mycophenolate
Mycophenolate (CellCept) belongs to a drug class called antiproliferatives and works as an immunosuppressant, meaning that it weakens your immune system. This medication is used in adults and children ages 3 months and older to help prevent their body from rejecting a transplanted organ. Mycophenolate (CellCept) is either taken by mouth or given as an infusion through the veins (IV). There are many potential side effects, including pain, headache, dizziness, and changes in blood pressure.
What is Mycophenolate (CellCept)?
What is Mycophenolate (CellCept) used for?
Prevention of kidney, heart, or liver transplant rejection in people ages 3 months and older; taken with other anti-rejection medications
How Mycophenolate (CellCept) works
Mycophenolate (CellCept) is an antiproliferative medication that works as an immunosuppressant (a medication that weakens your immune system). The medication lowers the activity of your immune system by blocking your body from making certain immune system cells. This helps prevent your body from rejecting a transplanted organ.
Drug Facts
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What are the side effects of Mycophenolate (CellCept)?
Common Side Effects
- Muscle, neck, or back pain (79%)
- High blood pressure (79%)
- Swelling (68%)
- Headache (59%)
- Fever (56%)
- Nausea (56%)
- Diarrhea (53%)
- Weakness (49%)
- High blood sugar (48%)
- High cholesterol (46%)
- Shortness of breath (44%)
- Constipation (44%)
- Difficulty sleeping (43%)
- Stomach pain (42%)
- Cough (41%)
- Vomiting (39%)
- Dizziness (34%)
- Low blood pressure (34%)
- Low blood potassium levels (33%)
- Viral infections (31%)
Other Side Effects
- Indigestion
- Depression
- Tremor (shakiness)
- Fast heart rate
- Low platelet count
- Low blood magnesium levels
Serious Side Effects
- Serious allergic reactions: difficulty breathing; hives; swelling of your face, lips, tongue, or throat
- Serious infection: fever; cough; difficulty breathing; diarrhea; weakness; sweating; chills; scaly, itchy, or burning skin; confusion, changes in personality, changes in vision, headache, stiff neck, light sensitivity, seizures
- Bleeding: blood in your urine or stool, unexplained bruising, bleeding that takes longer than usual to stop
- Cancer
Source: DailyMed
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The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
More common
Blood in the urine
chest pain or discomfort
cough or hoarseness
fever or chills
increased cough
lower back or side pain
painful or difficult urination
shortness of breath
swelling of the feet or lower legs
Less common
Abdominal or stomach pain
black, tarry stools
bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, or warmth at injection site
bloody vomit
enlarged gums
irregular heartbeat
joint pain
muscle aches or pain
pinpoint red spots on the skin
red, inflamed, or bleeding gums
sores inside the mouth
trembling or shaking of the hands or feet
unusual bleeding or bruising
white patches on the mouth, tongue, or throat
Incidence not known
Abdominal or stomach distention
back pain
blue lips, fingernails, or skin
blurred vision
chronic or occasional diarrhea
clumsiness
confusion
convulsions
coughing or spitting up blood
difficult or troubled breathing
difficulty speaking or understanding what others say
dizziness
drowsiness
general feeling of illness or nausea
headache
heart murmur
irregular, fast or slow, or shallow breathing
loss of coordination
memory loss
night sweats
severe headache
stiff neck or back
stools that float, are foul smelling, or "fatty"
sudden high fever or low-grade fever for months
unusual tiredness or weakness
vision changes
weakness in the legs
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Mycophenolate (CellCept)
Pros
Works well to prevent organ rejection
Available as an oral liquid for those who have a hard time swallowing pills
Available as an IV injection for people having trouble taking the medication by mouth
Comes as a lower-cost generic
Cons
Typically taken twice per day
Can have a lot of side effects (e.g., stomach upset, low blood cell counts, dizziness, changes in sleep, changes in blood pressure)
Not safe to take during pregnancy
Vaccines might not work as well to protect you from infection or be safe for you when you're taking mycophenolate (CellCept)
Pharmacist tips for Mycophenolate (CellCept)
Take mycophenolate (CellCept) twice daily at the same time every day on an empty stomach. Only take the medication with food if your provider told you that it's okay. If you do take it with food, make sure to be consistent and always take it with food; this will help keep the levels of the medication steady in your body.
