Myfortic (Mycophenolic Acid)

Myfortic, an antimetabolite immunosuppressant, is indicated to reduce immune‑mediated rejection in solid‑organ transplantation.

• Renal transplantation: helps prevent acute graft rejection, improves graft survival, and facilitates stable kidney function post‑surgery.
• Heart transplantation: reduces the incidence of early rejection episodes, supporting cardiac graft performance and patient recovery.
• Liver transplantation: maintains graft viability by suppressing immune activation, thereby decreasing the risk of acute hepatic rejection.

• Myfortic delivers mycophenolic acid, which selectively inhibits inosine monophosphate dehydrogenase (IMPDH), a key enzyme in the de novo synthesis of guanosine nucleotides. By limiting guanosine availability, the drug impairs proliferation of T‑ and B‑lymphocytes, which rely on this pathway for clonal expansion, thereby attenuating the immune response that leads to organ rejection. The inhibition is reversible and preferentially affects activated lymphocytes while sparing resting cells, contributing to its targeted immunosuppressive profile.

Myfortic may be associated with a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Nausea
• Diarrhea
• Vomiting
• Abdominal pain
• Headache
• Upper respiratory tract infection

Serious or Rare Side Effects

• Leukopenia or neutropenia
• Anemia or pancytopenia
• Severe or opportunistic infections
• Hepatic dysfunction
• Malignancies such as lymphomas
• Progressive multifocal leukoencephalopathy (rare)

When prescribing Myfortic, clinicians should observe several safety precautions to minimize risks.

• Monitor blood counts: perform regular complete blood count tests to detect leukopenia or anemia early.
• Assess renal function: adjust dosing in patients with impaired kidney function and monitor creatinine levels.
• Avoid use in pregnancy: the drug is category D and may cause fetal harm; contraception is recommended.
• Counsel on infection risk: advise patients to report fevers or signs of infection promptly.
• Review vaccinations: live vaccines should be avoided during therapy.
• Store at room temperature: keep below 25 °C in the original packaging, protected from moisture.

Myfortic can interact with several medicines, altering its exposure or increasing toxicity.

Major Interactions (Avoid)

• Cyclosporine: co‑administration markedly increases mycophenolic acid plasma concentrations.
• Tacrolimus: similar effect, leading to higher exposure and potential toxicity.
• Antacids or cholestyramine: reduce absorption of mycophenolic acid, decreasing efficacy.
• Live vaccines: heightened risk of infection due to immunosuppression.

Moderate Interactions (Monitor Closely)

• Azathioprine: additive bone‑marrow suppression may require dose adjustments.
• Ribavirin: combined use can increase risk of anemia.
• NSAIDs: may exacerbate renal impairment when used with Myfortic.