Mycophenolate Colestyramine

LEFLUNOMIDE MYCOPHENOLATE t risk of serious infections (sepsis) and of opportunistic infections (Pneumocystis jiroveci pneumonia, tuberculosis, aspergillosis) Additive immunosuppression Monitor platelets, white blood cells, haemoglobin and haematocrit at baseline and regularly - weekly -during concomitant therapy. With evidence of bone marrow suppression, discontinue leflunomide and administer colestyramine and charcoal to t elimination of leflunomide >- For signs and symptoms of immunosuppression, see Clinical Features of Some Adverse Drug Interactions, Immunosuppression and blood dyscrasias... 

MYCOPHENOLATE LIPID-LOWERING DRUGS -COLESTYRAMINE 1 plasma concentrations of mycophenolate by approximately 40%. Risk of therapeutic failure Due to interruption ofenterohep-atic circulation due to binding of recirculating mycophenolate with cholestyramine in intestine Avoid co-administration... 

Colestyramine reduces the absorption of mycophenolate but the clinical relevance of this is uncertain. 

Colestyramine 4 g three times daily for 4 days reduced the AUC of mycophenolic acid by 40% in a group of healthy subjects after they took a single 1.5-g oral dose of mycophenolate mofetil. The UK manufacturers advise caution with concurrent use, while the US manufacturers say that this combination is not recommended. Separating the administration of... 

The clinical importance of the reduction in mycophenolic acid levels has not been assessed but, if colestyramine is also given, it would seem prudent to confirm that the immunosuppressant effects of mycophenolate remain adequate. 

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