For mycophenolate (CellCept) capsules and tablets: Swallow the pills whole. Don’t open, cut, crush, or chew them.
For mycophenolate (CellCept) oral suspension: Don't mix the medication with any liquids before you take your dose. Follow your provider's instructions on how to measure out and take your dose. Ask your provider or pharmacist if you have any questions.
Mycophenolate (CellCept) can cause sleepiness, but it can also make you have trouble falling asleep. Pay attention to how this medication affects your sleep. Contact your provider if it's making you too sleepy or interrupting your sleep. Your provider might be able to adjust the dose or the timing of your doses to help.
Make sure you tell your provider and pharmacist about all of the medications you're taking before you start mycophenolate (CellCept) and also during treatment. They can check for drug interactions and make sure your medications are safe to take together.
If you take magnesium- or aluminum-containing antacids or sevelamer (Renvela), take them at least 2 hours after mycophenolate (CellCept). This makes sure the medications don't interfere with each other.
Before you get any vaccines, tell your provider or pharmacist that you're taking mycophenolate (CellCept) to make sure you can get them. Avoid live vaccines like Varivax (varicella) because it's not known whether they're safe during treatment. Also, some vaccines might work less well to protect you from infections. It's best to be up to date on all your vaccinations before you start this medication.
If you miss a dose, take it as soon as you remember unless it's 2 hours until your next dose. Otherwise, skip the missed dose and take your usual dose at the usual scheduled time. Talk with your provider or pharmacist if you consistently miss doses because this can lead to transplant rejection.
If you or your partner can become pregnant, use birth control during treatment with mycophenolate (CellCept) to prevent pregnancy because of the risk of harm to unborn babies. Continue using birth control for at least 6 weeks (for females) and for at least 3 months (for males) after you take your last dose. Tell your provider right away if you become pregnant while you're taking mycophenolate (CellCept).
Don't donate blood for at least 6 weeks after your last dose of mycophenolate (CellCept). Don't donate semen for at least 3 months after the last dose as well. This lowers the risk for harm to babies from the medication if the donated blood or semen happens to be given to someone who could get pregnant.
More on Mycophenolate (CellCept) tips
Frequently asked questions about Mycophenolate (CellCept)
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What are the risks and warnings for Mycophenolate (CellCept)?
Mycophenolate (CellCept) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Not safe during pregnancy
Mycophenolate (CellCept) shouldn't be used during pregnancy because it can raise the risk of miscarriage during the first trimester and birth defects. If you can become pregnant, you'll need to take a pregnancy test before you start the medication and also periodically during treatment.
Additionally, use effective birth control during treatment if you or your partner can have children. Continue using birth control for at least 6 weeks (for females) and for at least 3 months (for males) after you take your last dose. Note that mycophenolate (CellCept) can lower how well levonorgestrel-containing birth control works. Talk to your provider if you're thinking of becoming pregnant while you're taking mycophenolate (CellCept) because you'll need to use a different medication.
Possible risk of cancer
People taking immunosuppressants like mycophenolate (CellCept) might be at higher risk for cancer, like lymphomas and skin cancer, among others. The risk might be more related to how long your immune system is suppressed and by how much rather than any specific medication. Your provider will check your risk of cancer during treatment. Speak with your provider if you're concerned about the risk for cancer with mycophenolate (CellCept).
To help monitor for skin cancer specifically, make sure you schedule yearly screenings for skin cancer and tell your provider if you notice changes to your skin. To lower your risk for skin cancer, wear protective clothing and use sunscreen when you go outside and avoid UV light (e.g., tanning beds).
