Mycophenolate mofetil (Cellcept)

A purine analog that reduces rejection rate in transplantation.

Most cells have two pathways for supplying purines to support DNA synthesis and cellular function: a de novo synthesis and salvage of nucleotides from DNA turnover.

Mycophenolate starves the cells of purines, particularly guanosine, by inhibiting inosine 5’phosphate dehydrogenase, enzyme that generates guanosine 5’ monophosphate from -5’ monophosphate.

The inadequate supply of guanosine inhibits both B and T cells.

An immunosuppressant and prodrug of mycophenolic acid, used extensively in transplant medicine.

Trade name Cellcept.

A reversible inhibitor of inosine monophosphate dehydrogenase (IMPDH) in purine biosynthesis, specifically guanine synthesis, which is necessary for the growth of T cells and B cells.

Cells that are capable of recovering purines via a separate scavenger pathway are able to escape the effect.

Less toxic alternative to azathioprine.

Used in the treatment of autoimmune diseases, such as Behcet’s disease, pemphigus vulgaris, and systemic lupus erythematosus.

The most common side-effects of this drug are high blood sugars and increased blood cholesterol levels, hypomagnesemia, hypocalcemia, hyperkalemia, and an increase in BUN are regularly noted.

Coughing, shortness of breath and pleural effusions occur in one third of patients.

Back and abdominal pain, headache, nausea, diarrhea, and fever may occur.

Rarely associated with melanoma, lymphoma and other malignancies, with cancers of the skin being the most common site.

The addition of mycophenolate mofetil to a glucocorticoid for the first line treatment of ITP resulted in great response and the lower risk of refractory or relapsed ITP, with someone decrease quality of life.

Other rarer effects include GI bleeding and pulmonary fibrosis, and progressive multifocal leukoencephalopathy.

May be associated with abdominal pain, bradycardia, myalgias, and weakness.

When given in combination with  glucocorticoids results in a better response with fewer treatment failures than  glucocorticoids alone in ITP.

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