What is it?

Mycophenolate is a drug that affects the immune response in the body (i.e. an immunosuppressant).

Indications for use

The main use is in organ transplantation for prevention of donor organ rejection. It is being increasingly used to treat severe active inflammation in the bowel that does not respond to anti-inflammatory (5-ASA) drugs and also in steroid refractory or dependent disease. It is also used for patients who are allergic or sensitive to Azathioprine.

How is it taken?

It is taken by mouth in either tablet or capsule form. The dose is usually 1 g twice daily.

Monitoring

Due to the potential risk of bone marrow suppression it is extremely important to have regular blood checks whilst taking the medication. The type and frequency of monitoring should be as follows:

FBC+LFT’S on a weekly basis for 1 month, then 2 weekly for 2 months and monthly thereafter if all remains well during the first year.

NB: signs of bone marrow suppression e.g. infection [particularly opportunistic organisms, such as cytomegalovirus] and unexplained bruising or bleeding, should be reported to the doctor or IBD nurse immediately.

Contraindications

Pregnancy must be excluded prior to treatment and conception avoided until 6 weeks after treatment has finished. Breast feeding is also contraindicated.

Are there any side effects?

It is possible that side effects may occur during treatment. These may include some of the following:

• GI upsets e.g. diarrhoea, constipation, nausea/vomiting, indigestion and abdominal pain
• Disturbances in salt and water balance leading to raised blood pressure or swelling of the feet and ankles
• Breathing difficulties
• Chest pain
• Cough
• Runny nose
• Dizziness
• Poor sleep pattern
• Headaches
• Tremours
• Infection
• Blood disorders e.g. reduced white cells (leukopoenia), anaemia or reduced platelets(thrombocytopoenia)
• Raised blood sugar
• Raised cholesterol
• Decreased kidney function
• Acne

Other side effects may occur, but less frequently, such as:

• Low blood sugars
• GI perforation
• Abnormal liver function
• Hepatitis (inflammation of the liver)
• Inflamed gums
• Mouth ulcers
• Reduced blood pressure
• Cardiac arrhythmias(abnormal beats)
• Weight gain

Although this list of possible side effects may seem quite alarming it does not mean that you will have all, or indeed any of them. The fact that your doctor has decided that this medication is required to help control your symptoms means that you have difficult disease that needs strong medication to bring it under control and therefore reduce the risks of complications and possibly avoid the need for surgery.

You should be reassured that you will be closely monitored whilst taking this treatment and that if side effects do arise that these will be dealt with accordingly.

Your compliance with the monitoring programme is essential in the safety of your treatment.