Mechanism and Clinical Application of Mycophenolate in Interstitial Lung Disease

Primary Mechanism of Action

• This inhibition preferentially affects T and B lymphocytes because they are critically dependent on the de novo pathway for purine synthesis, unlike other cells that can use salvage pathways 1

Dosing in Interstitial Lung Disease

• Typical starting dose is 500 mg twice daily 2
• Dose is typically increased by 500 mg weekly to reach a target dose of 1000 mg twice daily (2 g/day) 2
• In some cases, doses may be increased to 1500 mg twice daily (3 g/day) if tolerated 2
• Monitoring of MMF levels (glucuronide) may be performed to ensure therapeutic range 2

Safety Profile and Adverse Effects

• Common side effects include gastrointestinal disturbances (nausea, diarrhea) 2, 3
• Potential for leukopenia and transaminitis requiring laboratory monitoring 2
• Contraindicated in pregnancy due to teratogenic effects 2
• Requires monitoring of complete blood count and liver function tests 3