II. Indications

  1. Solid Organ Transplant immunosuppression (maintenance prevention of rejection)

III. Adverse Effects: Mycophenolate or Mycophenolic acid

  1. See Azathioprine (Imuran)
  2. Bone Marrow suppression
  3. Gastrointestinal adverse effects (e.g. Nausea, Vomiting, Diarrhea, Abdominal Pain)

IV. Preparations

  1. Azathioprine (Imuran)
  2. Mycophenolate (Cellcept)
  3. Mycophenolic acid (MyFortic)

V. Drug Interactions

  1. See Cytochrome P-450 3A4
  2. Agents that increase Purine Synthesis Inhibitor concentrations
    1. Linezolid
    2. Valganciclovir (Valcyte) potentiates myelosuppression
    3. Allopurinol (esp. Azathioprine)
  3. Agents that decrease Purine Synthesis Inhibitor concentrations
    1. Rifampin

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Cost: Medications

mycophenolate (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
MYCOPHENOLATE 200 MG/ML SUSP Generic $5.87 per ml
MYCOPHENOLATE 250 MG CAPSULE Generic $0.22 each
MYCOPHENOLATE 500 MG TABLET Generic $0.25 each
cellcept (on 1/1/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
CELLCEPT 200 MG/ML ORAL SUSP Generic $5.87 per ml
CELLCEPT 250 MG CAPSULE Generic $0.22 each
CELLCEPT 500 MG TABLET Generic $0.25 each
mycophenolic acid (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
MYCOPHENOLIC ACID DR 180 MG TB Generic $2.61 each
MYCOPHENOLIC ACID DR 360 MG TB Generic $5.16 each
myfortic (on 4/19/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
MYFORTIC 180 MG TABLET Generic $2.61 each
MYFORTIC 360 MG TABLET Generic $5.16 each

Ontology: Mycophenolic Acid (C0026933)

Definition (NCI) An antineoplastic antibiotic derived from various Penicillium fungal species. Mycophenolic acid is an active metabolite of the prodrug mycophenolate mofetil. Mycophenolic acid inhibits inosine monophosphate dehydrogenase (IMPDH), preventing the formation of guanosine monophosphate and synthesis of lymphocyte DNA that results in inhibition of lymphocyte proliferation, antibody production, cellular adhesion, and migration of T and B lymphocytes. Mycophenolic acid also has antibacterial, antifungal, and antiviral activities. (NCI04)
Definition (MSH) An antibiotic substance derived from Penicillium stoloniferum, and related species. It blocks de novo biosynthesis of purine nucleotides by inhibition of the enzyme inosine monophosphate dehydrogenase. Mycophenolic acid is important because of its selective effects on the immune system. It prevents the proliferation of T-cells, lymphocytes, and the formation of antibodies from B-cells. It also may inhibit recruitment of leukocytes to inflammatory sites. (From Gilman et al., Goodman and Gilman's The Pharmacological Basis of Therapeutics, 9th ed, p1301)
Definition (CSP) antibiotic substance derived from Penicillium stoloniferum and related species which blocks de novo biosynthesis of purine nucleotides by inhibition of the enzyme inosine monophosphate dehydrogenase; mycophenolic acid has selective effects on the immune system, preventing the proliferation of T cells, lymphocytes, and the formation of antibodies from B cells.
Concepts Lipid (T119) , Antibiotic (T195)
MSH D009173
SnomedCT 409331009, 409330005
English Acid, Mycophenolic, 4-Hexenoic acid, 6-(1,3-dihydro-4-hydroxy-6-methoxy-7-methyl-3-oxo-5-isobenzofuranyl)-4-methyl-, (E)-, 4-Hexenoic acid, 6-(4-hydroxy-6-methoxy-7-methyl-3-oxo-5-phthalanyl)-4-methyl-, (E)-, -Hexenoic acid, 6-(1,3-dihydro-4-hydroxy-6-methoxy-7-methyl-3-oxo-5-isobenzofuranyl)-4-methyl-, (E)-, mycophenolic acid (medication), mycophenolic acid, MYCOPHENOLIC ACID, Mycophenolic Acid [Chemical/Ingredient], Mycophenolic acid (product), Mycophenolic acid (substance), Mycophenolic acid, MPA, Acide mycophenolique, Acido micofenolico, Acidum mycophenolicum, Mycophenolic Acid
Swedish Mykofenolsyra
Czech kyselina mykofenolová
Finnish Mykofenolihappo
Russian MIKOFENOLOVAIA KISLOTA, МИКОФЕНОЛОВАЯ КИСЛОТА
Spanish Ácido Micofenólico, ácido micofenólico (producto), ácido micofenólico (sustancia), ácido micofenólico
Polish Kwas mykofenolowy
Japanese セルセプト, ミコフェノール酸, ミコフェノール酸ジナトリウム, ミコフェノール酸ナトリウム, ミコフェノラートモフェチル, ミコフェノール酸モフェチル
French Acide mycophénolique
German Mycophenolsäure
Italian Acido micofenolico
Portuguese Ácido Micofenólico

Ontology: mycophenolate mofetil (C0209368)

Definition (NCI) The morpholinoethyl ester of mycophenolic acid (MPA) with potent immunosuppressive properties. Mycophenolate stops T-cell and B-cell proliferation through selective inhibition of the de novo pathway of purine biosynthesis. In vivo, the active metabolite, MPA, reversibly inhibits inosine 5'-monophosphate dehydrogenase, an enzyme involved in the de novo synthesis of guanine nucleotides. MPA displays high lymphocyte specificity and cytotoxicity due to the higher dependence of activated lymphocytes on both salvage and de novo synthesis of guanine nucleotides relative to other cell types. (NCI04)
Definition (NCI_NCI-GLOSS) A drug used to prevent graft-versus-host disease (GVHD) after organ transplants. It is also being studied in the prevention of GVHD after stem cell transplants for cancer, and in the treatment of some autoimmune disorders. Mycophenolate mofetil is a type of immunosuppressive agent.
Definition (CSP) immunosuppressant used in the prophylaxis of organ rejection.
Definition (PDQ) The morpholinoethyl ester of mycophenolic acid (MPA) with potent immunosuppressive properties. Mycophenolate stops T-cell and B-cell proliferation through selective inhibition of the de novo pathway of purine biosynthesis. In vivo, the active metabolite, MPA, reversibly inhibits inosine 5'-monophosphate dehydrogenase, an enzyme involved in the de novo synthesis of guanine nucleotides. MPA displays high lymphocyte specificity and cytotoxicity due to the higher dependence of activated lymphocytes on both salvage and de novo synthesis of guanine nucleotides relative to other cell types. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42797&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42797&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C1468" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C063008
SnomedCT 109131004, 386976000
English mycophenolic acid morpholinoethyl ester, mycophenolate mofetil (medication), Mycophenolate Mofetil, MYCOPHENOLATE MOFETIL, mycophenolate mofetil [Chemical/Ingredient], mofetil mycophenolate, Mycophenolate mofetil, Mycophenolate mofetil (product), Mycophenolate mofetil (substance), mycophenolate mofetil, MMF
Spanish micofenolato mofetilo, micofenolato mofetilo (producto), micofenolato de mofetilo (producto), micofenolato de mofetilo (sustancia), micofenolato de mofetilo

Ontology: Cellcept (C0592558)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C063008
English Cellcept, CellCept, cellcept