Mycophenolic Acid DI Flashcards
MoA of mycophenolic acid (MPA)
Inhibits IMPDH which interferes with purine metabolism required for lymphocyte development
Factors affecting MPA PK
Time after transplantation, drug interactions, enterohepatic circulation (especially with concurrent CNI therapy), concurrent disease states, food, ethnicity, possibly gender
Effect of CYA inhibiting the MRP2 transporter
Reduced enterohepatic circulation of MPAG to MPA, reduced MPA AUC
Effect of tacrolimus minimally inhibiting MRP2
Higher MPA AUC (lower daily MPA doses divided)
Effect of cholestyramine and bile acid resins
Reduces MPA AUC
Effect of ABX on MPA
Reduces MPA’s AUC
ABX that decrease MPA AUC
Norfloxacin, metronidazole, ciprofloxacin, amoxicillin with clauvanic acid, rifampin
Drugs that affect renal elimination of MPA
Acyclovir, ganciclovir, co-trimoxazole- they all compete with MPAG for tubular secretion which may increase MPAG concentrations
COCs and MMF
Use a second barrier method
MPA and MPAG on protein binding
May alter binding of drugs to albumin (phenytoin, ASA)
Glucocorticoids and MPA
Steroids may increase MPA metabolism
MPA drugs
Mycophenolate mofetil (MMF) (Cellcept); mycophenolic acid sodium (MPS) (Myfortic)
Mycophenolate mofetil brand name
CellCept
Mycophenolate acid sodium brand name
Myfortic
Which MPA drug is a prodrug?
Mycophenolate mofetil/CellCept
