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The patient has 20 year of lupus and on cytoxan for the last10 years, presented with gross hematuria. Would you switch the drug to mycophenolate mofetil and what other diagnostic test would you do ?
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What is the most important information I should know about mycophenolate mofetil?
• Therapy with mycophenolate mofetil may increase your risk of infection and the development of lymphoma and other types of cancer. Notify your doctor immediately if you develop fever or chills, a sore throat, unusual bleeding or bruising, mouth sores, abdominal pain, pale stools, or darkened urine. These symptoms could be early signs of dangerous side effects.
• Mycophenolate mofetil has caused birth defects in animals, and therefore is not recommended for use during pregnancy. Your doctor may ask that you have a pregnancy test with negative results within 1 week of starting therapy with mycophenolate mofetil. Birth control must be used before starting treatment, during treatment, and for six weeks following treatment with mycophenolate mofetil, unless abstinence is the chosen method or if you have had a hysterectomy. Do not take this medication without first talking to your doctor if you are pregnant or if you are thinking about becoming pregnant.
• Do not open the capsules or crush or chew the tablets. Do not inhale the powder, or allow the powder or suspension to come in contact with your skin, eyes, or mucous membranes. If contact with the skin, eyes or mucous membranes occurs, wash your skin with soap and water and rinse your eyes with plain water.
• Tell your doctor and dentist that you are taking this medication before having surgery, before starting any other medicines, and before receiving any vaccinations.
• Mycophenolate mofetil may increase the risk of developing skin cancer. Limit exposure to sunlight and UV light by wearing protective clothing and using a sunscreen with a high protection factor (SPF).
What is mycophenolate mofetil?
• Mycophenolate mofetil is an immunosuppressant. Immunosuppressants decrease the actions of your body's immune system.
• Mycophenolate mofetil is used to prevent your body from rejecting a kidney, liver, or heart transplant. It is usually combined with cyclosporine (Sandimmune, Neoral) and a steroid medication.
• Mycophenolate mofetil may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking mycophenolate mofetil?
• Before taking mycophenolate mofetil, tell your doctor if you have
· a stomach ulcer or other stomach disease;
· a viral, bacterial, or fungal infection; or
· a rare hereditary deficiency of hypoxanthine-guanine phosphoribosyl-transferase (HGPRT) such as Lesch-Nyhan and Kelley-Seegmiller syndrome.
• You may not be able to take mycophenolate mofetil, or you may require a lower dose or special monitoring if you have any of the conditions listed above.
• Before taking the CellCept Oral Suspension, tell your doctor if you have phenylketonuria. This product contains aspartame, which is a source of phenylalanine.
• Mycophenolate mofetil is in the FDA pregnancy category C. This means that it is not known whether mycophenolate mofetil will harm an unborn baby. Mycophenolate mofetil has caused birth defects in animals, and therefore is not recommended for use during pregnancy. Your doctor may ask that you have a pregnancy test with negative results within 1 week of starting therapy with mycophenolate mofetil. Birth control must be used before starting treatment, during treatment, and for six weeks following treatment with mycophenolate mofetil, unless abstinence is the chosen method or if you have had a hysterectomy. Do not take this medication without first talking to your doctor if you are pregnant or if you are thinking about becoming pregnant.
• It is not known whether mycophenolate mofetil passes into breast milk. Do not take mycophenolate mofetil without first talking to your doctor if you are breast-feeding a baby.
How should I take mycophenolate mofetil?
• Take mycophenolate mofetil exactly as directed by your doctor. If you do not understand these directions, ask your doctor, nurse, or pharmacist to explain them to you.
• Take each dose with a full glass of water.
• Take mycophenolate mofetil on an empty stomach, 1 hour before or 2 hours after a meal unless otherwise directed by your doctor.
• Mycophenolate mofetil is usually taken twice a day. Follow your doctor's instructions.
• Shake the suspension well before measuring a dose. Use the dose-measuring device supplied by your pharmacist to measure a dose of the suspension.
• Do not open the capsules or crush or chew the tablets. Do not inhale the powder, or allow the powder or suspension to come in contact with your skin, eyes, or mucous membranes. If contact with the skin, eyes or mucous membranes occurs, wash your skin with soap and water and rinse your eyes with plain water.
• Therapy with mycophenolate mofetil may increase your risk of infection and the development of lymphoma and other types of cancer. Notify your doctor immediately if you develop fever or chills, a sore throat, unusual bleeding or bruising, mouth sores, abdominal pain, pale stools, or darkened urine. These symptoms could be early signs of dangerous side effects.
• Store mycophenolate mofetil at room temperature away from moisture and heat. The suspension can be stored in the refrigerator, however this is not necessary. Do not allow the suspension to freeze. Throw away any unused suspension after 60 days.
What happens if I miss a dose?
• Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the dose you missed, and take only your next regularly scheduled dose. Do not take a double dose of this medication unless otherwise directed by your doctor.
• Notify your doctor if you miss a dose of this medication.
What happens if I overdose?
• Seek emergency medical attention.
• Symptoms of a mycophenolate mofetil overdose include nausea, vomiting, diarrhea, and unusual bleeding or bruising.
What should I avoid while taking mycophenolate mofetil?
• Avoid sources of infection. Mycophenolate mofetil decreases your body's immune system, and you are more susceptible to infection. Notify your doctor at the first sign of fever, chills, or a sore throat.
• Tell your doctor and dentist that you are taking this medication before having surgery, before starting any other medicines, and before receiving any vaccinations.
• Mycophenolate mofetil may increase the risk of developing skin cancer. Limit exposure to sunlight and UV light by wearing protective clothing and using a sunscreen with a high protection factor (SPF).
What are the possible side effects of mycophenolate mofetil?
• If you experience any of the following serious side effects, stop taking mycophenolate mofetil and seek emergency medical attention or contact your doctor immediately:
· an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
· unusual tiredness or weakness;
· cough, hoarseness, a sore throat, fever, or chills;
· painful or difficult urination;
· severe nausea, vomiting, or diarrhea;
· abdominal pain;
· pale stools or darkened urine;
· unusual bleeding or bruising; or
· a sudden unusual feeling of discomfort or illness.
• Other, less serious side effects may also occur. Continue to take mycophenolate mofetil and notify your doctor if you experience
· upset stomach, nausea, or vomiting;
· diarrhea or constipation;
· mild weakness;
· tremor or dizziness;
· headache;
· insomnia;
· swelling of the feet or lower legs; or
· a skin rash.
• Treatment with mycophenolate mofetil increases the risk of cancer of the immune system.
• Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect mycophenolate mofetil?
• Before taking mycophenolate mofetil, tell your doctor if you are taking any of the following medicines:
· another immunosuppressant medicine such as azathioprine (Imuran), tacrolimus (Prograf), or daclizumab (Zenapax);
· cholestyramine (Questran);
· an antacid (prescription or over the counter);
· acyclovir (Zovirax) or ganciclovir (Cytovene);
· probenecid (Benemid);
· phenytoin (Dilantin);
· theophylline (Theo-Dur, Theochron, Theolair, others); or
· any type of vaccination.
• You may not be able to take mycophenolate mofetil, or you may require a dosage adjustment or special monitoring if you are taking any of the medicines listed above.
• Drugs other than those listed here may also interact with mycophenolate mofetil. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.
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CellCept® (mycophenolate mofetil capsules)
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