What is Mycophenolate?
Mycophenolate is a medication that is classed as a DMARD- a disease modifying anti-rheumatic drug. This means it acts on the disease itself to reduce the effects of the immune system.
The immune system causes inflammation that protects the body from infections and injury. In certain diseases however, the immune system is over active and this can target healthy tissues such as joints and blood vessels. This results in pain, swelling and tenderness and eventually permanent damage.
Mycophenolate works to suppress the over activity of the immune system and prevent the inflammation from occurring, reducing the long-term risk of permanent damage.
What is Mycophenolate used for?
Mycophenolate is used in a number of conditions that result in inflammation. These include rheumatoid arthritis, systemic lupus erythematosus and vasculitis.
It can also be used by different specialities to treat eye inflammation and after organ transplant.
How is it taken?
Mycophenolate is taken as a tablet each day. It is taken whole, not crushed and with food.
The medication is usually started at a low dose of 500mg twice a day and gradually increased up by 500mg a week as recommended by your doctor. The maximum dose if needed is 1000mg three times a day.
It can take up to 12 weeks to have an effect, so it is important you continue to take it even though it may not seem to have any effect straight away.
It is a long-term treatment.
You will receive the first 8 weeks of tablets from the hospital. As the medication can affect the blood counts, liver and kidneys, your blood tests will be checked before you start the tablets and then at intervals during taking it. Initially you will need bloods taken at 2 weeks, 4 weeks and 6 weeks, then once a month for 3 months and then every 3 months whilst you remain on the medication.
Following the initial 8 weeks of monitoring by the rheumatology nurse specialists, they will contact you via the phone to ensure you are managing well and hand over the prescription and blood monitoring to your GP.
There are a small number of side effects that some people can experience when taking mycophenolate, these include:
- Feeling sick, vomiting and diarrhoea
- Stomach pains
As the immune system is targeted by mycophenolate, it is important to get your blood tests checked. Should you develop signs of infection, stop taking your mycophenolate and speak to your GP as you may require antibiotics. Once you are feeling better and have completed any antibiotics you can restart taking your tablets.
Mycophenolate can also affect the blood cell counts, liver and kidneys. If you notice any yellow discoloration to your skin or eyes, bruising and bleeding you should let your doctor know.
If you develop, or come into contact with anyone with shingles or chickenpox, you should speak to your doctor as you may need treatment and to stop taking your mycophenolate temporarily.
In very rare cases, mycophenolate is associated with a increased risk of skin cancers, it is recommended you wear sunscreen and check you skin regularly.
In extremely rare circumstances patients of mycophenalate can develop a condition called progressive multifocal leukoencephalopathy (PML). This affects the spinal cord and brain. It can cause symptoms such as weakness with problems moving your arms and legs, pins and needles, problems with your eyesight and speech and changes in behaviour. It is important if you develop any of these symptoms to speak to your doctor urgently.
Cautions of use
Interactions with other medications
- Mycophenolate can interact with other medications that affect the immune system; this will be checked before you start taking it.
Contraindications with other conditions
- As mycophenolate can affect the liver, your doctor will decide if its safe to give if you have underlying liver disease.
- Mycophenolate can usually be continued during minor surgery but this should be discussed with your doctor and surgeon.
During pregnancy and breastfeeding
- Mycophenolate is not safe when trying to conceive, pregnancy or breast feeding.
- Women of childbearing age should use 2 forms of contraceptives.
- Mycophenolate should be stopped for 6 weeks before trying to conceive.
- Men should use barrier protection whilst on mycophenolate and for 90 days following stopping it.
- As both mycophenolate and alcohol can affect the liver, it is advised that you do not consume over the recommended 14 units of alcohol weekly.
- It is safe to receive the flu and pneumonia vaccine whilst taking mycophenolate
- The shingles vaccine and other live vaccines are not recommended.
Versus Arthritis: http://www.versusarthritis.org