Myfortic (Mycophenolic Acid)

• Myfortic is an immunosuppressant that works by inhibiting lymphocyte proliferation, making it essential in transplant medicine.
• Kidney transplantation: helps prevent acute and chronic rejection of the transplanted kidney.
• Heart transplantation: reduces the risk of graft rejection and improves long‑term graft survival.
• Liver transplantation: supports maintenance of graft function by suppressing immune‑mediated damage.

• Myfortic (mycophenolate sodium) is converted to mycophenolic acid, which selectively inhibits inosine monophosphate dehydrogenase (IMPDH). This blocks de novo synthesis of guanosine nucleotides, a pathway critical for proliferation of T and B lymphocytes, thereby dampening the adaptive immune response that leads to organ rejection.

Myfortic may cause a range of adverse reactions, from mild to severe.

Common Side Effects

• Nausea: mild to moderate gastrointestinal upset.
• Diarrhea: frequent loose stools, often self‑limiting.
• Vomiting: occasional episodes, especially early in therapy.
• Abdominal pain: crampy discomfort in the stomach area.
• Headache: transient, usually resolves without intervention.
• Infections: increased susceptibility to bacterial, viral, or fungal infections.

Serious or Rare Side Effects

• Leukopenia: significant reduction in white blood cells, raising infection risk.
• Anemia: decreased red blood cell count leading to fatigue.
• Severe infection: opportunistic infections such as Pneumocystis jirovecii pneumonia.
• Malignancy: heightened risk of lymphoproliferative disorders.
• Hepatic dysfunction: elevated liver enzymes or hepatitis.
• Progressive multifocal leukoencephalopathy (PML): rare but potentially fatal brain infection.

Before initiating Myfortic, clinicians should assess patient-specific risk factors and monitor for adverse events.

• Monitor blood counts: perform regular complete blood counts to detect leukopenia or anemia.
• Assess renal function: adjust therapy if creatinine clearance is reduced.
• Screen for infections: evaluate for active infections and vaccinate appropriately before treatment.
• Avoid in pregnancy: potential teratogenic effects; use effective contraception.
• Store at room temperature: keep in the original container, protect from moisture and heat.

Myfortic interacts with several medicines that can alter its efficacy or safety.

Major Interactions (Avoid)

• Azathioprine: additive bone‑marrow suppression.
• Live vaccines: increased risk of vaccine‑derived infection.
• Cholestyramine: binds drug and reduces absorption.
• Rifampin: strong CYP3A4 inducer that lowers mycophenolic acid levels.
• Antacids containing aluminum or magnesium: may decrease bioavailability.

Moderate Interactions (Monitor Closely)

• ACE inhibitors: may enhance nephrotoxic potential.
• NSAIDs: increase risk of renal impairment.
• Warfarin: may affect INR and bleeding risk.
• Ganciclovir: potential additive myelosuppression.
• Diuretics: monitor electrolytes and renal function.