Mofetil

Mofetil is the ester component most commonly encountered in the prodrug mycophenolate mofetil (MMF). MMF is a prodrug of mycophenolic acid (MPA), an immunosuppressant used to prevent organ transplant rejection and to treat certain autoimmune diseases. In the body, MMF is rapidly hydrolyzed to MPA, the active compound that exerts therapeutic effects.

The primary mechanism of action is inhibition of inosine monophosphate dehydrogenase (IMPDH), an enzyme essential for de novo guanine nucleotide synthesis. By reducing guanosine nucleotides, MPA preferentially suppresses the proliferation of lymphocytes (T and B cells), which rely on this pathway for expansion during immune responses. This leads to immunosuppression with a lower impact on other cell types.

Industrial and clinical use centers on solid organ transplantation, where MMF is used to prevent rejection in combination with calcineurin inhibitors and corticosteroids. It is also used for certain autoimmune conditions, notably lupus nephritis, and off-label for other immune-mediated diseases. MMF can be administered orally or intravenously; oral dosing is the common route, with IV option for patients unable to take or absorb oral medication.

Common adverse effects include gastrointestinal symptoms (nausea, diarrhea, abdominal pain), leukopenia or anemia, infections, and an increased risk of certain cancers with long-term use. It is teratogenic and contraindicated in pregnancy. Drug interactions can alter MPA exposure, such as with cyclosporine or antacids that affect absorption; concomitant use requires monitoring of blood counts, liver function, and, where applicable, pregnancy status.

Naming and naming conventions aside, mofetil in clinical contexts is most often discussed as part of mycophenolate mofetil and its role as a prodrug to mycophenolic acid.