MycophenolateMofetil(Cellcept)

Description Mycophenolate(Cellcept)belongstoaclassofmedicationsknownasimmunosuppressives.This medicationwasusedoriginallyinthemanagementofpatientswithorgantransplants,butisnow recommendedinthetreatmentofsomeautoimmunediseases. Uses Mycophenolatehasbeenusedtotreatpeoplewithlupus(especiallythosewithsymptomsofkidney disease),rheumatoidarthritis,vasculitis,inflammatoryboweldiseasesuchasCrohn'sdisease,andsome otherkidneyorskindisorders. Howitworks Mycophenolatetargetsanenzymeinthebodycalledinosinemonophosphatedehydrogenasethatis importantfortheformationofdeoxyribonucleicacid(DNA)incells.ByinterferingwithDNA,the medicationimpairsfunctionofimmunesystemcellsthatbecomeoveractiveinautoimmunediseases suchaslupus. Dosing Inadults,mycophenolatetypicallyisgiventwicedailyforatotaldoseof2to3grams(2000to3000mg) aday,althoughthisdosagemaybereducedinpeoplewithunderlyingkidneyproblems.Thedose usuallyislowerthan2gramsadayforchildren. Takingmycophenolatewithfoodoftenhelpstopreventsideeffectssuchasnauseaorstomachpain. Mycophenolatecomesin250mgand500mgcapsulesortabletsaswellasinanintravenousform. Peoplewhoprefertotakemedicationinliquidformcanaskapharmacisttoprepareitasanoral suspension,butshouldnottrytoopenthecapsulesorcrushthetabletsontheirown.

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Timetoeffect Usuallythefirstbenefitsofthismedicationarenoticedinseveralweeks,butitmaytakeseveralmonths orevenlongertoachievemaximumresults. Sideeffects Themostcommonsideeffectswithmycophenolateincludeupsetstomach,nausea,vomitingor diarrhea.Otherpossiblesideeffectsincludeheadache,dizziness,difficultysleeping,tremorand, occasionally,rash.Thesesideeffectsusuallygoawaywithtime,buttelladoctoriftheypersist. Lesscommonbutmoreserioussideeffectsincludeareductionofwhitebloodcells(increasingthe chancesofinfections),redbloodcellsthatferryoxygentotissues(whichmayleadtoanemia),and plateletsthataidclotting(whichcanleadtogastrointestinalbleeding).Periodicbloodtestscandetect reducedbloodcountsearlyontoavoidtheseproblems. Patientsolderthan65maybeatincreasedriskforsomesideeffects,especiallyinfectionsand gastrointestinalbleeding.Peoplewhohavehadulcersorotherseriousgastrointestinalconditions shouldtalkwiththeirdoctorsbeforetakingthismedication. Studiesoftransplantpatientstakingmycophenolatehavefounditmayincreaseriskofsomecancers suchaslymphomasandskincancers.Becausetheremaybeasimilarriskinpeoplewithrheumatic conditionswhotakemycophenolateforlongperiodsoftime,discussthisissuewithaphysicianbefore startingthemedication.Whenonmycophenolate,itisimportanttoseeaphysicianregularly,usea sunscreenandavoidprolongedsunexposure. Pointstoremember Regularbloodtestsmaybenecessaryforpeopletakingmycophenolate.Suchtestsmaybeperformed morefrequentlyduringthefirstseveralmonths,andthenlessoftenwithtime. Notifyyourdoctorifyoubruiseorbleedeasily,orifyouexperiencepersistentorbloodydiarrhea, shortnessofbreath,feversorothersignsofaninfection. Theeffectsofmycophenolateduringpregnancyhavenotbeenwellstudied,soitisnotclearif mycophenolatecausesbirthdefects.Ifyouarepregnantorareconsideringhavingachild,youshould discussthiswithyourdoctorbeforebeginningthismedication.Useaneffectiveformofbirthcontrol whiletakingthismedicationandforuptosixweeksafteryoustoptakingit.Becauseonestudyfound thatmycophenolatereducedthebloodlevelsofsomeoralcontraceptives(althoughitisnotknownif thatmeantitdecreasestheireffectiveness),otherformsofbirthcontrolarerecommended.Donot breastfeedwhiletakingmycophenolatebecausethedrugmaybepassedintothebreastmilk. Somevaccinationsshouldbeavoidedwhiletakingthismedication.Besuretodiscusswithyourdoctor beforereceivinganyvaccines.Also,besuretonotifyyourdoctorbeforeanysurgerieswhiletakingthis medication.

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Druginteractions Tellyourdoctoraboutallofthemedicationsyouaretaking,includingoverthecounterdrugsand naturalremedies.Apartiallistofmedicationsthatmayinterferewithmycophenolateinclude: cholestyramine(Questran) acyclovir(Zovirax) gancyclovir(Cytovene) azathioprine(Imuran) antacidscontainingmagnesiumoraluminumhydroxide(suchasMaalox,Rolaids,orMylanta) oralcontraceptives trimethoprim/sulfamethoxazole(Bactrim) theophylline(TheoDur) phenytoin(Dilantin) probenecid(Benemid) aspirinandothersalicylates Becausemanyantacidsinterferewiththeabsorptionofmycophenolate,theyshouldnotbetakenatthe sametime.Instead,youshouldeithertakeantacidsatleast1hourbeforemycophenolateorwaitat least2hoursaftertakingmycophenolatebeforetakinganantacid. Formoreinformation NationalInstitutesofHealth:MedlinePlus http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601081.html
UpdatedJune2006. WrittenbyMichaelCannon,MD,andreviewedbytheAmericanCollegeofRheumatologyPatientEducationTask Force. Thispatientfactsheetisprovidedforgeneraleducationonly.Individualsshouldconsultaqualifiedhealthcare providerforprofessionalmedicaladvice,diagnosesandtreatmentofamedicalorhealthcondition. 2010AmericanCollegeofRheumatology

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