Mycophenolate. Dosage and monitoring record for patients with interstitial lung disease

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1 Mycophenolate Dosage and monitoring record for patients with interstitial lung disease

2 This booklet contains information about your immunosuppressant treatment. Keep this booklet with you at all times and show it to those treating you, such as your doctor, pharmacist and nurse. Important information This booklet gives some information about your medicine. It is not intended to be exhaustive and should not be used as a substitute for consulting with your doctor on any particular issue. If you have further questions, please ask your doctor, pharmacist or nurse. Take this medicine only as prescribed by your doctor. Do not change anything without checking with your doctor first. This medicine has been prescribed for you only. Do not give it to anyone, even if their symptoms are the same as yours. What is mycophenolate mofetil (brand name: Cell-Cept)? Mycophenolate is an immunosuppressant drug that is used to control your body s immune system in conditions where it is overactive and reacting against your own body. Examples include: Organ transplant: to prevent the body rejecting a new organ. Lung disease: to reduce the inflammation that may contribute to symptoms of breathlessness and reduced exercise tolerance. If you are already taking prednisolone therapy, starting mycophenolate may mean that your dose of prednisolone can be reduced. Inflammatory conditions: for example rheumatoid arthritis. We have prescribed you mycophenolate for: How to take mycophenolate Mycophenolate is usually taken twice a day, once in the morning and evening. Swallow the tablets whole with a glass of water. Mycophenolate is best taken after food. Handle the tablets as little as possible. 2 Mycophenolate

3 Dose to take Your doctor will decide the best dose for you to take, depending on your body weight. The dose will usually start off low for the first month to ensure that you do not suffer any side effects. If you tolerate it well, the dose of mycophenolate may be increased by your doctor. It may take up to six to 12 weeks before you see any benefit from the treatment. Date of dose change Dose (mg) to be taken once a day Side effects If any of these symptoms develop, stop taking mycophenolate and see your doctor immediately: redness of the skin or a skin rash, fever, shivering or chills feeling dizzy, confused, light-headed, weak or generally tired muscle and bone pain kidney problems such as changes in the amount of urine passed and colour of the urine unexpected bleeding or bruising bad diarrhoea and/or abdominal pain fever or any other signs of infection developing jaundice (skin or white of the eyes turn yellow) blistering and/or peeling of the skin, lumps on the body or patches on the skin loss of appetite, nausea and vomiting (reduced by taking tablets after food) For a full list of all possible side effects that may occur when taking mycophenolate, please read the leaflet supplied with your medicine. Mycophenolate 3

4 Your immune system Because mycophenolate suppresses your immune system, your body may not be as effective at fighting off infection. If you have any signs of infection (sore throat or fever), experience jaundice (yellowing of the skin or whites of the eyes), or any unexplained bruising or bleeding, tell your doctor immediately. If you have not had chickenpox but come into contact with someone who has chickenpox or shingles, you should see your doctor immediately as you may need special treatment. Patients receiving mycophenolate may be more likely to develop different kinds of cancers, including skin cancers. Try to limit your time in the sun, cover up with clothing and use high factor sun screen. Mycophenolate may cause hair loss or thinning. Hair growth does usually return to normal even if treatment continues but you should avoid hair dyes or perms for the first few months as your hair will be weaker than normal. Blood tests Regular blood tests are important while taking mycophenolate, to check for any unwanted effects on your liver and kidney function or blood cell production. Your GP should arrange for you to have a blood test every week for the first two months of therapy and then every two weeks until your target dose has been reached. Your blood should then be tested monthly for the first year and every second month thereafter. Pregnancy and breastfeeding Mycophenolate can cause problems for unborn babies so make sure that you are not pregnant before starting to take mycophenolate. Due to this, treatment will only start after a negative pregnancy test. 4 Mycophenolate

5 Use adequate contraception before starting treatment, during treatment and for eight weeks after stopping treatment. Please contact your doctor immediately if you become pregnant while taking mycophenolate. Similarly, do not breastfeed while you are taking mycophenolate as a small amount of the drug can pass into breast milk. Taking mycophenolate with other medicines If you take any other medicines then please let your doctor know so that they can check whether they are safe for you to take with mycophenolate. If you are taking allopurinol or warfarin then your doctor would need to give you a lower dose of mycophenolate and your warfarin dose would need to be changed. Buying medicines over-the-counter Always let the pharmacist know that you are taking mycophenolate when buying medicines. It is important that the pharmacist checks that the new medicines will not interact with the mycophenolate and are safe for you to take. It is also possible that the symptoms you are trying to treat with the medicine may be a sign that the mycophenolate is not working safely for you. Keep a record of any symptoms and discuss them with your doctor. Vaccinations Do not have any live vaccines while taking mycophenolate, and for a short while afterwards. The fact that your body s immune system is suppressed when you are taking mycophenolate may mean that having the vaccine can cause an infection and the response that you get to the vaccine may be reduced. Discuss any vaccinations with your doctor as some vaccines are safe and recommended, such as the pneumovax and flu vaccinations. Mycophenolate 5

