Mycophenolate Mofetil

INTRODUCTION

Indications

Mycophenolate mofetil: Prevention of rejection in allogenic renal, hepatic, and cardiac transplantations (used concurrently with cyclosporine and corticosteroids).

Mycophenolic acid: Prevention of rejection in allogenic renal transplantation (used concurrently with cyclosporine and corticosteroids).

Action

Inhibits the enzyme inosine monophosphate dehydrogenase, which is involved in purine synthesis. This inhibition results in suppression of T- and B-lymphocyte proliferation. Therapeutic Effects: Prevention of heart, kidney, or liver transplant rejection.

Adverse Reactions/Side Effects

CNS: PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY, anxiety, dizziness, headache, insomnia, paresthesia, tremor. CV: edema, hypertension, hypotension, tachycardia. Derm: rashes. Endo: hypercholesterolemia, hyperglycemia, hyperkalemia, hypocalcemia, hypokalemia, hypomagnesemia. GI: GI BLEEDING, anorexia, constipation, diarrhea, nausea, vomiting, abdominal pain. GU: renal dysfunction. Hemat: leukocytosis, leukopenia, thrombocytopenia, anemia. Resp: cough, dyspnea. Misc: fever, infection, increased risk of malignancy.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of progressive multifocal leukoencephalopathy. Signs include memory lapses, decreased cognition, vision loss, speech problems, incoordination, ataxia, and muscle weakness that can progress to paralysis, seizures, and coma. Report these signs to the physician or nursing staff immediately.

• Monitor signs of GI bleeding, including abdominal pain, vomiting blood, blood in stools, or black, tarry stools. Report these signs to the physician or nursing staff immediately.

• Assess blood pressure (BP) periodically and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension) or a fall in BP (hypotension) that causes dizziness or fainting.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report a rapid heart rate (tachycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Assess any breathing problems, and report persistent or severe cough or difficult, labored breathing.

• Monitor signs of leukopenia (fever, sore throat, mucosal lesions, signs of infection, bruising), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia. Periodic blood tests may be needed to monitor WBC and RBC counts.

• Be alert for signs of increased white blood cell counts (leukocytosis), including fever, weakness, weight loss, loss of appetite, dizziness, fainting, dyspnea, bleeding/bruising, or pain or tingling in the arms, legs, or abdomen. Report these signs to the physician or nursing staff immediately.

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