Monograph
L04AA06 - Mycophenolic Acid |
Propably not porphyrinogenic |
PNP |
Important Information
Patients on immunosuppressive therapy have an increased risk of infections. Since infections have a potential to trigger acute porphyric attacks vigilance is motivated regarding signs or symptoms of infection and/or possible symptoms of a porphyric attack. Side effects like nausea and vomiting may potentially be porphyrinogenic through reduction in carbohydrate intake.
Side effects
Infections are common in patients using immunosuppressants and since infections might trigger an acute porphyric attack, vigilance regarding signs and symptoms of an infection and/ or a porphyric attack is recommended. Common adverse reactions of mycophenolic acid that can be confused with an acute porphyric attack are nausea and vomiting. These side effects may potentially be porphyrinogenic if leading to a decrease in carbohydrate intake.
Rationale
Mycophenolic acid is not metabolized by cytochrome P450 enzymes. No pharmacokinetic porphyrinogenic effects are suspected.
Chemical description
Mycophenolic acid (or mycophenolate), derived from Penicillium stoloniferuma, is a reversible inhibitor of inosine monophosphate dehydrogenase and thus inhibits purine synthesis. The most commonly used form of the drug is mycophenolate mofetil, the 2-morpholinoethyl ester of mycophenolic acid.
Therapeutic characteristics
Mycophenolic acid is an immunosuppressant used for the prevention of graft rejection, and has also been tried in diseases with an auto-immune or immune-mediated inflammatory component. It is administered orally or as an intravenous infusion.
Metabolism and pharmacokinetics
Mycophenolate undergoes presystemic metabolism to active mycophenolic acid (MPA). MPA undergoes enterohepatic recirculation and secondary increases in plasma MPA concentrations are seen. MPA is metabolised by glucuronidation to the inactive mycophenolic acid glucuronide.
Published experience
Mycophenolate was used uneventfully after kidney transplants in two female AIP patients (Barone, 2001; Warholm, 2003), one 49 year old male AIP patient (El-Haggan, 2002) and one female HCP patient (Telkes 2013).
IPNet drug reports
Uneventful use reported in 4 patients with acute porphyria.
Similar drugs
References
| # | Citation details | PMID |
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| * | Scientific articles | |
| 1. | The tolerability of newer immunosuppressive medications in a patient with acute intermittent porphyria.
Barone GW, Gurley BJ et al. J Clin Pharmacol. 2001;41(1):113-5. |
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| 2. | Sirolimus tolerability in a kidney transplant recipient with acute intermittent porphyria.
El-Haggan W, Lobbedez T, et al. Nephrol Dial Transplant. 2002;17(6):1147. |
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| 3. | Kidney transplantation in hereditary coproporphyria using tacrolimus and mycophenolate mofetil: a case report.
Telkes G, Pusztai A et al. Transplant Proc. 2013;45(10):3703-4. |
24315002 |
| 4. | Renal transplantation in a case of acute intermittent porphyria.
Warholm C, Wilczek H. J Clin Pharmacol. 2003;43(10):1158-60. |
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| * | Drug reference publications | |
| 5. | McEvoy GK, editor. Mycophenolate. The AHFS Drug Information 2008. Bethesda, MD: American Society of Health-System Pharmacists; 2009. Electronic version (23.08.10).
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| 6. | Sweetman SC, editor. Martindale: The complete drug reference. Mycophenolic acid. Pharmaceutical Press 2009.
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| * | Summary of Product Characteristics | |
| 7. | The electronic Medicines Compendium (emc). Summary of Product Characteristics (SPC). CellCept.
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Tradenames
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Bold names are the searchable terms, while the gray names that follow are all mapped to the bolded term.
