Introduction

Name

• Mycophenolate mofetil.

Class of drug

• Immunosuppressant.

Description

Chemical name

• 2-morpholinoethyl (E)-6-(1,3-­dihydro-4-hydroxy-6-methoxy-7-methyl-3-oxo-5-isobenzofuranyl)-4-methyl-4­-hexenoate

Molecular formula

• C₂₃H₃₁NO₇

Molecular weight

• 433.50

Physical properties

• Oral: 250 mg capsules, 500 mg tablets,1 g/5 ml powder for oral suspension; 180 mg, 360 mg tablets.
• Injectable: 500 mg powder for reconstitution and slow IV infusion.

Storage requirements

• Capsules, tablets and injections: 25°C. Discard reconstituted injection after 7 days.
• Reconstituted oral suspension: 4°C or 25°C. Discard reconstituted suspension after 60 days.

Uses

Indications

• For treatment of immune-mediated disease, eg IMHA Anemia: immune mediated hemolytic, aplastic anemia, immune-mediated thrombocytopenia Immune-mediated thrombocytopenia, glomerulonephritis Glomerulonephritis and myasthenia gravis Myasthenia gravis.
• Prevention of tissue rejection following organ transplantation.

Administration

Pharmacokinetics

Precautions

Interactions

With other drugs

• Competes with other drugs that undergo active renal tubular secretion resulting in increased concentration of either drug.
• Concomitant administration of antacids (eg omeprazole Omeprazole) may decrease absorption.
• May interfere with antibody response to vaccination.

With diagnostic tests

• May elevate blood glucose concentrations.

Adverse Reactions

Further Reading

Publications

Refereed Papers

• Recent references from VetMedResource and PubMed.
• Ackermann A L, May E R, Frank L A (2017) Use of mycophenolate mofetil to treat immune-mediated skin dosease in 14 dogs - a retrospective evaluation. Vet Dermatol 28(2), 195-e44 PubMed.
• Cummings F O, Rizzo S A (2017) Treatment of presumptive primary immune-mediated thrombocytopenia with myophenolate mofetil versus cyclosporine in dogs. JSAP 58(2), 96-102 PubMed.
• Barnoon I, Shamir M H, Aroch I, Bdolah-Abram T, Srugo I, Konstantin L, Chai O (2016) Retrospective evaluation of combined mycophenolate mofetil and prednisone treatment for meningoencephalomyelitis of unknown etiology in dogs: 25 cases (2005-2011). J Vet Emerg Crit Care (San Antonio) 26(1), 116-124 PubMed.
• Woolcock A D, Wang A, Haley A et al (2016) Treatment of canine meningoencephalomyelitis of unknown aetiology with mycophenolate mofetil and corticosteroids: 25 cases (2007-2012). Vet Med Sci 2(2), 125-135 PubMed. 
• IRIS Canine GN Study Group Established Pathology Subgroup, Segev G, Cowgill L D, Heiene R, Labato M A, Polzin D J  (2013) Consensus recommendations for immunosuppressive treatment of dogs with glomerular disease based on established pathology. J Vet Intern Med 27 Suppl 1, S44-54 PubMed.
• Yau V K, Bianco D (2013) Treatment of five haemodynamically stable dogs with immune-mediated thrombocytopenia using mycophenolate mofetil as single agent. J Vet Intern Med 27 Suppl 1, S44-54 PubMed.
• West L D, Hart J R (2014) Treatment of idiopathic immune-mediated hemolytic anemia with mycophenolate mofetil in five dogs. J Vet Emerg Crit Care (San Antonio) 24(2), 226-31 PubMed.
• Downing H J, Pirmohamed M, Beresford M W, Smyth R L (2013) Paediatric use of mycophenolate mofetil. Br J Clin Pharmacol 75(1), 45-59 PubMed.
• Wang A, Smith J R, Creevy K E (2013) Treatment of canine idiopathic immune-mediated haemolytic anaemia with mycophenolate mofetil and glucocorticoids: 30 cases (2007 to 2011). JSAP 54(8), 399-404 PubMed.
• Whitley N T, Day M J (2011) Immunomodulatory drugs and their application to the management of canine immune-mediated disease. JSAP52(2), 70-85 PubMed.
• Dewey C W, Cerda-Gonzalez S, Fletcher D J, Harb-Hauser M F, Levine J M, Badgley B L, Olby N J, Shelton G D (2010) Mycophenolate mofetil treatment in dogs with serologically diagnosed acquired myasthenia gravis: 27 cases (1999-2008). JAVMA 236(6), 664-668 PubMed.

Other sources of information

• Ramsey I (2017) BSAVA Small Animal Formulary. 9th edn BSAVA, UK.