Pharmacy - Mycophenolate/Mycophenolic Acid

Why have I been prescribed mycophenolate or mycophenolic acid?

Mycophenolate and mycophenolic acid are medications that can be used to manage auto immune conditions. They are used in several specialities including renal, dermatology, rheumatology & neurology. They are also used as an anti-rejection medicine after organ transplantation to stop the body rejecting the transplant. The clinical team that prescribes this medicine for you will tell you about your condition and why mycophenolate or mycophenolic acid is being prescribed.

How does it work?

Mycophenolate and mycophenolic acid belong to a group of medicines known as immunosuppressants. They help to reduce or supress your body’s own immune system (your immune system helps to protect you against infections). However, sometimes they can overreact or react abnormally and cause illness.  Mycophenolate and Mycophenolic acid can be used to treat these conditions, often in combination with other medicines.

Mycophenolate and mycophenolic acid work slowly and may take several weeks to take effect.

What dose do I take?

The dose of mycophenolate and mycophenolic acid depends on your weight and the medical condition being treated. Typical doses vary between 180mg to 1000mg, twice a day.

How do I take mycophenolate and mycophenolic acid?

Mycophenolate mofetil is available as 250mg capsules, 500mg tablets and a 1g/5ml suspension. Mycophenolate is also available as mycophenolate sodium (mycophenolic acid) 180mg and 360mg tablets.

Mycophenolate and mycophenolic acid are taken at least twice a day. If you feel unwell after taking it, try taking it at a different time in relation to food. If you find it difficult to swallow the tablets or capsules, please discuss with your medical team. It is very important that you swallow the tablets and capsules whole. They must not be chewed or crushed.

Does mycophenolate or mycophenolic acid interfere with my other medicines?

Mycophenolate and mycophenolic acid can interact with other medicines. You should tell your doctor which medicines you are taking before starting this medication.

Your regular prescription medicines will be checked, and any changes will be made if needed. If you buy any medication from the chemist such as 'over the counter' or herbal medicines, for example, you must talk to your pharmacist before taking them, as some medicines can affect how mycophenolate and mycophenolic acid works.

• Always check with your doctor or pharmacist first before starting any new medication
• You should avoid ‘live’ vaccines but most travel vaccines and the ’flu jab are ok (see below)
• It is safe to drink alcohol in moderation while taking mycophenolate but it may make nausea worse

Can mycophenolate or mycophenolic acid cause side effects?

Mycophenolate and mycophenolic acid act on the white cells of your immune system so it is important to know the signs that the white cells are too low. You should seek medical attention if you have any of the following:

• Sore throat
• Fever
• Feeling generally unwell
• Unexpected bruising or bleeding

Please also contact the team if you notice any yellowing of the eyes or unexpected bruising or bleeding as this may indicate issues with your liver.

The most common side effects are:

• Heartburn
• Nausea (feeling sick)
• Diarrhoea and vomiting (being sick)

These symptoms can often be worse at the start of treatment and will hopefully settle after a few days or weeks. However, it is important to remember these side effects as they can happen if you have been taking mycophenolate or mycophenolic acid for several years, not just at the start of treatment.

Mycophenolate and mycophenolic acid can affect the liver; a small number of patients can have abnormal liver function blood test results. Usually this happens in the first month of starting treatment. Patients don’t usually have any symptoms and blood test results usually return to normal by themselves or by reducing the dose of the medication.
 
In the long-term there is a higher risk of cancers compared with the general population. We recommend that you avoid excessive exposure to sunlight by wearing long sleeves, long trousers and a sun hat, not sunbathing and using high factor sun cream, of at least SPF 30 even in winter. This will help to reduce skin damage. Regular surveillance, such as cervical screening (smear tests) and mammograms when eligible are recommended for women.

What happens if I forget to take a dose?

If you miss a dose of mycophenolate or mycophenolic acid, take it as soon as you remember. If it is over 6 hours after your usual dose, then miss that dose and take your next dose at the usual time. Never double up on doses. If you have missed more than one dose, or are not sure what to do, contact your medical team for advice. If you have diarrhoea or vomiting for 48 hours (2 days), you might not be absorbing enough of the drug to work properly, so you must contact your medical team.

Can I have a family while I’m taking mycophenolate or mycophenolic acid?

Advice for women

The medicines regulator in the UK advises that you should not become pregnant whilst taking mycophenolate or mycophenolic acid.

