Cellcept Flashcards
What is the mechanism of action of cellcept ?
MPA selectively and non-competitively inhibits the enzyme inosine monophosphate dehydrogenase (IMPDH), preventing conversion of inosine- and xanthine-5-phosphate to guanosine- 5-phosphate.
This blocks de novo synthesis of guanine nucleotides and their subsequent incorporation into DNA.
DNA synthesis in T and B lymphocytes is preferentially inhibited because these cells lack the purine
salvage pathway and are dependent on de nuovo purine synthesis. MPA decreases immunoglobulin levels and delayed- type hypersensitivity responses by inhibiting proliferative responses to mitogenic and allospecific stimulation; MPA also suppresses antibody formation by B lvmnhocytes.
Followup monitoring
CBC with PLT count every 2 weeks for 2- 3 months,
then monthly for first year
CMP cimprehensive metabokic panel includes liver functiontesrs after I month and
then every 3-4 months
When to discontinue / decrease dose ?
Discontinue or decrease dose if WBC
declines to <3500-4000 cells/mm3
When to discontinue / decrease dose ?
Discontinue or decrease dose if WBC
declines to <3500-4000 cells/mm3
Cellcept is a useful treatment for
autoimmune bullous diseases - such as pemphigus severe forms of atopic dermatitis cutaneous LE dermatomyositis refractory pyoderma gangrenosum GVHD (acute abd chronic) Oral lichen planus Systemic sclerosis ( pulmonary) See text and Table 130.6
True / False
Relative contraindications include lactation, as MPA is partially excreted in breast milk.
Controversial
Text not clear
Other relative CI for cellcept
Peptic ulcer disease
hepatic, renal or cardiopulmonary disease
are also relative contraindications.
As noted previously, renal insufficiency can increase plasma concentrations up to sixfold18.
Cellcept is CI in pregnancy
How to prevent this ?
pregnancy test must be done immediately before starting an MPA preparation as well as 8–10 days later and at routine follow-up visits.
What are the drugs/ substances that interact with cellcept ?
Drugs that alter the enterohepatic recirculation or
gastrointestinal absorption of mycophenolate mofetil, such as
cholestyramine, iron or aluminum and magnesium hydroxides,
may decrease the effectiveness of mycophenolate mofetil.
cholestyramine is a bile acid sequestrant.
What are the drugs/ substances that interact with cellcept ?
Drugs that alter the enterohepatic recirculation or
gastrointestinal absorption of mycophenolate mofetil, such as
cholestyramine, iron or aluminum and magnesium hydroxides,
may decrease the effectiveness of mycophenolate mofetil.
cholestyramine is a bile acid sequestrant.
