items note and cautious). In clinical trials with control in kidney transplantation patients (with a dose of 2g), the heart and liver are monitored for at least 1 year, it is found that the most common opportunistic infections in patients using Cellcept (2G or 3G per day) along with other immunosuppressive drugs are: Candida fungal infection of the skin mucosa, CMV blood virus/cytomalovirus syndrome and Herpes Simplex. The proportion of patients infected with CMV blood virus/Cytomegalovirus syndrome is 13.5%.
Children (from 3 months - 18 years old)
Types and frequency of adverse reactions in clinical trials over 100 children from 3 months - 18 years old using 600 mg/Mo Mycophenolate Mofetil oral twice a day is similar to adult patients using 1g Cellcept twice a day. However, adverse events related to the following treatment occur at a frequency of> 10% in young children and occur more often above children, especially children under 6 years of age when compared to patients with mature diarrhea, leukopenia, blood infection, infection, anemia.
Older patients (> 65 years old)
Older patients, especially patients who use Cellcept in the immunosuppressant combination regimen, may be at a higher risk for some infections compared to young people (including cytomegalovirus infections spread in organizations), gastrointestinal bleeding and pulmonary edema.
Cellcept safety is used by oral
Understanding events are reported 10% and from 3% - 10% of patients treated with cellocpt in tests that verify the prophylactic treatment for kidney rehabilitation (3 tests, 2G and 3G data) A heart transplant trial, and a verified liver transplant test in the table below.
Understanding events are reported 10% and from 3% - ciclosporin and corticosteroids.
A disadvantageous event is recorded in kidney transplant patients (n = 991)*
Body:
Digestive:
Respiratory:
The senses:
Endocrine:
Blood and lymph:
Metabolism, nutrition:
Respiratory:
Blood and lymph:
Respiratory:
The senses:
*(Total number n = 1483); ** (total number n = 578); *** (Total number n = 564).
In three clinical trials that are verified in the prevention of kidney transplantation, the safety of the drug in patients treated 2g Cellcept is higher than those who are treated for 3G Cellcept daily.
Warnings
Before using the drug you need to read the instructions carefully and refer to the information below.
Contraindicated
Cellcept medicine is contraindicated in the following cases:
Precautions when using
tumors
As well as for all patients who use the regimen combining immunosuppressive drugs, patients who use cellcept in immunosuppressive regimen are at risk of lymphoma or other malignant diseases, especially in the skin (see unwanted effect section). The risk of a day seems to be related to the intensity and duration of immunosuppressive treatment rather than the use of a certain drug.
As all patients are at high risk of skin cancer, should limit exposure to sunlight and ultraviolet rays by wearing protective clothes and sunscreen wearing high -protective factors.
Infections
Excessive immune system inhibition may also increase infections, including opportunistic infections, life -threatening infections and blood infections.
Infections include potential virus triggers, such as recurrence of hepatitis B or hepatitis C or infections caused by polyomavirus. Some cases of hepatitis due to recurrence of hepatitis B or hepatitis C have been recorded in patients with pathogens treated by immunosuppressive drugs. Progressive multifocal leukentphalopathy (PML) involves JC virus, some deaths have been recorded in Cellcept treatment patients. The recorded cases are often at high risk for PML, including immunosuppressive treatment and impaired immune function.
For patients taking immunosuppressive drugs, doctors should pay attention to the case of PML when diagnosis distinguishes in patients with neurological symptoms and should consult with neurologists. Kidney disease associated with BK virus has been recorded during the use of cellcept in post -renal transplant patients. This infection can lead to serious consequences, sometimes leading to kidney failure. Monitoring patients helps detect patients at risk of kidney disease associated with BK virus. It is necessary to consider reducing immunosuppressive in patients with evidence of kidney disease related to BK virus.
Blood and immune system
Some cases of simple red blood cells (PRCA) have been recorded in the Cellcept treatment patient with other immunosuppressive drugs. The mechanism of causing Prca of Mycophenolate Mofetil is unknown; The relationship of other immunosuppressants and their combination in an immunosuppressive regimen is not clear. In some cases, PRCA has been recorded as recovery if the dose is reduced or stopped with cellocpt. However, in patients with organ transplantation, if reduced immunosuppressive therapy will appear risk at each transplant.