You should only start taking this medication if you know you are not pregnant. Whilst on mycophenolate or mycophenolic acid, you must use effective contraception. You need two reliable types, for example: an implant or coil as well as a barrier method, such as condoms or a diaphragm. You must carry on with the two types for at least six weeks after stopping the drug. If you are planning to become pregnant, you must discuss this when you come to the outpatient clinic. Do not stop taking this medicine without talking with your specialised team. There are other medicines that may be suitable for you to take for your condition and that may be safer to the unborn baby. If you suspect you may be pregnant you should contact your medical team for urgent review. Taking mycophenolate or mycophenolic acid can harm your unborn baby.

Mothers who are taking mycophenolate or mycophenolic acid must not breastfeed.

Research studies have shown that:

• Up to half of pregnant women taking this medicine can have a miscarriage.
• Around 1 in 4 babies born to women taking this medication during their pregnancy are born with birth defects.

Advice for men

Research studies in men taking mycophenolate or mycophenolic acid have not shown any increase in birth defects in the baby compared to men not taking the medicine. However, no-one can say with absolute certainty that this medication won't affect the genes in the sperm and cause harm to the unborn baby. The MHRA recommend using condoms and advises against fatherhood whilst taking mycophenolate or mycophenolic acid. If you and your partner are planning a pregnancy you should discuss this with your specialist team before you start trying for a family.

Do I need any special checks while on mycophenolate or mycophenolic acid?

Yes. At first, you will need to have regular blood tests to check your kidney function, liver function and full blood count at the start of treatment. The frequency of these tests will be reduced as your treatment carries on.

Can I drink alcohol while taking mycophenolate or mycophenolic acid?

Because mycophenolate and mycophenolic acid can affect the liver, you should ensure you don’t drink large amounts of alcohol whilst taking this medication. Don’t drink more than 14 units of alcohol each week and have at least two alcohol-free days a week.

You can get more information about alcohol, units of alcohol and help and support at:

https://www.nhs.uk/live-well/alcohol-support/calculating- alcohol-units/

Can I travel while taking mycophenolate or mycophenolic acid?

If you are planning on travelling, it is important to discuss this with the specialist clinic. Keep in mind the following advice:

• Always take extra supplies of your medication when travelling
• Keep your medication in your hand luggage
• Carry your medication in their original boxes
• If you’re travelling to a different time zone, try to take your medication at your usual 'native' time. If this is difficult, discuss with your clinician in the clinic

In many parts of the world there is a greater risk of developing an infection. To help avoid picking up these infections you must:

• Wash your hands thoroughly, especially after using public toilets
• Use alcohol hand gel: you can buy this from most supermarkets and chemists to take with you
• Follow the advice below on food and water safety:

–    Don’t drink tap water or use it to brush your teeth. Use bottled water instead
–    Don’t put ice in drinks
–    Bottled fizzy drinks with an unbroken seal are usually safe
–    Boiled water and drinks made with boiled water are usually safe
–    Don’t eat salads, raw (uncooked) fruits and vegetables, unless you have washed and peeled them yourself
–    Don’t eat food that has been kept at room temperature in warm places or that could have been exposed to flies
–    Don’t eat or drink unpasteurised milk, cheese, ice cream or other dairy products
–    Don’t eat raw or undercooked seafood

Can I have vaccinations while taking mycophenolate or mycophenolic acid?

Whilst taking mycophenolate or mycophenolic acid, you must not have any live vaccines. Your immune system is dampened down whilst taking this medication, which increases your risk of infection. Other types of vaccines are safe for you to have. Ensure you discuss any vaccinations you need with the clinic.

We strongly advise that all patients who have a reduced immune system have the flu vaccination each year and follow the recommended COVID vaccination schedule – your clinical team will advise you. If your GP or Practice Nurse needs advice about vaccinations, they can contact the clinic.

Tips to reduce your risk of infection

• Try to avoid close contact with people you know have an active infection
• Wash your hands regularly and carry round a small bottle of antibacterial gel to use
• Keep your mouth clean by brushing your teeth regularly
• Make sure your food is stored and prepared properly
• Try to keep your house clean and hygienic, especially the kitchen, bathrooms and toilets
• Ensure your annual vaccines are up to date

Contact details

Medicines information: 0161 206 5223