Mycophenolate

Question 1

Mycophenolate - mechanism of action

Answer 1

Inhibits purine biosynthesis (anti-metabolite)

Results in immunosupression

Question 2

Mycophenolate - absorption

Answer 2

Rapid GI absorption

Question 3

Mycophenolate - metabolism and excretion

Answer 3

Converted to MPA (active form) in the plasma, liver and kidney

Inactivated in the liver

**Excreted in the urine. **

Question 4

Mycophenolate - when do peak levels occur?

Answer 4

Two peaks
- 0.8 hours
- 6 - 12 hours

Twice daily dosing
Half life = 16 hours

Question 5

Pregnancy cateogry of Mycophenolate

Answer 5

D - known teratogen

Question 6

Contraindications to Mycophenolate

Answer 6

Hypersensitivity
Pregnancy

Relative:
- Lactation
- concurrent Aza use
- peptic ulcer disease

Question 7

Advers effects of Mycophenolate?

THINNGG

Answer 7

T - Teratogen - first trimester loss, ear / facial / limb anomolies

H - Hamatological: anaemia, thrombocytopaenia, neutropaenia, agranulocytosis,

I - Infections opportunistic infections

**N - Neoplastic **

N - Neurologic - weakness, fatigue

**G- GI ** most common - N / V / D

** G - Genitourinatry ** urgency, frequency, dysuria

Question 8

Mycophenolate dosing

Answer 8

Start at 500mg daily
Increase to 500mg BD
then by 500mg/day every 1 -2 weeks as tolerated

Target dose of 2 -3 g / day

Question 9

Onset of Mycophenolate response

Answer 9

6 - 8 weeks

Question 10

Pre-treatment screening

Answer 10

bHCG

FBC
UEC
LFTs

Pre-immunosupression screen

Hx of neurological / peptic ulcer disease

Question 11

Mycophenolate monitoring

Answer 11

FBC, UEC, LFTs
- weekly while titrating dose
- then every 3 months