Serious infections
Mycophenolate (CellCept) can affect your body's ability to fight off infections. This can raise your risk for serious and sometimes life-threatening bacterial, fungal, or viral infections. In particular, reported serious viral infections include polyomavirus-associated nephropathy (PVAN), progressive multifocal leukoencephalopathy (PML), and COVID-19. Your provider will routinely examine you for infections before and during treatment with mycophenolate (CellCept). Let your provider know as soon as possible if you notice any signs of infection like fever, chills, body aches, pain when urinating, or cough.
Low blood cell counts
Some people taking mycophenolate (CellCept) had lower numbers of red blood cells (RBCs), white blood cells (WBCs), and platelets in the body. This can raise the risk for bleeding, anemia, and infections. Your provider might order blood draws to check your blood cell counts.
Let your provider know if you have possible symptoms of low blood cell counts, such as bleeding (small, flat red spots under the skin; bloody urine or stool; easy bleeding or bruising) or anemia (feeling tired, headache, pale skin, fast heart rate, trouble breathing). Also tell your provider right away if you have an infection with fever, chills, tiredness, cough, body aches, and runny nose symptoms.
Stomach bleeding and ulcers
Risk factors: Older adults | History of stomach bleeding or ulcers | Stomach or liver problems | Bleeding problems | Taking other medications that raise your risk of bleeds | Drinking a lot of alcohol
Some people who took mycophenolate (CellCept) had serious stomach problems, including bleeding and ulcers (sores). These stomach problems can be dangerous and might require treatment right away. You might be at risk for stomach bleeds if you're also taking other medications that can cause bleeding, like blood thinners. Get medical help right away if you're feeling faint, vomiting blood, have bloody or dark stools, or have severe stomach pain or discomfort that doesn't go away while you're taking mycophenolate (CellCept).
Avoid in people with a genetic condition called hypoxanthine-guanine phosphoribosyl-transferase (HGPRT) deficiency
Avoid taking mycophenolate (CellCept) if you have a genetic condition called hypoxanthine-guanine phosphoribosyltransferase (HPRT) deficiency. The medication can worsen your symptoms, including gout, kidney stones, other kidney problems or even kidney failure.
Inflammation in the body
Mycophenolate (CellCept) weakens the immune system to lower inflammation to help prevent organ rejection. But very rarely, some people have reported symptoms of inflammation in the body during treatment. Symptoms can include fever, joint or muscle pain, and changes in certain lab results. These symptoms can happen within weeks to months of starting mycophenolate (CellCept) or after dose changes. Your provider will check for signs and symptoms of inflammation during treatment with mycophenolate (CellCept). Tell your provider right away if you have these symptoms.
Must be careful when driving
Risk factors: Taking high doses of mycophenolate (CellCept) | Age 65 years or older | Drinking alcohol | Taking other medications that can cause sleepiness
Make sure you know how Mycophenolate (CellCept) affects you before driving a car or doing activities that require your concentration. Mycophenolate (CellCept) can cause sleepiness, dizziness, low blood pressure, and confusion. These side effects can lower your ability to think, react, and focus. Your risk for these side effects is higher if you're also taking other medications that can cause drowsiness, such as benzodiazepines, anxiety medications, and muscle relaxants. Mycophenolate (CellCept) can also cause tremors (shakiness), which can make driving harder to do safely. Talk to your provider right away if you have these side effects while you're taking mycophenolate (CellCept) and if they're not getting better with time.
Caution use in people with phenylketonuria (PKU) - oral suspension only
The mycophenolate (CellCept) oral suspension contains phenylalanine, a component of the artificial sweetener aspartame. If you have a genetic condition called phenylketonuria (PKU), the liquid suspension can be dangerous for you. Tell your provider if you have PKU so you can be prescribed a different formulation of mycophenolate (CellCept) that's safer for you.
Mycophenolate (CellCept) dosage forms
Typical dosing for Mycophenolate (CellCept)
Mycophenolate (CellCept) is available in different forms that are taken by mouth: tablets, capsule, and a suspension (liquid). There's also an injectable form that's infused into the veins for people in the hospital right after they get a transplant and for people who can't take the medication by mouth.
