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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 25°C

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)