Patients using cellcept should be instructed to immediately report the signs of infection, bruises, bleeding or bone marrow inhibitors.
Patients using cellcept should be checked for total blood recipe, once a week for the first month, twice a month in the 2nd and 3rd month, then check monthly until the end of the first year. In particular, patients who use Cellcept should be monitored to detect neutrophils. Multi -person leukopenia may be related to the use of cellcept, combined drugs, virus infections or due to the combination of these causes. If there is a neutrophils of neutropenia (the number of absolute neutrophils
It is advisable to let patients know that during the cellocpt treatment, the effectiveness of vaccination may be reduced and should avoid the use of live vaccines that reduce toxicity (see interactive items with other drugs and forms of drug interactions). Influenza can be vaccinated. Doctors should refer to the national instructions on Influenza vaccination.
StomachDue to the increase in the incidence of adverse events occurring in the digestive system, including cases of rarity such as gastrointestinal ulcers, hemorrhage and perforation, caution should be cautious when taking cellcept for patients with the disease of the digestive system. Cellcept is an Inosine monophosphate dehydrogenase inhibitor (IMPDH), so it should not be used for patients with hypoxanthin-guaninephosphoribosyl-gansferase (HGPRT) (HGPRT) such as Lesch -nyhan and Kelley-Seegmiller syndrome.
Interaction
Be careful when changing the treatment regimen from therapy containing immunosuppressive drugs that can inhibit the intestinal circulation of MPA such as Ciclosporin to other drugs that do not have this effect such as syirolimus, belatacept, or vice versa, due to the change of treatment regimen can change the MPA level. Careful with drugs that can inhibit the intestinal cycle of MPA such as cholestyramin, antibiotics due to the ability to reduce plasma concentrations and effectiveness of cellcept.
It is recommended that the cellcept should not be used with azathioprine because both of these drugs can inhibit bone marrow and this combination has not been studied.
Special cases
The risk of adverse events can increase in older patients such as infections (including tissue invasive virus) and gastrointestinal bleeding and pulmonary edema when compared to younger patients (see unwanted effects). Contraindicated use of cellcept for pregnant women and nursing mothers.
Should avoid using the dose exceeding 1g, twice daily in patients with chronic renal function.
No dose adjustment in patients after organ transplant has a slow recovery function, but must monitor patients carefully (see Section 3.2 Pharmacokinetic properties and special dose instructions). There are no data in patients with heart transplant or liver transplant with severe kidney failure.
Oral cellcept cells containing aspartame, the origin of phenylamine (equivalent to 2.78 mg/ 5 ml of oral fluid). Therefore, it is necessary to be cautious when using the oral cellcept for patients with phenylketonuria.
Use drugs for women during pregnancy and lactation
Pregnant women
Contraindicated to use cellcept for pregnant women and women who are likely to be pregnant without using highly effective contraception. (See section 2.3 contraindications)
Before starting treatment, male and female patients with fertility must be warned of increased risk of miscarriage and congenital fetal defects and must be advised on contraception and pregnancy plan.
Before starting to be treated with cellcept, female patients are likely to have two results of serum or negative pregnancy tests with at least 25 mlu/ml sensitivity, the second test should be conducted 8-10 days after the first and right test before starting with cellCept.
Pregnancy tests should be repeated in periodic monitoring. Discuss with patients on the results of all pregnancy tests. Patients should be instructed to consult a doctor right after pregnancy.
Because cellcept is likely to cause genetic and monster mutations, women are likely to be pregnant, so they should use two reliable contraceptive measures, including at least one highly effective measure before starting treatment, during treatment, and for 6 weeks after stopping treatment, except in case of abstaining from sex. For men, it is recommended to use condoms during treatment and at least 90 days after stopping treatment. Applying the use of condoms for both men with fertility and men who have vased pipes due to semen -related risk can also occur with men who have vasectomy. In addition, the recommendation of the use of contraception is highly effective for the partners of the male patient during the treatment process and in 90 days after the last dose.
birth defects, including multiple defects, have been reported after circulation of drugs in children of patients who used Mycophenolate Mofetil in combination with other immunosuppressive drugs during pregnancy.
