Myfortic (Mycophenolic Acid)

• Myfortic is an immunosuppressive agent used to reduce immune‑mediated rejection in solid‑organ transplantation.
• Organ transplant rejection: prevents acute and chronic rejection of transplanted organs.
• Kidney transplant: lowers the risk of graft loss and improves long‑term kidney function.
• Liver transplant: reduces incidence of immune‑driven graft injury.

• Mycophenolic acid inhibits inosine monophosphate dehydrogenase (IMPDH), the key enzyme for de novo guanosine nucleotide synthesis. By blocking this pathway, the drug selectively suppresses proliferation of T‑ and B‑lymphocytes, which rely on this pathway for DNA synthesis, thereby diminishing the immune response that can lead to organ rejection.

Common Side Effects

• Nausea: mild to moderate stomach upset.
• Diarrhea: frequent loose stools.
• Headache: transient cranial discomfort.
• Abdominal pain: cramping or discomfort in the abdomen.
• Infections: increased susceptibility to bacterial, viral or fungal infections.
• Fatigue: feeling unusually tired.

Serious or Rare Side Effects

• Leukopenia: marked reduction in white blood cells.
• Severe infection: opportunistic infections such as pneumonia or sepsis.
• Hepatic dysfunction: elevated liver enzymes or hepatitis.
• Malignancy: increased risk of certain cancers with long‑term use.
• Progressive multifocal leukoencephalopathy (PML): rare brain infection.
• Pregnancy loss: potential teratogenic effects.

• Before initiating therapy, patients should be evaluated for infection risk and baseline laboratory values.
• Monitor blood counts: perform regular complete blood count tests.
• Assess renal function: adjust dosing if renal impairment is present.
• Avoid live vaccines: live attenuated vaccines can cause disease.
• Use effective contraception: pregnancy category unknown; avoid pregnancy.
• Adjust for hepatic impairment: consider dose reduction in liver disease.
• Store at room temperature: keep in the original pack, protect from moisture.

Myfortic may interact with several concomitant medications, requiring careful management.

Major Interactions (Avoid)

• Azathioprine: additive bone‑marrow suppression.
• Cyclosporine: increases mycophenolic acid exposure.
• Tacrolimus: may raise drug levels and toxicity.
• Live vaccines: risk of infection.
• Cholestyramine: reduces absorption of mycophenolic acid.

Moderate Interactions (Monitor Closely)

• Warfarin: monitor INR for altered anticoagulation.
• ACE inhibitors: watch for renal function changes.
• NSAIDs: increased risk of nephrotoxicity.
• Antacids (aluminum‑magnesium): may decrease absorption if taken simultaneously.