Mycophenolate mofetil
An IMPDH inhibitor prodrug used with other immunosuppressants to prevent kidney, heart and liver transplant rejection.
Also called mycophenolic acid (active form, also given as delayed-release mycophenolate sodium) or MMF (abbreviation).
Drug card
- How it works
- Inhibiting IMPDH so lymphocytes run short of guanine nucleotides
- Used for
- Preventing kidney, heart and liver transplant rejection
- Lupus nephritis, as background therapy
- Known for
- Diarrhea
- Low white cells (leukopenia, neutropenia)
- Miscarriage and birth defects
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Mechanism of action
How does mycophenolate mofetil work?
After absorption, mycophenolate mofetil is hydrolyzed to mycophenolic acid, a selective, uncompetitive and reversible inhibitor of IMPDH. Blocking this enzyme shuts the de novo route to guanosine nucleotides, which activated T and B lymphocytes rely on, so their proliferation and antibody production fall.
Like other antiproliferative immunosuppressants: Lymphocytes activated by an antigen must copy their DNA to multiply, and these drugs cut their supply of purine nucleotides. Azathioprine releases mercaptopurine, whose thioguanine nucleotides block purine synthesis and enter DNA; mycophenolate's active form inhibits IMPDH, the enzyme lymphocytes rely on to make guanine nucleotides. Fewer T and B cells expand, and antibody production falls.
Uses
What is mycophenolate mofetil used for?
- Preventing kidney, heart and liver transplant rejection
- Lupus nephritis, as background therapy
Side effects
Side effects of mycophenolate mofetil
- DiarrheaKnown for
- Low white cells (leukopenia, neutropenia)Known forSerious
- Miscarriage and birth defectsKnown forSerious
- Serious and opportunistic infections, such as CMVSerious
- Hepatitis B or C reactivationSerious
- JC virus brain infection (PML)Serious
- Lymphoma (post-transplant lymphoproliferative disorder)Serious
- Skin cancerSerious
- Pure red cell aplasia (severe anemia)Serious
- Gut bleeding, ulcers or perforationSerious
- Vomiting
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- Pregnancy: it causes first-trimester loss and malformations, so pregnancy is excluded and contraception used; it may weaken the pill.
- Blood counts are monitored for neutropenia, closely in the first months.
- Magnesium or aluminum antacids, proton pump inhibitors and drugs that interrupt enterohepatic recirculation lower its levels.
- Immunosuppression raises the risk of serious infections, lymphoma and skin cancer; live vaccines are avoided.
Good to know: Mycophenolic acid is also sold as delayed-release mycophenolate sodium tablets, which are not interchangeable with mycophenolate mofetil.
Remember it
A way to remember it
BLIPS
- B
- Bone marrow suppression
- L
- Lymphoma
- I
- Infections
- P
- Pregnancy harm: miscarriage and birth defects
- S
- Skin cancer
Written for biofideX
Its class
Antiproliferative immunosuppressants
Other antiproliferative immunosuppressants with a card:
Easily mixed up with calcineurin inhibitors and antimetabolites.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
- Mycophenolate mofetil: label (DailyMed)
- Mycophenolate Mofetil (NCI Thesaurus)
- Mycophenolic Acid (NCI Thesaurus)
- Mycophenolic acid delayed-release tablets: label (DailyMed)
- Voclosporin capsules: label (DailyMed)
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Targeted therapy and the immune system
Mycophenolate mofetil is one of 13 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
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