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Mycophenolate Intravenous for Adults
Who can administer
May be administered by registered competent doctor or nurse/midwife
Important information
- Treatment with mycophenolate should be initiated and maintained by appropriately qualified specialists
- Imunosuppressants should be continued in the peri-operative period if being used for transplant patients (ref 1) For other indications, specialist review is indicated
- Supplies of this drug for IV use are routinely kept in stock in GUH
- See Monitoring requirements overleaf
- Flush before and after with glucose 5%
- Consider intravenous to oral switch as soon as possible as excellent bioavailability (see under dose for details)
- Some clinically significant drug interactions may occur, particularly with the use of other immunosuppressive therapy (check the manufacturers information carefully).
- IV to PO switch- see under Dose
- Brands are NOT interchangeable (see "Further information")
Available preparations
Cellcept 500mg vial
Reconstitution
Glucose 5%
14ml per 500mg vial - produces a 500mg in 15ml solution
Dilute further prior to administration
Infusion fluids
Glucose 5%
Methods of intravenous administration
Intermittent intravenous infusion (administer using an electronically controlled infusion device)
- Reconstitute as above- then dilute as follows to give a final concentration of ~ 6mg/ml
| Dose | Add to this volume of infusion fluid |
|---|---|
| 500mg (1 x 15ml) | 70ml |
| 1000mg (2 x 15ml) | 140ml |
| 1500mg (3 x 15ml) | 210ml |
Example: to prepare a 500mg dose, reconstitute a 500mg vial with 14ml Glucose 5%. Remove and discard 30ml from a 100ml Glucose 5% infusion bag (to make a 70ml volume), and add in the 15ml of reconstituted drug solution
Administer required dose over 2 hours, via either peripheral or central line
The residual volume in the infusion line must be flushed through at the same rate to avoid significant underdosing
Dose in adults
Usual dose
- Renal or hepatic transplantation (IV dose): 1g twice daily, started within 24 hours of transplantation and continued for 4 days in liver transplant, and up to a maximum of 14 days in either indication
Renal impairment
- Avoid doses greater than 1g twice daily in renal transplant patients with GFR < 25ml/min/1.73m2 outside the immediate post-transplant period. Monitor the patient carefully.
Dose for Intravenous to Oral switch (ref 2) |
- Cellcept = mycophenolate mofetil
- Myfortic = mycophenolic acid
- When switching from mycophenolate mofetil IV to oral mycophenolate mofetil, or vice versa, a dose adjustment is not needed (the manufacturers note a difference in doses of IV vs PO for hepatic transplant patients- but this is in the first 4 days post transplantation only)
- If switching from oral mycophenolic acid to IV mycophenolate mofetil- first convert the dose of mycophenolic acid to mycophenolate mofetil, and then change to IV
Monitoring
- FBC every week for 4 weeks, then twice a month for 2 months, then monthly in the first year.
- If neutropenia develops it may be appropriate to interrupt or discontinue treatment.
- Advise patient to report immediately any bleeding, bruising or infection which may indicate bone marrow suppression.
Further information
- Avoid direct contact of prepared solution with skin or mucous membranes: if such contact occurs wash thoroughly with soap and water. Rinse eyes with water.
- Avoid the use of live attenuated vaccines.
- Mycophenolate mofetil (Cellcept) is not interchangeable with mycophenolic acid (Myfortic). The brand of mycophenolate must be specified by the prescriber because of differences in bioavailability between brands.
Storage
- Store below 250C
References
SPC 16/02/2022
1: UKCPA The handbook for perioperative medicines, Transplant antirejection Medications
2:Uptodate downloaded 24/05/2022
Therapeutic classification
Immunosuppressant (purine synthesis inhibitor)