Home Drug Guide Mycophenolic Sodium

Drug Guide

Generic Name

Mycophenolic Sodium

Brand Names Myfortic

Classification

Therapeutic: Immunosuppressant

Pharmacological: Purine synthesis inhibitor

FDA Approved Indications

Prevention of organ rejection in heart, kidney, and liver transplant patients

Mechanism of Action

Mycophenolic Sodium inhibits inosine monophosphate dehydrogenase, leading to decreased guanine nucleotide synthesis, which impairs lymphocyte proliferation and function.

Dosage and Administration

Adult: Typically 720 mg twice daily, adjusted based on clinical response and tolerability.

Pediatric: Use not established; consult specialist.

Geriatric: Adjust dose with caution, considering renal function.

Renal Impairment: Dose adjustment required; monitor renal function.

Hepatic Impairment: Use with caution; no specific dosing guidelines.

Pharmacokinetics

Absorption: Well-absorbed with oral administration.

Distribution: Widely distributed; crosses placenta and enters breast milk.

Metabolism: Metabolized to mycophenolic acid, the active form.

Excretion: Primarily via kidneys.

Half Life: Approximately 16-18 hours.

Contraindications

Hypersensitivity to mycophenolic acid or any component.
Pregnancy (category D), unless clearly necessary.

Precautions

Risks of infection and malignancy due to immunosuppression.
Monitor blood counts, renal function, and signs of infection.

Adverse Reactions - Common

Gastrointestinal upset (nausea, diarrhea) (Common)
Leukopenia (Common)
Anemia (Less common)

Adverse Reactions - Serious

Infections (bacterial, viral, fungal) (Serious but less common)
Progressive multifocal leukoencephalopathy (PML) (Rare)
Lymphoma or other malignancies (Rare)

Drug-Drug Interactions

Azathioprine, tacrolimus, cyclosporine, live vaccines.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of infection, blood cell counts, renal function.

Diagnoses:

Risk for infection
Risk for bleeding due to thrombocytopenia

Implementation: Administer with food to reduce gastrointestinal upset. Monitor labs regularly.

Evaluation: Efficacy is indicated by lack of rejection episodes; monitor for adverse effects.

Patient/Family Teaching

Report signs of infection immediately.
Take medication consistently with food.
Avoid live vaccines.
Use effective contraception during therapy and 6 weeks after discontinuation.

Special Considerations

Black Box Warnings:

Increased risk of infections and malignancies.
Fetal harm – pregnancy category D; strict contraceptive measures required.

Genetic Factors: Genetic variations in drug metabolism may influence efficacy and toxicity.

Lab Test Interference: May cause false-positive urine protein tests.

Overdose Management

Signs/Symptoms: Gastrointestinal symptoms, leukopenia.

Treatment: Supportive care; no specific antidote. Hemodialysis is not effective for overdose clearance.

Storage and Handling

Storage: Store at room temperature, away from moisture and light.

Stability: Stable for the period specified in packaging.