The following defects are reported most often:
In literature, children's defects of mothers using Mycophenolate Mofetil during pregnancy have been reported from 23-27% of children. To compare, the risk of deformities is estimated at 2% of children living in the total population and about 4-5% in special organ transplant patients treated with non-mycophenolate mofetil non-inhibitors.
Cases of natural miscarriage have been reported in patients using Mycophenolat Mofetil, mainly in the first 3 months of pregnancy (see the post -circulating experience section)
In literature, the risk of reporting is about 45-49% after using Mycophenolate Mofetil comparison with the rate of about 12 to 33% in special organ transplant patients treated with other immunosuppressive drugs.
Animal research shows that there is toxicity on the reproductive system (see items that cause decline in fertility, teratogenicity)
Women who are breastfeeding
Contraindicated to use Cellcept during breastfeeding due to the ability to cause serious unwanted reactions in breastfed babies (see contraindicated sections) studies on mice show that Mycophenolate Mofetil is excreted in milk. It is not clear whether the cellCep will excrete in breast milk.
The effect of the drug on the ability to drive and operate machinery
The impact of driving and operating machinery has no research on influence when driving and operating machinery. Data are recorded and adverse reactions have been reported showing no influence.
Drug interaction
Acyclovir: Plasma concentrations of acyclovir and mpag when used with mycophenolate mofetil with acyclovir are higher when used separately each one. Because the mpag concentration in plasma as well as acyclovir concentration or its form of quality, valacyclovir, increases when the kidney failure, is capable of harmful drugs with competition elimination in the renal tubules and can cause more concentration of both drugs.
antacids and proton pump inhibitors (PPIS): When taking poor antacids such as hydroxide magnesium and aluminum hydroxide, and PPIS, such as Lansoprazole and Pantoprazole, the absorption of mycophenolate mofetil is reduced. When comparing the ratio of transplantation or the loss of organ loss between Cellcept patients with PPLS and patients who do not take PPIS, do not observe significant differences. These data help foreign conclusions for all antacids due to the reduction of absorption when used simultaneously cellcept with hydroxide magnesium and aluminum hydroxide are considered lower when using cellcept simultaneously with PPIS.
Cholestyramine: In normal healthy people, 4G Cholestyramine used three times a day for 4 days then used a single dose of 1.5 g Mycophenolate mofetil, the area under the curve of MPa decreased by 40%. Should be cautious when used with drugs that limit the re-circulating ring (see the item note and be cautious).
Ciclosporin A: The pharmacokinetics of Ciclosporin A (CSA) is not affected by Mycophenolate Mofetil. However, CSA inhibits MPA's intestinal circulation, reduces MPa levels from 30-50% in kidney transplant patients with Cellcept and CSA treatment when compared to patients using syrolimus or belatacept and cellcept with similar doses of cellCept. In contrast, the changes in the concentration of MPa should be expected when transferred to patients from CSA to other immunosuppressive drugs that do not affect the gut liver cycle of MPA.
Telmisartan: Concomitant use of Telmisartan and Cellcept reduces about 30% of mycophenolic acid level (MPA). Telmisartan changes the excretion of MPA due to activation of PPAR Gamma (Peroxisome Proliferator activating gamma receptors) that increases the activity of UGT1A9. When comparing the ratio of transplantation, the ratio of organ broken or adverse events between patients using cellcept simultaneously and not simultaneously with Telmisartan, no clinical conclusions about DDI pharmacokinetics are observed.
ganciclovir: Based on the results of the single dose research of the dosage of the use of Mycophenolate Mofetil oral and ganciclovir intravenously; And the known kidney impact on pharmacokinetics of Mycophenolate Mofetil (see the item of pharmacokinetic properties and items 2.4 are ideas and cautious) and ganciclovir, when concurrent use these drugs have competition in the mechanism of renal secretion) will increase the concentration of MPAG and Ganciclovir. There is no significant change in the pharmacokinetics of MPA and no need to adjust the dose of mycophenolate mofetil. In patients with renal failure, simultaneously using Mycophenolate Mofetil and Ganciclovir or its precursors, for example Valganciclovir, should monitor patients carefully.
