8.2.1 Antiproliferative immunosuppressants

Azathioprine

• Tablets 25mg, 50mg (£1.30 = 25mg)

Indications

• Inflammatory bowel disease
• Rheumatoid arthritis
• Dermatological conditions
• Suppression of transplant rejection

Notes

1. Refer to individual shared care guidelines for use in Gastroenterology, Rheumatology, or Dermatology conditions
2. Avoid concomitant use of azathioprine with allopurinol, unless supervised by an appropriate specialist.

Mycophenolate mofetil (CellCept®)

• Capsules 250mg (£82.26 = 100 capsules)
• Tablets 500mg (£82.26 = 50 tablets)
• Oral suspension 1g/5ml (£115.16 = 175ml)
• IV infusion 500mg vial

Notes

1. Refer to individual shared care guidelines for use in Rheumatology and Dermatology conditions
2. The prescribing of mycophenolate mofetil for the prevention of rejection in renal transplant patients has been repatriated to secondary care.
3. MHRA Drug Safety Update (January 2015): When using mycophenolate mofetil or any other medicine containing mycophenolic acid (MPA) as its active ingredient:
   1. measure serum immunoglobulin levels if recurrent infections develop
   2. in cases of sustained, clinically relevant hypogammaglobulinaemia, consider appropriate clinical action. Take into account the potent cytostatic effects of MPA on B-lymphocytes and T-lymphocytes
   3. consider bronchiectasis or pulmonary fibrosis if patients develop persistent respiratory symptoms, such as cough and dyspnoea
4. MHRA Drug Safety Update (February 2018): Mycophenolate mofetil, mycophenolic acid: updated contraception advice for male patients, and reminder for healthcare professionals prescribing mycophenolate to female patients. Please refer to the update for information.
   1. See also resources for: contraception for drugs with teratogenic potential, and prescribing in pregnancy and lactation
5. NICE TA481 and NICE TA482: Mycophenolate mofetil, when used as part of an immunosuppressive regimen, is recommended as an initial option to prevent organ rejection in children, young people, and adults having a kidney transplant. (October 2017) (NHS England Commissioned)

Mycophenolic acid (Myfortic®)

• Tablets 180mg, 360mg (£96.72 = 120 tablets x 180mg)

Notes

1. The prescribing of mycophenolic acid for the prevention of rejection in renal transplant patients has been repatriated to secondary care.
2. MHRA Drug Safety Update (January 2015): When using mycophenolate mofetil or any other medicine containing mycophenolic acid (MPA) as its active ingredient:
   1. measure serum immunoglobulin levels if recurrent infections develop
   2. in cases of sustained, clinically relevant hypogammaglobulinaemia, consider appropriate clinical action. Take into account the potent cytostatic effects of MPA on B-lymphocytes and T-lymphocytes
   3. consider bronchiectasis or pulmonary fibrosis if patients develop persistent respiratory symptoms, such as cough and dyspnoea
3. MHRADrug Safety Update (February 2018): Mycophenolatemofetil, mycophenolic acid: updated contraception advice for male patients, andreminder for healthcare professionals prescribing mycophenolate to femalepatients. Please refer to the updatefor information.
   1. See also resources for: contraception for drugs with teratogenic potential, and prescribing in pregnancy and lactation
4. NICE TA481 and NICE TA482: Mycophenolate sodium, is not recommended as an initial option to prevent organ rejection in children, young people, and adults having a kidney transplant. (October 2017)

 

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