How is MMF supplied and used?
- • Available formulations: 250-mg, 500-mg capsules; oral suspension (200 mg/mL) and intravenous (IV) form (500 mg/20 mL) available.
- • Side effects: GI (especially diarrhea 25%), leukopenia, anemia, hepatotoxicity, infections (Pneumocystis jirovecii, progressive multifocal leukoencephalopathy, herpes zoster, and CMV); lymphoproliferative malignancies (Epstein–Barr virus [EBV]-associated).
- • Dosage: 500 to 1500 mg two times a day (BID). Taking with food may decrease not only absorption but also GI side effects. Decrease maximum dose to 1000 mg BID if severe renal insufficiency (creatinine clearance [CrCl] <30 cc/minute) and in Asians.
- • Cost (1000 mg BID): generic ($120/month); brand Cellcept ($1500/month).
- • Monitoring: baseline CBC with differential, hepatic function tests, creatinine, serologic testing for hepatitis B and C, and screening for latent tuberculosis. Follow CBC and liver enzymes weekly with dose change and then CBC every 6 to 8 weeks.
- • Precautions: avoid in pregnancy and lactation; vaccinate appropriately. Cholestyramine and administration with food or antacids/ proton pump inhibitors decrease bioavailability. Tacrolimus may potentiate effects of MMF.
Pearl: good alternative to AZA in patients with gout who need allopurinol or febuxostat and in patients who need warfarin.
