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.

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.

Mycophenolic acid is not metabolized by cytochrome P450 enzymes. No pharmacokinetic porphyrinogenic effects are suspected.

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.

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.

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.

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).

Uneventful use reported in 4 patients with acute porphyria.