One of the biggest problems faced by recipients of organ transplant is the possibility of rejection by the body. This may occur immediately or in some instances may occur after some time. This effectively negates the entire process of organ transplant and the efforts that go into complex procedures. Mycophenolic acid belongs to the category of immunosuppressant medications that are used in mitigating and preventing organ transplant rejections. Subsequent sections offer detailed information about the product, the mechanism of action, drug interactions and possible mycophenolic acid side effects that may be experienced by recipients. This will help patients and families to prevent and mitigate the possible adverse outcomes of the medication.

Overview of mycophenolic acid

In addition to its classification as an immunosuppressant drug, it is also a powerful anti-proliferative drug. It is typically part of combination therapy involving three different types of medication. For instance, it is generally combined with calcineurin inhibitors and prednisolone as part of treatment regimen. The drug is administered after transplantation of organs such as kidneys, liver and heart from donors. While it is recommended for use in preventing organ transplant rejection in adults, it is also used in preventing rejection of kidney transplants in kids above the age of three. By weakening the immune system that is responsible for the rejection, the medication facilitates the gradual acceptance of the new organ in the body.

Mechanism of action of this immunosuppressant

The drug delivers outcomes through selective inhibition of pathways, and this inhibition is responsible for cytostatic properties on the lymphocytes. In addition to preventing the proliferative actions of lymphocytes, it helps to suppress and prevent the formation of antibodies. The antibodies are responsible for the actions that result in rejection of transplanted organs. By virtue of the prevention of glycosylation, the drug inhibits the recruitment of leukocytes into sites that experience inflammation.

Drug interactions of the medication

There are possible drug interactions that may be experienced with other medications and substances. This includes herbal remedies, supplements, OTC products and alternative medications. It is necessary to note that drug interactions are common to all patients unlike side effects. For instance, the possibility of undesirable effects from the medication may being experienced differ from person to person, with some experiencing stronger effects, while others may experience mild effects. There is also the possibility of certain individuals not experiencing any effects whatsoever. However, when it comes to possible drug interactions the effects are the same among users, as the interaction is between two medications.

Increase in levels of the immunosuppressant: Commonly reported drug interactions of mycophenolic acid include reactions with acyclovir and ganciclovir. The main outcome is essentially an increase in the levels of mycophenolic acid in the blood when taken along with either of the two medications. Patients on the medication are to avoid use of antacids, as this may cause a reduction in the levels of the immunosuppressant. This may result in les than desired results or outcome from the drug. In the event that the antacid cannot be stopped, it will be imperative to stagger the intake of both medications, so as to give a clear gap between the two medications and their respective mechanisms of action.

Proton pump inhibitors: Other interactions of the drug include with medications that belong to the category of proton pump inhibitors. For instance, medications such as omeprazole, pantoprazole etc are known to bring down the blood levels of the immunosuppressant. This may have an impact on the desired outcomes. Similarly, the drug also interacts with cholestyramine, which is known to bring down the levels of mycophenolic acid, by binding to the medication in the intestines. As a result of this binding action, the amount of the drug that may have been absorbed in the intestines normally, is reduced considerably, thereby weakening the outcome or impact of the medication.

The other medications that are known to bring down the levels of the drug include cyclosporine and sevelamer. Studies indicate that the single biggest nature of interaction of the drug with other medications is the reduction in the blood levels of mycophenolic acid when combined with other medications. The list includes:

Effect on contraceptives: In addition to the above interactions, mycophenolic acid is also known to bring down the efficacy of oral contraceptives. Consequently, couples planning birth control may end up with unplanned pregnancies. One interaction that is different from the most common types of interaction includes an increase in the blood levels of mycophenolic acid when taken along with probenecid. This is mainly attributed to the prevention of elimination of the drug, thereby causing an increase in the blood levels of the immunosuppressant.

Precautions to be taken when on mycophenolic acid

The medication comes with the risk of causing miscarriage in pregnant women. There is also the possibility of birth defects in the new born, as a result of the medication. It is therefore necessary for couples on the medication to choose different forms of fool proof and proven contraceptives to prevent unplanned pregnancy when on the drug. As adequate studies have not been conducted to determine if the drug ends up in breast milk, it is necessary for nursing mothers to exercise ultimate caution when on the drug. The safest option would be to avoid the drug as far as possible and choose other medications that do not have this element of risk.

