MycophenolateDose, contraindications and adverse effects for Cats and Dogs.

Immunosuppressive drug that inhibits lymphocyte proliferation by blocking purine synthesis; used for immune-mediated disease. Although clinical experience using mycophenolate in veterinary medicine has been limited and no large well-controlled studies were located, mycophenolate appears useful in the treatment of a variety of autoimmune diseases, including immune-mediated hemolytic anemia (IMHA),1-4 immune-mediated thrombocytopenia (IMTP),5,6 myasthenia gravis,7,8 meningoencephalomyelitis,9,10 glomerulonephritis,11…

Mycophenolate mofetil (MMF) is a prodrug that must be hydrolyzed in vivo to mycophenolic acid (MPA) to be pharmacologically active. Mycophenolic acid noncompetitively, but reversibly, inhibits inosine monophosphate dehydrogenase (IMPDH). Two distinct forms of IMPDH exist in the body, including type 1 found in most cells and type 2 existing in activated lymphocytes.

Do not use mycophenolate in patients with documented hypersensitivity reactions to mycophenolate. Patients with severe renal dysfunction may require dosage adjustment. Because MMF can cause diarrhea, use with caution in patients with inflammatory bowel disease. IV mycophenolate must be administered over at least 2 hours; do not give it as an IV bolus or via rapid IV infusion. In humans, the active metabolite, MPA, is primarily excreted as the MPA-glucuronide metabolite.

Because of limited experience with mycophenolate in veterinary patients, the adverse effect profile is not well established. At usual doses (10 mg/kg PO twice daily), mycophenolate is usually well tolerated in dogs. Dose-dependent diarrhea appears to be the most common adverse effect, but vomiting, anorexia, lethargy/reduced activity, lymphopenia, papillomatosis, and increased rates of dermal infections can be seen.

■ Efficacy ■ Baseline and periodic CBCs every 2 to 3 weeks for the first month, then every 2 to 3 months during treatment.4 ■ Baseline and periodic serum chemistry profile, urinalysis, and urine culture ■ Signs associated with infection (eg, fever, malaise, inappetence) ■ GI effects (eg…