8.2.1 Antiproliferative immunosuppressants

Azathioprine
  • Tablets 25mg, 50mg (£2.25 = 56 x 50mg)
  • Injection 50mg vial (£15.38 = 1 vial)
  • Suspension 50mg/5ml (unlicensed preparation)

Indications

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

Notes

  1. West Devon: refer to individual shared care guidelines for use in Gastroenterology, Haematology, or Renal, Rheumatology, Hepatology, or Dermatology conditions
  2. South Devon: refer to shared care guidelines for use in Gastroenterology, Ophthalmology and Respiratory, or Rheumatology conditions
  3. Avoid concomitant use of azathioprine with allopurinol, unless supervised by an appropriate specialist.
  4. Monitoring of azathioprine is essential.
CellCept®

(Mycophenolate mofetil)

  • Capsules 250mg
  • Tablets 500mg
  • Suspension 1g/5ml
  • IV infusion 500mg vial

Notes

  1. Prescribe by brand
  2. West Devon: refer to individual shared care guidelines for use in Rheumatology, or Dermatology conditions
  3. South Devon: Mycophenolate is restricted to hospital only prescribing unless an exceptional arrangement to prescribe is agreed by the GP and specialist as being in the best interest of the patient
  4. The prescribing of mycophenolate mofetil for the prevention of rejection in renal transplant patients has been repatriated to secondary care.
  5. Mycophenolate mofetil has been used by the gastroenterologists for resistant Crohn's disease in patients unable to tolerate alternative immunosuppressants (unlicensed indication). It is not recommended for GP prescribing for this indication.
  6. 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
  7. MHRA Drug Safety Update (December 2015): Mycophenolate mofetil, mycophenolic acid: new pregnancy-prevention advice for women and men and 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
  8. 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)
Myfortic®

(Mycophenolic acid)

  • Tablets 180mg, 360mg

Notes

  1. Prescribe by brand
  2. The prescribing of mycophenolic acid 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 (December 2015): Mycophenolate mofetil, mycophenolic acid: new pregnancy-prevention advice for women and men and 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 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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