Mycophenolate

What is mycophenolate?

Mycophenolate is a medicine called an immunosuppressant. An immunosuppressant reduces the body's immune response. It is used to prevent rejection of transplanted organs, such as the kidney, heart, and liver. It also helps prevent graft versus host disease (GVHD) in bone marrow and stem cell transplant patients. Mycophenolate may also be used to treat other conditions.

You may hear mycophenolate called mycophenolate mofetil, MMF, or by its brand name, Cellcept. Mycophenolate comes in capsule, tablet, liquid, and injection forms.

Before giving mycophenolate to your child

Talk to your doctor if your child has:

• ever reacted badly to mycophenolate or any other medication, food, preservative, or colouring agent

Talk with your doctor or pharmacist if your child has any of the following conditions. Precautions may need to be taken with this medication if your child:

• has a history of kidney problems or reduced kidney function
• has a history of stomach or intestine problems
• has phenylketonuria (PKU)
• could be pregnant

How should you give your child mycophenolate?

Follow these instructions when you give your child mycophenolate by mouth:

• Give your child mycophenolate exactly as your doctor or your pharmacist tells you to, even if your child seems better. Talk to your child's doctor before you stop giving this medicine for any reason. Your child may become ill if they stop taking this medicine suddenly.
• Give your child mycophenolate at the same times every day (exactly as your child's doctor or pharmacist tells you). Pick times that are easy for you so that you do not miss doses.
• Give mycophenolate on an empty stomach (at least one hour before meals or two hours after meals) with a full glass of water, if possible.
• If your child is taking the tablets or capsules, these should be swallowed whole. Do not cut, crush, or chew them.
• If your child is taking liquid mycophenolate, shake the bottle very well and then measure the dose with the special spoon or syringe that the pharmacist gave you.
• Do not mix mycophenolate with other liquids.
• Wash your hands after giving each dose of mycophenolate.
• You should avoid inhaling the powder from damaged capsules or tablets. Do not let the powder or liquid touch your skin.
• Wash the skin well with soap and water if mycophenolate does touch the skin. If it gets in your eyes, rinse with water. If you spill mycophenolate, wipe it up using paper towels wetted with water to remove the powder or liquid.

Mycophenolate is also a clear liquid a nurse will give by needle into your child's vein. Your child will get this medicine in the hospital clinic or the nursing unit.

What should you do if your child misses a dose of mycophenolate?

• Give the missed dose as soon as you remember.
• If it is almost time for the next dose, skip the missed dose. Give the next dose at the regular time.
• Do not give your child two doses to make up for one missed dose.

If your child throws up within 30 minutes of taking a dose of mycophenolate, repeat the full dose of mycophenolate. If your child throws up more than 30 minutes after a dose, do not give another dose. If your child misses more than one dose, is vomiting or has diarrhea, speak to your doctor or nurse as soon as possible.

What are the possible side effects of mycophenolate?

Your child may have some of these side effects while they take mycophenolate. Check with your child's doctor if your child continues to have any of these side effects, and they do not go away, or they bother your child:

• nausea (upset stomach)?
• constipation (trouble having a bowel movement)
• diarrhea (loose stools)
• heartburn
• stomach pain
• mild headache
• dizziness
• weakness
• trouble sleeping
• acne (pimples)

Call your child's doctor during office hours if your child has any of these side effects:

• vomiting (throwing up) or diarrhea (loose, watery stools)
• abdominal pain
• swelling of feet or lower legs
• redness, swelling, or pain in the gums
• sores or white patches in the mouth
• joint or muscle pain
• skin rash

Most of the following side effects are not common, but they may be a sign of a serious problem. Call your child's doctor right away or take your child to the Emergency Department if your child has any of these side effects:

• fever or chills
• cough or sore throat
• chest pain or shortness of breath
• fast, irregular, or uneven heart beat
• throwing up blood or material that looks like coffee grounds
• blood in urine or stools or dark, tarry stools
• unusual bleeding or bruising
• trembling or shaking of the hands or feet
  
• unusual tiredness or weakness
• severe headache

What safety measures should you take when your child is using mycophenolate?

Keep all appointments at the clinic or doctor's office so that the doctor can check your child's reaction to mycophenolate. The doctor may need to change the dose so that your child is getting the right amount.

