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
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)
