Indications: prophylaxis of acute renal, cardiac, or hepatic transplant rejection (in combination with cyclosporine and corticosteroids) under specialist supervision.

Cautions: monitor full blood count every week for 4 weeks then twice a month for 2 months then every month in the first year (consider interrupting treatment if neutropenia develops) exclude pregnancy: before starting treatment. elderly (increased risk of infection, gastro- intestinal haemorrhage and pulmonary oedema). children (higher incidence of side effects: may call for temporary reduction of dose or interruption). active serious gastro- intestinal disease (risk of haemorrhage, ulceration and perforation). delayed graft function. increased susceptibility to skin cancer (avoid exposure to strong sunlight. Bone marrow suppression: Patients should be warned to report immediately any signs or symptoms of bone marrow suppression e.g. infection or inexplicable bruising or bleeding.

Contra-indications: Hypersensitivity to mycophenolate mofetil, mycophenolic acid, mycophenolate sodium, or any component of the formulation.

Renal impairment: no data available in cardiac or hepatic transplant patients with renal impairment.

Pregnancy: Avoid (congenital malformations reported): effective contraception required before treatment, during treatment, and for 6 weeks after discontinuation of treatment. manufacturer of Myfortic also advise that men should use condoms during treatment and for 13 weeks after last dose.

Breast-feeding: Avoid (present in milk in animal studies)

Side Effects: taste disturbance, gingival hyperplasia, nausea, constipation, flatulence, anorexia, weight loss, vomiting, abdominal pain, gastro-intestinal inflammation, ulceration, and bleeding, hepatitis, jaundice, pancreatitis, stomatitis, oedema, tachycardia, hypertension, hypotension, vasodilatation, cough, dyspnea, insomnia, agitation, confusion, depression, anxiety, convulsions, paraesthesia, myasthenic syndrome, tremor, dizziness, headache, influenza-like syndrome, infections, hyperglycaemia, renal impairment, malignancy (particularly of the skin), blood disorders (including leucopenia, anaemia, thrombocytopenia, pancytopenia, and red cell aplasia, disturbances of electrolytes and blood lipids, arthralgia, alopecia, acne, skin hypertrophy, and rash also reported intestinal villous atrophy, progressive multifocal leucoencephalopathy, interstitial lung disease, pulmonary fibrosis.

Dose: Renal transplantation,

by mouth, 1 g twice daily starting within 72 hours of transplantation Or by intravenous infusion, 1 g twice daily starting within 24 hours of transplantation for max. 14 days (then transfer to oral therapy).

child and adolescent 2–18 years, by mouth 600 mg/m2 twice daily (max. 2 g daily)

Note: Tablets and capsules not appropriate for dose titration in children with body surface area less than 1.25m2 Cardiac transplantation: by mouth: ADULT over 18 years 1.5 g twice daily starting within 5 days of transplantation.Hepatic transplantation: by intravenous infusion ADULT over 18 years 1 g twice daily starting within 24 hours of transplantation for 4 days (up to max. 14 days) then by mouth, 1.5 g twice daily as soon as is tolerated.