Adults:
Kidney transplant: The typical dose is 1,000 mg twice a day.
Heart or liver transplant: The typical dose is 1,500 mg twice a day.
Children ages 3 months and older: The dose is based on your child's body size (height and weight). In general, the typical dose is 750 mg or 1,000 mg twice a day.
Your provider will adjust your dose based on how well the medication is working for you and whether you're having side effects. For people with a kidney transplant, your provider will also adjust your dose based on whether you have kidney problems.
Interactions between Mycophenolate (CellCept) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Amoxicillin
- Cholestyramine
- Ciprofloxacin
- Clavulanic Acid
- Colesevelam
- Colestipol
- Desogestrel
- Dexlansoprazole
- Dienogest
- Drospirenone
- Esomeprazole
- Estradiol
- Ethinyl Estradiol
- Ethynodiol
- Gestodene
- Isavuconazonium Sulfate
- Lansoprazole
- Levonorgestrel
- Mestranol
- Metronidazole
- Nomegestrol
- Norethindrone
- Norfloxacin
- Norgestimate
- Norgestrel
- Omeprazole
- Pantoprazole
- Rabeprazole
- Rifampin
- Telmisartan
- Tofacitinib
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Cyclosporine
- Lanthanum Carbonate
- Sevelamer
How much does Mycophenolate (CellCept) cost?
Mycophenolate (CellCept) contraindications
Allergy to mycophenolate (CellCept) or mycophenolic acid (Myfortic)
What are alternatives to Mycophenolate (CellCept)?
Prevention of kidney, heart, or liver transplant rejection in people ages 3 months and older; taken with other anti-rejection medications
To prevent the body from rejecting a transplanted kidney
Rheumatoid arthritis
Prevention of heart, liver, and kidney transplant rejection
Treatment of chronic (long-term) rejection in heart, liver, and kidney transplant recipients previously treated with other immunosuppressive medications
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References
Best studies we foundairis PHARMA Private Limited. (2023). Mycophenolate mofetil powder, for suspension [package insert]. DailyMed.
American Cancer Society. (n.d.). Lymphoma.
Behrend, M. (2001). Adverse gastrointestinal effects of mycophenolate mofetil: aetiology, incidence and management. Drug Safety.
Centers for Disease Control and Prevention. (2023). Fungal infections: Protect your health.
Costa, C., et al. (2012). Polyomavirus-associated nephropathy. World Journal of Transplantation.
Dhakal, Prajwal, et al. (2017). Clinical Features and Outcomes of Mycophenolate Mofetil-induced Diarrhea: A Systematic Review. Journal of Advances in Medicine and Medical Research.
Dykes, D. M., et al. (2012). Mycophenolate mofetil-related enterocolitis and weight loss: A pediatric case series. Case Reports in Pediatrics.
Genentech, Inc. (2022). Cellcept- mycophenolate mofetil tablet, film coated; mycophenolate mofetil capsule; mycophenolate mofetil hydrochloride injection, powder, lyophilized, for solution; mycophenolate mofetil powder, for suspension [package insert]. DailyMed.
Hochegger, K. et al. (2006). Acute inflammatory syndrome induced by mycophenolate mofetil in a patient following kidney transplantation. American Journal of Transplantation.
MedlinePlus. (2022). Progressive multifocal leukoencephalopathy.
National Heart, Lung, and Blood Institute. (2022). What is anemia?
National Human Genome Research Institute. (2014). About phenylketonuria.
National Institute of Diabetes and Digestive and Kidney Diseases. (2020). Mycophenolate. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury.
Pile, T., et al. (2011). A possible explanation for anemia in patients treated with mycophenolic acid. Transplantation.
Torres, R. J., et al. (2007). Hypoxanthine-guanine phosophoribosyltransferase (HPRT) deficiency: Lesch-Nyhan syndrome. Orphanet Journal of Rare Diseases.
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