Mycophenolate
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Dosing and administration[3]
Oral mycophenolate mofetil (or enteric-coated mycophenolate sodium). A powerful teratogen; a pregnancy-prevention program with effective contraception is mandatory.
| Indication | Starting dose | Titration and maximum |
|---|---|---|
| Lupus nephritis and other severe autoimmune disease | Mycophenolate mofetil 1 to 1.5 g twice daily (2 to 3 g/day) for lupus nephritis; mycophenolate sodium 720 mg twice daily is roughly equivalent to 1 g mofetil twice daily. | Titrate to response and tolerability; reduce for cytopenias or GI intolerance. |
Renal adjustment. Use with caution in renal impairment; avoid doses above 1 g twice daily in severe chronic renal impairment outside the immediate transplant setting.
Powerful teratogen: confirm a negative pregnancy test, ensure effective contraception during and for 6 weeks after treatment, and do not use in pregnancy.
Monitoring
- CBC weekly for the first month, then twice monthly for 2 months, then monthly through the first year.
- Monitor for infection (including CMV) and gastrointestinal effects.
Contraindications
- Pregnancy and women not using effective contraception.
- Hypersensitivity to mycophenolate.
Key interactions
- Antacids and proton pump inhibitors reduce absorption.
- Cholestyramine and some antibiotics reduce enterohepatic recirculation and levels.
- Avoid live vaccines.
Clinical notes
How it is used in lupus
A core steroid-sparing immunosuppressive for SLE and a preferred agent for lupus nephritis, where the target dose is 2 to 3 g/day, used alone or as part of combination regimens.[1, 2]
Common side effects
Gastrointestinal intolerance is common and often dose-related; cytopenias and increased infection risk occur. Described from background clinical knowledge; reconcile with the product monograph.
Tests and monitoring
CBC with differential at initiation and approximately 2 weeks after each dose change, then regularly on stable dosing. Urine pregnancy screen at baseline, 8 to 10 days after baseline, and at subsequent visits for people of reproductive potential. A REMS program applies.[1]
Important cautions
Teratogenic; generally stopped before conception, with effective contraception during use (an IUD or two other methods if continued). Azathioprine is the usual agent when pregnancy is planned. Full reproductive-health guidance is maintained on the pregnancy record.[1, 2]
References
- Sammaritano LR, Askanase A, Bermas BL, et al. 2025 American College of Rheumatology (ACR) Guideline for the Treatment of Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken). 2025. doi:10.1002/acr.25690 https://doi.org/10.1002/acr.25690
- Sammaritano LR, Askanase A, Bermas BL, et al. 2024 American College of Rheumatology (ACR) Guideline for the Screening, Treatment, and Management of Lupus Nephritis. Arthritis Care Res (Hoboken). 2025;77(9):1045-1065. doi:10.1002/acr.25528 https://doi.org/10.1002/acr.25528
- CELLCEPT (mycophenolate mofetil) Product Monograph. Health Canada authorized product monograph. https://health-products.canada.ca/dpd-bdpp/