Immunosuppressant, selective inosine monophosphate dehydrogenase inhibitor
ATC code: L04AA06 (Mycophenolic acid)
Brand names
CellCept, Myfortic
Prodrug hydrolysed in plasma to active mycophenolic acid. Selectively blocks type II inosine monophosphate dehydrogenase, the purine synthesis enzyme in T and B lymphocytes. Suppresses lymphocyte proliferation without significant effect on neutrophils. Metabolised via UGT1A9, not CYP. Excreted in bile and urine.
First line
First-line in triple immunosuppression after kidney, heart, liver transplantation per ESOT 2024. Dose 1–1.5 g twice daily. Compared with azathioprine, better control of acute rejection and long-term graft survival (RPCG, ETPS).
First line
Mycophenolate mofetil is first-line for rejection prophylaxis after kidney, heart and liver transplantation, usually combined with tacrolimus or ciclosporin and a glucocorticoid. and AEMPS approved. Requires CBC monitoring (myelosuppression risk) and strict contraception in women of childbearing age due to high teratogenic risk.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Mycophenolate mofetil is an antimetabolite immunosuppressant. It is prescribed to prevent organ transplant rejection and for severe autoimmune diseases (systemic lupus erythematosus, vasculitis) when other drugs are ineffective (AEMPS Ficha Técnica). In alt-anti-aging circles, mycophenolate mofetil is occasionally promoted as a selective immunosuppressant to slow immune aging. In healthy adults, no clinical studies of such use exist. The drug has serious risks: myelosuppression (neutropenia, lymphopenia, anemia), GI disturbances (severe diarrhea in 30% of patients), opportunistic infections, increased lymphoma and other malignancy risk, and significant teratogenicity ( boxed warning, mandatory contraception). If mycophenolate mofetil was recommended to a healthy person, seek a second opinion immediately.
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Boxed warning
FDA boxed warning: embryo-fetal toxicity (marked teratogenicity – cleft lip/palate, ear and cardiac defects; T1 spontaneous abortion risk up to 45%); increased risk of malignancies (especially lymphoma and skin); increased risk of serious infections.
Teratogen: high miscarriage and malformation risk (cleft lip/palate, ear/heart/oesophageal defects). Strictly contraindicated in pregnancy. Women of childbearing age need confirmed contraception 1 month before, during and 6 weeks after withdrawal.
Milk excretion data conflicting. Breastfeeding not recommended.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Mycophenolate mofetil is evaluated for the following indications with varying evidence strength: Transplant rejection prophylaxis (evidence tier A), Organ transplant rejection prevention (evidence tier A), Anti-aging and longevity (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Mycophenolate mofetil (≥ 1 in 100): Nausea, vomiting, diarrhoea, Leukopenia, Anaemia, Urinary tract infections, Hypertension, Headache. See the Safety section for uncommon and serious reactions.
FDA category D. Teratogen: high miscarriage and malformation risk (cleft lip/palate, ear/heart/oesophageal defects). Strictly contraindicated in pregnancy. Women of childbearing age need confirmed contraception 1 month before, during and 6 weeks after withdrawal.
Milk excretion data conflicting. Breastfeeding not recommended.
Mycophenolate mofetil is contraindicated in: Pregnancy; Breastfeeding; Mycophenolic acid hypersensitivity; Severe active infections. Full list in the Safety section.
FDA boxed warning: embryo-fetal toxicity (marked teratogenicity – cleft lip/palate, ear and cardiac defects; T1 spontaneous abortion risk up to 45%); increased risk of malignancies (especially lymphoma and skin); increased risk of serious infections.