Myfortic (Mycophenolic Acid)

Myfortic is an antimetabolite immunosuppressant used in several transplant and autoimmune pathways.

• Renal transplantation: helps prevent acute graft rejection after kidney transplant.
• Cardiac transplantation: reduces the risk of early heart‑transplant rejection.
• Hepatic transplantation: supports maintenance of liver graft function by limiting immune attack.
• Lupus nephritis: used as adjunct therapy to control renal inflammation in systemic lupus.
• Vasculitis: added to standard regimens to suppress immune‑mediated vessel inflammation.

• Mycophenolic acid selectively and reversibly inhibits inosine monophosphate dehydrogenase (IMPDH), a key enzyme in the de novo synthesis of guanosine nucleotides. This inhibition depletes guanosine pools, impairing proliferation of T‑ and B‑lymphocytes while sparing most other cell types, thereby dampening the adaptive immune response essential for graft rejection and autoimmune activity.

Adverse reactions may range from mild to severe and should be monitored during therapy.

Common Side Effects

• Nausea: mild to moderate stomach upset.
• Diarrhea: frequent loose stools.
• Vomiting: occasional emesis.
• Abdominal pain: cramping or discomfort.
• Headache: transient head pain.
• Tremor: fine shaking of hands.

Serious or Rare Side Effects

• Infections: increased susceptibility to bacterial, viral or fungal infections.
• Leukopenia: marked reduction in white blood cells.
• Anemia: decreased red blood cell count.
• Lymphopenia: low lymphocyte levels.
• Malignancy: rare reports of post‑transplant lymphoproliferative disorders.
• Hepatic dysfunction: elevated liver enzymes or hepatitis.

Careful monitoring and patient education are essential when using Myfortic.

• Monitor blood counts: regular CBC to detect leukopenia or anemia.
• Assess renal function: check serum creatinine and eGFR periodically.
• Avoid in pregnancy: teratogenic risk; contraindicated for women who are pregnant or may become pregnant.
• Counsel on infection risk: advise patients to report fever, cough or unusual infections promptly.
• Dose adjustment in hepatic impairment: consider reduced dosing in patients with significant liver disease.
• Store below 25°C: keep in the original packaging, protect from moisture and direct sunlight.

Myfortic may interact with several medicines, altering its efficacy or safety.

Major Interactions (Avoid)

• Cyclosporine: increases mycophenolic acid exposure, raising toxicity risk.
• Tacrolimus: synergistic immunosuppression may lead to excessive immune suppression.
• Rifampin: induces metabolism and reduces mycophenolic acid levels, compromising effectiveness.

Moderate Interactions (Monitor Closely)

• Azathioprine: combined bone‑marrow suppression can exacerbate cytopenias.
• NSAIDs: concurrent use may increase risk of nephrotoxicity, especially in transplant recipients.