Your child may have the levels of active mycophenolate (called mycophenolic acid or MPA) in the blood checked from time to time. This is done through blood tests. If your child is to have their levels checked, you may be given special instructions about when to give the doses on the day of this check.

As mycophenolate works by lowering the body's natural immunity, your child has an increased risk of getting infections. You can take the following precautions to prevent infections:

• Keep your child away from people with infections, such as colds or stomach flu.
• Teach your child to wash their hands. Hand washing is the most important way to prevent the spread of germs that cause infections.
• Wash your hands before touching your child's eyes, mouth, or the inside of your child's nose.

Because mycophenolate lowers the body's immune system, it may increase the risk of developing cancers including skin cancers and lymphomas. The following symptoms are some possible warning signs of cancer. To help detect any cancers as soon as possible, report any of these symptoms to your doctor right away:

• a change in bowel or bladder habits
• any sore that does not heal
• unusual bleeding or discharge
• the appearance of a lump or thickened areas anywhere on the body
• unexplained stomach upset or any trouble with swallowing
• an obvious change in a wart or a mole
• a nagging cough or hoarseness
• night sweats
• persistent and severe headaches

As mycophenolate may increase the risk of skin cancer, exposure to the sun should be limited. Your child should use a sun block with an SPF of 15 or higher and protect the skin with clothing when outside for extended periods of time. Your child should avoid tanning beds and sunlamps.

Your child should not receive any immunizations (vaccines) without your child's doctor's approval. Your child or anyone else in your household should not get oral polio vaccine while your child is being treated with mycophenolate. Tell your child's doctor if anyone in your household has recently received oral polio vaccine. Your child should avoid contact with anyone who has recently received this vaccine. Other live vaccines that your child should not get include measles, mumps and rubella (MMR), and chicken pox vaccine.

There is a chance that mycophenolate may cause birth defects if it is taken at the time of conception or if it is taken during pregnancy. If your child is sexually active, she should use at least two forms of birth control while receiving mycophenolate. Tell the doctor right away if your child may be pregnant.

While your child is taking mycophenolate, good mouth care is important. Talk to your doctor, dentist, or pharmacist about what special steps should be taken to keep the mouth clean while using mycophenolate.

Check with your child's doctor or pharmacist before giving your child any other medicines (prescription, non-prescription, herbal, or natural products).

There are some medicines that should not be taken together with mycophenolate or in some cases the dose of mycophenolate or the other medicine may need to be adjusted. It is important that you tell your doctor and pharmacist if your child takes any other medications including:

• other immunosuppressants (azathioprine, cyclosporine, tacrolimus)
• antiviral drugs (acyclovir, ganciclovir)
• cholestyramine
• oral contraceptives

What other important information should you know about mycophenolate?

• Tell the doctor or dentist that your child is taking mycophenolate before your child has any kind of operation, even on the teeth, or an emergency treatment.
• Although it is preferred that mycophenolate be given without food (on an empty stomach), some children will need to take it with some food to decrease irritation of the stomach. If your child needs to take their mycophenolate with food, always give this medicine to your child with food.
• Avoid giving mycophenolate at the same time as antacids (such as Maalox, Diovol, and Tums), magnesium or other supplements. These may reduce the amount of mycophenolate absorbed into the body. Separate the dose times of these medications from mycophenolate by about two hours.
• Liquid mycophenolate contains aspartame, a source of phenylalanine, and should not be used if your child has phenylketonuria (PKU).
  
• Keep a list of all medications your child is on and show the list to the doctor or pharmacist.
• Do not share your child's medicine with others and do not give anyone else's medicine to your child.
• Make sure you always have enough mycophenolate to last through weekends, holidays, and vacations. Call your pharmacy at least two days before your child runs out of medicine to order refills. Not all pharmacies will carry this medication.
• Keep mycophenolate at room temperature in a cool, dry place away from sunlight. Do not store it in the bathroom or kitchen.
• Liquid mycophenolate is good for 60 days once it is mixed. It should be stored in a glass bottle.
• Do not keep any medicines that are out of date. Check with your pharmacist about the best way to throw away outdated or leftover medicines.
  

Keep mycophenolate out of your child’s sight and reach and locked up in a safe place. If your child takes too much mycophenolate, call your local Poison Information Centre at one of these numbers. These calls are free. 

• Call 1-844 POISON-X, or 1-844-764-7669, from anywhere in Canada except Quebec.
• Call 1-800-463-5060 if you live in Quebec.