Oral contraceptive pills: A study on the use of cellcept (1g twice daily) with oral contraceptive pills containing ethinylestradiol (0.02-0.04mg) and levonorgestrel (0.05-0.20mg), Desogestrel (0.15mg) or Gestodene (0.05-0.10mg) are progressed in 18 women with psalus It has shown that the cellcept does not affect clinical effects on the concentrations of progesterone, LH and FSH, so the cellcept does not affect the inhibition of ovulation of oral contraceptives. The pharmacokinetics of oral contraceptives are not affected at the level of clinical level when used simultaneously with cellocpt (see the pregnant woman item).
Rifampicin: After adjusting the dose at the right dose, it is still observed that there is a 70% reduction in MPA (AUC-P) concentration when used in combination with rifampicin in a heart-pitcher patient. Therefore, it is advised to closely monitor MPA concentration and need to adjust the Cellcept concentration accordingly to maintain clinical effect when using these two drugs together,
tacrolitis: Using Tacrolimus simultaneously with cellcept does not affect the area under the AUC curve as well as MPA's CMAX peak concentration in patients with liver transplant. In a recent study, it was found that this also happened in patients with kidney transplant. In patients with kidney transplant, the concentration of Tacrolimus does not seem to be changed by cellcept. However, in patients with stable liver transplantation, there is a phenomenon of increasing the AUC value of Tacrolimus about 20% when using multiple doses of cellcept (1.5g x 2 times/day) in combination with Tacrolimus.
Antibiotics kill bacteria producing b-glucuronidase in the intestine (for example, aminoglycoside, cephalosporin, fluoroquinolon, and penicillin group antibiotics) can affect the mpag/mpa liver circulatory cycle thus led to reduced mpa levels (see warning and caution, drug interaction)
Information related to antibiotics are as follows:
ciprofloxacin or amoxicillin in combination with clavulanic acid: 54% reduction of mpa (sunken) level before the dose was recorded in kidney transplant patients right after the beginning of drinking ciprofloxacin and amoxicillin in combination with clavulanic acid. This effect tends to reduce the continued use of antibiotics and completely stop using antibiotics. The change of concentration before this dose may not represent the total MPA level, so the clinical related of this change is still unclear.
Norfloxacin and Metronidazole: Norfloxacin combined with Metronidazole reduces the AUC0-48 of MPa 30% after taking the single doses of Cellcept. There is no effect on MPa concentration with one of the two antibiotics when they are used separately.
trimethoprim/sulphamethoxazole: MPA concentration (AUC, CMAX) is not affected when combined with trimethoprim/sulfamethoxazole
Other interactions: Use a combination of probenecid with mycophenolate mofetil when increasing the area below the curve of MPAG 3 times. Thus, other drugs are known to be excreted through the renal tubules that can compete with MPAG and thus increasing the plasma concentration of MPEG or removal drugs through the renal tubules. Using SEVELAMER combination with cellcept in adults and in children will reduce the CMAX peak concentration of MPa by 30% and reduce the AUC0-12 value of MPa by about 25%. From this fact, it is suggested that after using a new 2 -hour cellcept, SEVELAMER and calcium drugs have a binding force associated with other free phosphate roots to minimize the impact of these drugs on the absorption of MPA.
Living vaccine: Living vaccine should not be used for patients with impaired immune response. Antibody response to other vaccines may be reduced (see items note and caution).
taboo
Cellcept uses intravenous lines that are not compatible with other intravenous solutions, except for the Dextrose intravenous solution. Do not mix or simultaneously cellcept with other intravenous drugs through the same transmission line.
Storage
Leave a cool place, avoid light, temperature below 30⁰C.
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