Mycophenolate Ganciclovir

Drugs that may be affected by mycophenolate include acyclovir, ganciclovir, live attenuated vaccines, oral contraceptives, phenytoin, and theophylline. 

Drugs that may affect mycophenolate include acyclovir, antacids, azathioprine, cholestyramine, ganciclovir, iron, probenecid, and salicylates. 

Drug interactions In a randomized, double-blind study, Zenapax or placebo was added to an immunosuppressive regimen of cyclosporine, mycophenolate mofetil, and steroids to assess tolerability, pharmacokinetics, and drug interactions. The addition of Zenapax did not result in an increased incidence of adverse events or a change in the types of adverse events reported. The following medications have been administered in clinical trials with Zenapax with no incremental increase in adverse reactions cyclosporine, mycophenolate mofetil, ganciclovir, acyclovir, azathioprine, and corticosteroids. 

MYCOPHENOLATE ANTIVIRALS -ACICLOVIR, GANCICLOVIR t plasma concentrations of both drugs. Toxic effects of both drugs likely Attributed to competition for renal tubular excretion Monitor blood counts - For signs and symptoms of immunosuppression, see Oinical Features of Some Adverse Drug Interactions, Immunosuppression and blood dyscrasias... 

MYCOPHENOLATE ANTIVIRALS-ACICLOVIR, GANCICLOVIR Possible T efficacy Competition for renal excretion Monitor renal function, particularly if on >4g valacidovir. 1 dose of acidovir if there is a background of renal failure... 

GANCICLOVIR/ VALGANCICLOVIR ANTICANCER AND IMMUNOMODULATING DRUGS -1. CICLOSPORIN 2. MYCOPHENOLATE 3. TACROLIMUS 1. t risk of nephrotoxicity 2. Possible T efficacy 3. Possible T nephrotoxicity/neurotoxicity 1. Additive nephrotoxic effects 2. Competition for renal excretion 3. Additive side-effects 1. Monitor renal function 2. Monitor renal function particularly if on >4g valacidovir i dose of acidovir if there is a background of renal failure 3. Monitor more closely check tacrolimus levels... 

To evalnate whether mycophenolate mofetil is effective in treating moderate to severe atopic dermatitis, an open pilot stndy was condncted in 10 patients (34). There were no serions adverse effects, bnt one patient had to discon-tinne treatment becanse he developed Herpes simplex retinitis, which resolved after treatment with aciclovir. Althongh there is no direct evidence that mycophenolate mofetil is a major canse of Herpes retinitis, in this patient it seems likely that it was dne to immunosuppression. In contrast, in vivo and in vitro mycophenolate mofetil strongly potentiates the antiherpetic effects of aciclovir, ganciclovir, and penciclovir (35). It is probably therefore enough to give antiviral therapy only when clinical signs of Herpes infection occur. 

Neyts J, Andrei G, De Clercq E. The novel immunosuppressive agent mycophenolate mofetil markedly potentiates the antiherpesvirus activities of acyclovir, ganciclovir, and penciclovir in vitro and in vivo. Antimicrob Agents Chemother 1998 42(2) 216-22. 

Wolfe EJ, Mathur V, TomlanovichS, et al. Rharmacokinetics of mycophenolate mofetil and intravenous ganciclovir alone and in combination in renal transplant recipients. Pharmacotherapy 1997 17 591-598. 

The concurrent use of aciclovir or ganciclovir and mycophenolate mofetil does not appear to significantly affect the pharmacokinetics of either drug, but the manufacturers recommend care in renal impairment. There are reports of neutropenia in patients taking mycophenolate with valaciclovir or ganciclovir. 

Note that some data suggests that mycophenolate potentiates the antiherpes virus activity of ganciclovir, which may be clinically useful. ... 

Kennedy G A, Kay TD, Johnson DW, Hawley CM, Campbell SB, Isbel NM, Marlton P, Cob-croft R, Gill D, Cull G. Neutrophil dysplasia characterised by a pseudo-Pelger-Huet anomaly occurring with the use of mycophenolate mofetil and ganciclovir following renal transplantation a report of five cases. Pathology (2002) 34, 263-6. 

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