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CellCept 1 g/5 ml, poeder voor orale suspensie · Cellcept 500 mg poeder voor concentraat voor oplossing voor infusie · CellCept capsules, capsule 250 mg · CellCept tabletten, tabletten 500 mg · Mofetil mycophenolate Teva · Myclausen 250 mg, capsule, hard · Myclausen 500 mg, filmomhulde tabletten · Mycofenolaat Mofetil Accord 250 mg capsules · Mycofenolaat Mofetil Accord 500 mg filmomhulde tabletten · Mycofenolaat mofetil Mylan 500 mg, filmomhulde tabletten · Mycofenolaat mofetil Sandoz 250 mg, capsules, hard · Mycofenolaat mofetil Sandoz 500 mg, filmomhulde tabletten · Mycofenolaatmofetil Accord 500 mg poeder voor concentraat voor oplossing voor infusie · Mycofenolaatmofetil Auro 500 mg, filmomhulde tabletten · Mycofenolaatmofetil Aurobindo 250 mg, harde capsules · Mycofenolaatmofetil Aurobindo 500 mg, filmomhulde tabletten · Mycofenolzuur Accord 180 mg, maagsapresistente tabletten · Mycofenolzuur Accord 360 mg, maagsapresistente tabletten · Myfenax 250 mg capsules · Myfenax 500 mg filmomhulde tabletten · Myfortic 180 mg, maagsapresistente tablet · Myfortic 360 mg, maagsapresistente tablet 
Cellcept · Cellcept 1 g/5 ml susp. buv. (pdr.) · Cellcept 250 mg g?l. · Cellcept 500 mg compr. pellic. · Cellcept 500 mg sol. perf. (pdr., ? diluer) i.v. flac. · Myclausen · Myclausen 250 mg g?l. · Myclausen 500 mg compr. pellic. · Mycophenolat Mofetil · Mycophenolat Mofetil Sandoz 250 mg g?l. · Mycophenolat Mofetil Sandoz 500 mg compr. pellic. · Mycophenolate Mofetil · Mycophenolate Mofetil Teva 250 mg g?l. · Mycophenolate Mofetil Teva 500 mg compr. pellic. · Myfenax · Myfenax 250 mg g?l. · Myfenax 500 mg compr. pellic. · Myfortic · Myfortic 180 mg compr. gastro-r?sist. · Myfortic 360 mg compr. gastro-r?sist. 
Acido Micofenolico · Acido Micofenolico Ratiopharm 360 mg Comprimidos Gastrorresistentes efg · Acido Micofenolico Stada 180 mg Comprimidos Gastrorresistentes efg · Acido Micofenolico Stada 360 mg Comprimidos Gastrorresistentes efg · CELLCEPT 1 g/5 ml POLVO PARA SUSPENSION ORAL · Cellcept 250 mg Capsulas · Cellcept 500 mg Comprimidos Recubiertos con Pelicula · Cellcept 500 mg Polvo Para Concentrado Para sol. Para Perfusion · Ceptava 180 mg Comprimidos Gastrorresistentes efg · Ceptava 360 mg Comprimidos Gastrorresistentes efg · MICOFENOLATO DE MOFETILO ACCORD 500 mg COMPRIMIDOS RECUBIERTOS CON PELICULA EFG · Micofenolato de Mofetilo Accord 500 mg Polvo Para Concentrado Para Solucion Para Perfusion efg · Micofenolato de Mofetilo Aristo 250 mg Capsulas Duras efg · Micofenolato de Mofetilo Aristo 500 mg Comprimidos Recubiertos con Pelicula efg · Micofenolato de Mofetilo Aurovitas 500 mg Comprimidos Recubiertos con Pelicula efg · Micofenolato de Mofetilo Cinfa 250 mg Comprimidos Recubiertos con Pelicula efg · Micofenolato de Mofetilo Cinfa 500 mg Comprimidos Recubiertos con Pelicula efg · MICOFENOLATO DE MOFETILO GENESIS 500 mg COMPRIMIDOS