Mycophenolate mofetil (MMF) is a prodrug of mycophenolic acid (MPA), a potent, selective, non-competitive, and reversible inhibitor of inosine monophosphate dehydrogenase (IMPDH). It is an immunosuppressive agent primarily used to prevent organ rejection in transplant recipients. The 360mg strength is a common formulation used in India, often for maintenance therapy or in specific dosing regimens.
Adult: Renal Transplant: 720 mg (i.e., 360mg x 2 tablets) orally twice daily (total 1440 mg/day). Cardiac Transplant: 1500 mg orally twice daily. Hepatic Transplant: 1500 mg orally twice daily. For autoimmune diseases (e.g., Lupus Nephritis): 360-720 mg twice daily, titrated based on response and tolerance.
Note: Administer on an empty stomach, 1 hour before or 2 hours after food to avoid reduced MPA exposure. Tablets should be swallowed whole with a glass of water; do not crush, break, or chew. If a dose is missed, take it as soon as remembered unless it is nearly time for the next dose. Do not double the dose. For women of childbearing potential, pregnancy must be excluded before initiation and two reliable forms of contraception must be used.
MMF is a prodrug that is rapidly hydrolyzed to mycophenolic acid (MPA). MPA is a potent, selective, uncompetitive, and reversible inhibitor of inosine monophosphate dehydrogenase (IMPDH), specifically the type II isoform which is upregulated in activated lymphocytes. This inhibition blocks the de novo pathway of guanosine nucleotide synthesis, a pathway crucial for DNA and RNA synthesis in T- and B-lymphocytes. This leads to cytostatic arrest of lymphocyte proliferation, suppressing cell-mediated immune responses and antibody formation.
Pregnancy: Pregnancy Category D. Contraindicated. Associated with a high risk of first-trimester pregnancy loss and congenital malformations (including external ear, facial, cardiovascular, CNS, and limb abnormalities). Women of childbearing potential must have a negative pregnancy test within 1 week prior to initiation and use two reliable forms of contraception for 4 weeks before, during, and 6 weeks after therapy.
Driving: May cause dizziness, somnolence, or blurred vision. Patients should be cautioned about operating machinery or driving until they know how MMF affects them.
| Acyclovir, Valacyclovir, Ganciclovir, Valganciclovir | Competition for renal tubular secretion may increase plasma concentrations of both MPA and the antiviral drug, potentially increasing toxicity (myelosuppression, neuropenia). | Major |
| Antacids with Magnesium and Aluminum Hydroxides | Decrease absorption of MMF, reducing MPA bioavailability by up to 33%. Administer MMF at least 2 hours apart. | Moderate |
| Cholestyramine and other bile acid sequestrants | Interrupt enterohepatic recirculation, significantly reducing MPA exposure (AUC). Avoid concomitant use. | Major |
| Cyclosporine (CsA) | CsA inhibits the MRP2 transporter, reducing biliary excretion of MPAG, thereby decreasing enterohepatic recirculation and MPA exposure. Switching from CsA to other calcineurin inhibitors may increase MPA levels. | Moderate |
| Proton Pump Inhibitors (PPIs) like Omeprazole | May slightly decrease MPA exposure. Clinical significance is uncertain but monitor efficacy. | Minor |
| Rifampicin | Induces UGT enzymes and possibly P-gp, decreasing MPA plasma concentrations. Dose adjustment of MMF may be needed. | Moderate |
| Live Vaccines (e.g., MMR, Varicella, Yellow Fever) | Risk of disseminated infection due to immunosuppression. Contraindicated. | Major |
| Sevelamer | Decreases MPA Cmax and AUC if taken simultaneously. Administer MMF at least 2 hours before sevelamer. | Moderate |
| Oral Contraceptives | Theoretical risk of decreased contraceptive efficacy due to induction of UGT. Women must use a second, highly effective barrier method. | Moderate |