Precautions from infections: Other precautions that need to be followed when on the medication includes the need for patients to avoid proximity with individuals from other transmissible diseases. As explained earlier, the desired outcome of the medication is to lower the immune response in such a manner so as to prevent the rejection of the transplanted organ. As the immune response remains lowered, the possibility of getting infected increases. It is therefore essential to avoid situations where there is a likelihood of getting infected. In the event of individuals falling sick, it is necessary to immediately seek medical intervention to prevent the sickness from turning serious in nature, or developing into other strong ailments.

In addition to the above, it is necessary for men to avoid sperm donation when on the immunosuppressant. The typical period or window for avoiding sperm donation when on the drug is three months after the conclusion of the treatment regimen. Similarly, men and women on the mycophenolic acid are to avoid donating blood when on the medication. The duration in this instance is around two months from the end of treatment with the immunosuppressant. Finally, precautions include avoiding exposure to the sun when on the medication. In the event that it is essential to go out, adequate protection is to be in place, such as a good sunscreen with SPF 30 or more.

Avoid live virus vaccines when on immunosuppressants

Vaccines that contain a live virus work by recognizing and combating infections from viruses that are the same as the weakened virus in the vaccine. Individuals on immunosuppressants are not to take live virus vaccines as the efficacy of the vaccine gets degraded or compromised. Consequently, the desired results or protection from the disease will not be achieved, and the vaccination will essentially be a failure. It is therefore necessary to put off the vaccination to a later date, after the immunosuppressant treatment schedule is over. Examples of live virus vaccines include polio, yellow fever, typhoid, measles, chickenpox, mumps, shingles and rubella.

Commonly reported mycophenolic acid side effects

As outlined earlier, side effects are a possibility with all medications. Commonly reported undesirable outcomes of the immunosuppressant include discoloration of the stools, that may appear dark/black with a tar like appearance. Pain in the bladder is another commonly reported undesirable outcome of the medication. The individual is likely to experience bleeding from the gums, and this may cause some kind of discomfort. Other unwanted effects of the medication include swelling that may be witnessed in the limbs, and the face. Traces of blood in the urine or the stools is another possibility, while some individuals may observe urine to appear clouded.

Effects that need attention: The medication is also known to have an effect on vision, with blurred vision being reported among users. Certain tell-tale sensations and feelings are also likely to be felt or experienced by patients on the medication. For instance, there could be numb sensation, while others may experience a prickling sensation, or a burning feeling.  A distinct tightening in the chest may be experienced, accompanied by pain, and this indicates that the individual needs some kind of medical intervention to prevent the condition from turning serious in nature. Similarly, any difficulty in breathing is to be considered as an indication that requires medical attention.

Need to avoid certain tasks: The amount of urine passed may reduce, while some may experience pain or discomfort while passing urine. A small section of individuals is known to end up in a confused state of mind. The voice may turn hoarse or there could be unusual coughing in certain patients.  There could be an impact on the normal mobility of the patient, and this may improve over time. Individuals in certain responsibilities are to be on guard and avoid tasks that require an alert state of mind with fast reflexes. This is because there could be a light headed feeling experienced by users on the medication, and this could also turn into dizziness. It is important to rise slowly from a reclining position and to be aware of the probable dizziness.

Side effects that may be commonly experienced by users include a change in the heart beat rate, with the rate either increasing to a pounding or slowing down. This irregular heart beat is to be evaluated and treated at a healthcare facility. The patient may experience a dry mouth, when on the medication, while some are known to end up with a fever or experience abnormal chills. Discernible symptoms of side effects include skin that appears dry and flushed, while some end up with breath that smells abnormal like that of fruit. The possibilities of side effects are lengthy and this compilation is neither exhaustive nor complete in nature. It is also necessary to bear in mind that not all users are likely to experience side effects. Effects that are serious or persistent in nature need medical attention, while mild, moderate effects are more likely to resolve naturally, without any need for panic.

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