RECUBIERTOS CON PELICULA EFG · MICOFENOLATO DE MOFETILO KERN PHARMA 500 mg COMPRIMIDOS RECUBIERTOS CON PELICULA EFG · MICOFENOLATO DE MOFETILO MYLAN 500 mg COMPRIMIDOS RECUBIERTOS CON PELICULA EFG · MICOFENOLATO DE MOFETILO SANDOZ 250 mg CAPSULAS DURAS EFG · MICOFENOLATO DE MOFETILO SANDOZ 500 mg COMPRIMIDOS RECUBIERTOS CON PELICULA EFG · MICOFENOLATO DE MOFETILO STADA 500 mg COMPRIMIDOS RECUBIERTOS CON PELICULA EFG · MICOFENOLATO DE MOFETILO TECNIGEN 250 mg COMPRIMIDOS RECUBIERTOS CON PELICULA EFG · MICOFENOLATO DE MOFETILO TECNIGEN 500 mg COMPRIMIDOS RECUBIERTOS CON PELICULA EFG · Micofenolato de Mofetilo Tillomed 250 mg Capsulas efg · Micofenolato de Mofetilo Tillomed 500 mg Comprimidos Recubiertos con Pelicula efg · MICOFENOLATO DE MOFETILO UR 500 mg COMPRIMIDOS RECUBIERTOS CON PELICULA EFG · MICOFENOLATO DE MOFETILO ZENTIVA 500 mg COMPRIMIDOS RECUBIERTOS CON PELICULA EFG · Micofenolato Mofetilo · MICOFENOLATO MOFETILO NORMON 250 mg COMPRIMIDOS RECUBIERTOS CON PELICULA EFG · MICOFENOLATO MOFETILO NORMON 500 mg COMPRIMIDOS RECUBIERTOS CON PELICULA EFG · MICOFENOLATO MOFETILO TEVA 250 mg CAPSULAS DURAS EFG · MICOFENOLATO MOFETILO TEVA 500 mg COMPRIMIDOS RECUBIERTOS CON PELICULA EFG · Myfenax 250 mg Capsulas Duras efg · Myfenax 500 mg Comprimidos Recubiertos con Pelicula efg · Myfortic 
Acido Micofenolico · Cellcept · Ceptava · Micofenolato Mofetile · Myfenax · Myfortic 
CELLCEPT 1 mg/5 ml · CELLCEPT 250 mg · CELLCEPT 500 mg · MICOFENOLAT MOFETIL SANDOZ 500 mg · MICOFENOLAT MOFETIL STADA 250 mg · MICOFENOLAT MOFETIL STADA 500 mg · MYFORTIC 180 mg · MYFORTIC 360 mg 
Arzip · CellCept · Ceptava · Mycophenolate mofetil · Mycophenolic acid · Myfenax · Myfortic 
Cellcept · Myastad · Myclausen · Mycophenolate mofetil Hexal · Mycophenolate mofetil TEVA · Mycophenolatemofetil Sandoz · Mycophenolatmofetil Accord · Mycophenolatmofetil Nordic Prime · Mycophenolsyre Accord · Mycophenolsyre Tillomed · Myfenax · Myfortic 
CellCept · Mycophenolatemofetil Accord · Myfenax · Myfortic · Mykofenolat Accord · Mykofenolatmofetil Accord · Mykofenolsyre Accord 
CellCept · Marelim · Myclausen · Mycofit · Mycophenolate mofetil Sandoz 250 mg kapsulki twarde · Mycophenolate mofetil Sandoz 500 mg tabletki powlekane · Mycophenolate mofetil Teva · Myfenax · Myfortic · Mykofenolan mofetylu Accord 
Cellcept · Myclausen · Mycophenolate Mofetil-Teva · Myfenax · Myfortic-180 · Myfortic-360 
Cellcept · Myclausen · Mycofenols?ra Accord · Mycofenolsýra · Mycophenolate mofetil Teva · Mycophenolatmofetil Stada · Myfenax · Myfortic · Mykofenolatmofetil Actavis 
Cellcept · Myastad · Myclausen · Mycophenolate Mofetil Accord · Mycophenolate mofetil Hexal · Mycophenolate Mofetil Sandoz · Mycophenolate Mofetil Teva · Myfenax · Myfortic 
CellCept · Myclausen · Mycophenolate Mofetil Accord · Mycophenolate mofetil Teva · Myfenax · Myfortic 
Cellcept® · Mycophenolat Mofetil Accord
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