mofetilo

Mofetilo, commonly known as mycophenolate mofetil (MMF), is an immunosuppressive medication used to prevent organ transplant rejection and to treat certain autoimmune conditions. It is a prodrug of mycophenolic acid (MPA). After administration, MMF is hydrolyzed to MPA, which inhibits inosine monophosphate dehydrogenase (IMPDH), a key enzyme in de novo guanine nucleotide synthesis. Because lymphocytes depend heavily on this pathway, MMF suppresses the proliferation of T and B cells.

Clinical use: In organ transplantation, MMF is used with calcineurin inhibitors (such as tacrolimus or cyclosporine) and corticosteroids to reduce acute rejection in kidney, heart, and liver transplants. It is available as mycophenolate mofetil (MMF) or as enteric-coated mycopoplate sodium (MPS) to improve gastrointestinal tolerance. Off-label or second-line uses include certain autoimmune diseases such as lupus nephritis; the evidence varies by condition.

Dosage and administration: Dosing is adjusted by indication and body weight; typical regimens for adults involve 1 gram twice daily (2 g/day) in divided doses, with adjustments for kidney function and drug interactions. MPA exposure is affected by enterohepatic recirculation; taking formulations with meals can influence tolerance and absorption.

Safety: Common adverse effects include gastrointestinal symptoms (diarrhea, nausea), leukopenia, anemia, infections, and elevated liver enzymes. It increases the risk of fetal harm; pregnancy should be avoided, and effective contraception used. Monitoring of blood counts and signs of infection is recommended; vaccines should be up to date, but live vaccines are generally avoided during immunosuppression.

Interactions: Cyclosporine increases MPA exposure; certain antacids, iron, and bile acid sequestrants can reduce absorption. Proton pump inhibitors may lower MPA levels.