Prophylaxis of acute rejection in renal transplantation (in
combination with a corticosteroid and ciclosporin)
(under expert supervision)
▶BY MOUTH
▶Adult: 1 g twice daily, to be started within 72 hours of
transplantation
▶BY INTRAVENOUS INFUSION
▶Adult: 1 g twice daily for maximum 14 days, then
transfer to oral therapy, to be started within 24 hours
of transplantation
Prophylaxis of acute rejection in cardiac transplantation
(in combination with ciclosporin and corticosteroids)
(under expert supervision)
▶BY MOUTH
▶Adult: 1.5 g twice daily, to be started within 5 days of
transplantation
Prophylaxis of acute rejection in hepatic transplantation
(in combination with ciclosporin and corticosteroids)
(under expert supervision)
▶INITIALLY BY INTRAVENOUS INFUSION
▶Adult: 1 g twice daily for 4 days, up to a maximum of
14 days, to be started within 24 hours of
transplantation, then (by mouth) 1.5 g twice daily, the
dose route should be changed as soon as is tolerated
CEPTAVA ®
Renal transplantation (specialist use only)
▶BY MOUTH
▶Adult: 720 mg twice daily, to be started within 72 hours
of transplantation
DOSE EQUIVALENCE AND CONVERSION
▶For Ceptava ®: Mycophenolic acid 720 mg is
approximately equivalent to mycophenolate mofetil 1 g
but avoid unnecessary switching because of
pharmacokinetic differences.
MYFORTIC ®
Renal transplantation (specialist use only)
▶BY MOUTH
▶Adult: 720 mg twice daily, to be started within 72 hours
of transplantation
DOSE EQUIVALENCE AND CONVERSION
▶For Myfortic ®: Mycophenolic acid 720 mg is
approximately equivalent to mycophenolate mofetil 1 g
but avoid unnecessary switching because of
pharmacokinetic differences.
PDF page 913
Active serious gastro-intestinal disease (risk of
haemorrhage, ulceration and perforation). children
(higher incidence of side-effects may call for temporary
reduction of dose or interruption). delayed graft function.
elderly (increased risk of infection, gastro-intestinal
haemorrhage and pulmonary oedema). increased
susceptibility to skin cancer (avoid exposure to strong
Immune system and malignant disease
sunlight). risk of hypogammaglobulinaemia or
bronchiectasis when used in combination with other
immunosuppressants
CAUTIONS, FURTHER INFORMATION
▶Hypogammaglobulinaemia or bronchiectasis Measure serum
immunoglobulin levels if recurrent infections develop, and
consider bronchiectasis or pulmonary fibrosis if persistent
respiratory symptoms such as cough and dyspnoea
develop.
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NICE decisions
▶Immunosuppressive therapy for kidney transplant in adults
(October 2017) NICE TA481
Mycophenolate mofetil, when used as part of an
immunosuppressive regimen, is recommended as an initial
option to prevent organ rejection in adults having a kidney
transplant. Treatment should be started with the least
expensive product, but if this is not suitable, an alternative
dosage form may be given. The use of mycophenolate
mofetil with tacrolimus is outside the terms of the
marketing authorisation. If this combination is prescribed,
the prescriber should follow relevant professional
guidance, taking full responsibility for the decision.
Informed consent should be obtained and documented.
Patients whose treatment was started within the NHS
before this guidance was published should have the option
to continue treatment, without change to their funding
arrangements, until they and their NHS clinician consider
it appropriate to stop.
www.nice.org.uk/guidance/TA481
▶Immunosuppressive therapy for kidney transplant in adults
(October 2017) NICE TA481
Mycophenolate sodium (Ceptava ®, Myfortic ®) is not
recommended as an initial treatment to prevent organ
rejection in adults having a kidney transplant. Patients
whose treatment was started within the NHS before this
guidance was published should have the option to
continue treatment, without change to their funding
arrangements, until they and their NHS clinician consider
it appropriate to stop.
www.nice.org.uk/guidance/TA481
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