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Impaired absorption of mycophenolate?


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#1 Speedo

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Posted 20 March 2016 - 07:13 AM

I discussed the 2012 paper published in the Journal of Clinical Pharmacology "Omeprazole impairs absorption of mycophenolate mofetil but not of enteric-coated mycophenolate sodium in healthy volunteers" with my doctors and pharmacist.  I am currently taking both mycophenolate mofetil (MMF)and omeprazole (proton pump inhibitor) twice a day for problems associated with diffuse systemic sclerosis.  I'm especially concerned about any reduced efficacy of MMF as it relates to holding my interstitial lung disease in check.  All of the health care professionals didn't seem too concerned about this drug interaction as long as I separated the doses of MMF and omeprazole.  Maybe I worry too much or that I'm being too scientific, but I'd sure like to know what the ph of my stomach is during the times I take my meds (the journal article cites reduced absorption above ph 4.5).  I currently separate the timing of these two medications while trying to follow the MMF guidelines to dose 1 hour before and 2 hours after a meal, another absorption complication.  Has anyone had a similar concern and if so how do you take your medications (timing to separate MMF and omeprazole)?



#2 Joelf

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Posted 20 March 2016 - 11:17 AM

Hi Speedo,

 

That's an interesting article and I've included a link about mycophenolate, which does suggest if you are taking antacids, to take them 2 hours before or 4 hours after you take mycophenolate.

 

I've never taken mycophenolate, so can't advise you from my own experience, although I do take azathioprine and omeprazole without any ill effects. (I tend to take the omeprazole about an hour and a half to two hours before the azathioprine.)

 

Although I don't really suffer with acid reflux to any great degree, I take the omeprazole on the advice of my lung consultant, just in case any stomach acid should inadvertently go down into my lungs.

 

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#3 Shelley Ensz

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Posted 22 March 2016 - 04:48 AM

Hi Speedo,

 

I may be wrong, I often am, but I think the take-home message from that research article was supposed to be that using enteric-coated mycophenolate sodium, instead of just plain mycophenolate mofetil, solves the absorption problem, when someone is also taking omeprazole. From what I can tell, it looks like the two drugs are supposed to be therapeutically equivalent.

 

Enteric coated is a more advanced formula, which is supposed to help reduce gastrointestinal side effects. Which means it probably costs more, too. Oh whoops, I just looked it up, and it seems Myfortic has finally gone generic, so the generic cheaper than Cellcept now.

 

You might also want to talk to the manufacturers directly. Genentech may be able to advise you as to whether just spacing out the medications is enough to overcome the malabsorption. Cellcept is made by Genentech, and Myfortic (the enteric coated) is made by Novartis.

 

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#4 Speedo

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Posted 22 March 2016 - 05:26 AM

Thanks Shelley. I think you're right. I just get too buried in the details. The lower strength of the enteric-coated version was of concern, but I guess my rheumatologist can figure out how to make up the difference. I'm putting a lot of faith in this drug to keep me breathing. I sure hope it works! Thanks again for your read on this!

Speros

#5 janey

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Posted 24 May 2016 - 05:09 PM

Hey Speedo,

Sorry for the late reply, but just saw your initial post.  I was put on mycophenolate (cellcept) 9 years ago for pulmonary fibrosis and it seems to have stopped it in its tracks.  My fibrosis started in the lower lobes and has not progressed any further.  I also take omeprazole twice a day and it doesn't seem to be impairing it, but like you I do not take them together.  I take one omeprazole when I first get up, then 1 gram of cellcept an hour or two later right before I eat breakfast.  I take the second omeprazole around 6 pm, an hour before dinner.  Then I take another gram of cellcept around 8 - 9 pm. Both medications seem to be doing their job, so that method is working for me. 

 

Hope you find a regimen that works for you.

 

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Janey


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#6 Speedo

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Posted 25 May 2016 - 05:17 AM

Janey - thanks so much for sharing.  I also need to give Jo a belated thanks for the info. she provided.  That is the only professional recommendation anyone has provided me (i.e. taking mycophenolate 2 hours before or 4 hours after an antacid).  I have settled in to an almost identical regime as yours although I stretch out my mycophenolate a little further given the post 4 hour antacid advice.  I find that can be a scheduling headache especially at night.  Your response is reassuring and again shows I might be worrying too much.

 

A lot happened since my original post and I'd like to share in case I can help others with a similar question.  When I discussed the absorption concern with my rheumatologist, we agreed to up my mycophenolate dosage from 2 g a day to 2.5 g to help compensate for any absorption issue.  While still below the recommended maximum of 3 g per day, I had a bad reaction to the half gram increase.  I gained 10 pounds almost overnight (fluid retention) and had extreme swelling in my extremities below my waist, especially in my joints.  I felt horrible!  Coincidentally, my rheumatologist called to discuss my recent lab results and an upcoming Rituxan infusion and requested that I reduce my mycophenolate dosage to 1 g per day in preparation for the infusion.  My weight gain and swelling disappeared within 2 days of reducing my daily dosage.  I have to assume the reaction was related to the mycophenolate increase, ironically all because I worried about impaired absorption.  I remain on 1 g of mycophenolate daily with no problem and I have my second Rituxan infusion tomorrow.  Now I'm hoping for an encouraging PFT in June.

 

I know this disease and associated medications can effect everyone differently, just thought I'd pass this along for info.  I really appreciate everyone's help and support as I stumble through this relatively new phase in my life.  Thanks to all of you!

 

Speros



#7 Joelf

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Posted 25 May 2016 - 08:38 AM

Hi Speedo,

 

Thanks very much for your helpful and encouraging post.

 

I'm very pleased that things have stablised for you and I do hope that your next PFT results are good.

 

Kind regards,


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