6 Forgetting to take your medicine Never take two doses at once. If you forget to take mycophenolate, take it as soon as you remember. If it is close to the time that your next dose is due, however, miss the first dose and take the next one at the usual time. If you are unsure what to do, please contact your doctor for advice. If you take more tablets than you have been told to take, contact your doctor immediately. Storing your medicine Keep your mycophenolate tablets out of the reach of children and at room temperature. Glossary Hb: the oxygen carrying component of red blood cells MCV: the average volume of a red blood cell WBC: white blood cells Platelets: an irregular, disc shaped element in the blood that helps in blood clotting. Lymphocytes: a small white blood cell that plays a large role in defending the body against disease. They are responsible for immune responses. Neutrophils: a type of white blood cell filled with enzymes used to kill and digest micro-organisms. ALT: an enzyme normally present in the liver and heart cells that is released into the blood stream when the liver or heart is damaged. Abnormally high ALT levels may indicate that the liver is not functioning normally. ALK phos: an enzyme made in the liver which is usually released into the blood during injury. Abnormally high levels may indicate some liver damage. CRP: a component of the blood that rises in response to inflammation in the body. This rate increases with more inflammation. Urea and creatinine: substances normally cleared from the blood by the kidneys. Increased blood levels of urea and creatinine indicate that kidneys may not be functioning normally. 6 Mycophenolate

7 Monitoring results Please ask the person responsible for prescribing/monitoring your treatment to record your test results below: Date of blood test Dose of mycophenolate HB Male g/l Female g/l MCV fL WBC 4-11 x 109/L Platelets x 109/L Neutrophils x 109/L Lymphocytes x 109/L ALT IU/L Alk phos IU/L CRP mg/l Urea mmol/l Creatinine umol/l Total Bilirubin 0-20 umol/l Next test date Mycophenolate 7

8 Monitoring results Please ask the person responsible for prescribing/monitoring your treatment to record your test results below: Date of blood test Dose of mycophenolate HB Male g/l Female g/l MCV fL WBC 4-11 x 109/L Platelets x 109/L Neutrophils x 109/L Lymphocytes x 109/L ALT IU/L Alk phos IU/L CRP mg/l Urea mmol/l Creatinine umol/l Total Bilirubin 0-20 umol/l Next test date 8 Mycophenolate

9 Monitoring results Please ask the person responsible for prescribing/monitoring your treatment to record your test results below: Date of blood test Dose of mycophenolate HB Male g/l Female g/l MCV fL WBC 4-11 x 109/L Platelets x 109/L Neutrophils x 109/L Lymphocytes x 109/L ALT IU/L Alk phos IU/L CRP mg/l Urea mmol/l Creatinine umol/l Total Bilirubin 0-20 umol/l Next test date Mycophenolate 9

10 Monitoring results Please ask the person responsible for prescribing/monitoring your treatment to record your test results below: Date of blood test Dose of mycophenolate HB Male g/l Female g/l MCV fL WBC 4-11 x 109/L Platelets x 109/L Neutrophils x 109/L Lymphocytes x 109/L ALT IU/L Alk phos IU/L CRP mg/l Urea mmol/l Creatinine umol/l Total Bilirubin 0-20 umol/l Next test date 10 Mycophenolate

11 Monitoring results Please ask the person responsible for prescribing/monitoring your treatment to record your test results below: Date of blood test Dose of mycophenolate HB Male g/l Female g/l MCV fL WBC 4-11 x 109/L Platelets x 109/L Neutrophils x 109/L Lymphocytes x 109/L ALT IU/L Alk phos IU/L CRP mg/l Urea mmol/l Creatinine umol/l Total Bilirubin 0-20 umol/l Next test date Mycophenolate 11

12 Your details: Name Date of birth Address Contact telephone number Contact details of the healthcare team looking after you: Consultant GP Community pharmacy For further information on medicines Medicines information helpline (9am to 6.30pm) For help outside of working hours call your out-of-hours GP or speak to the on-call respiratory doctor via University Hospital Southampton switchboard If you need a translation of this document, an interpreter or a version in large print, Braille or audio, please call for help University Hospital Southampton NHS Foundation Trust. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright holder. Version 2. Published July Due for review July MYCO001.02

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