Selective immunosuppressant – inosine monophosphate dehydrogenase inhibitor
ATC code: L04AA06 (Mycophenolate mofetil)
Brand names
CellCept, Myfortic, Micofenolato Cinfa
A prodrug hydrolyzed to active mycophenolic acid. A selective reversible inhibitor of inosine monophosphate dehydrogenase (IMPDH) – the key enzyme in de novo guanine nucleotide synthesis. T- and B-cells depend on the de novo pathway (no salvage pathway), so IMPDH inhibition selectively suppresses their proliferation. Used with tacrolimus or cyclosporine and steroids.
First line
First-line in triple immunosuppression after kidney, heart, liver transplantation per ESOT 2024. Dose 1–1.5 g twice daily. Compared with azathioprine, better control of acute rejection and long-term graft survival (RPCG, ETPS).
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Mycophenolate mofetil is an antimetabolite immunosuppressant. It is prescribed to prevent organ transplant rejection and for severe autoimmune diseases (systemic lupus erythematosus, vasculitis) when other drugs are ineffective (AEMPS Ficha Técnica). In alt-anti-aging circles, mycophenolate mofetil is occasionally promoted as a selective immunosuppressant to slow immune aging. In healthy adults, no clinical studies of such use exist. The drug has serious risks: myelosuppression (neutropenia, lymphopenia, anemia), GI disturbances (severe diarrhea in 30% of patients), opportunistic infections, increased lymphoma and other malignancy risk, and significant teratogenicity ( boxed warning, mandatory contraception). If mycophenolate mofetil was recommended to a healthy person, seek a second opinion immediately.
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Boxed warning
FDA boxed warning: embryo-fetal toxicity (marked teratogenicity – cleft lip/palate, ear and cardiac defects; T1 spontaneous abortion risk up to 45%); increased risk of malignancies (especially lymphoma and skin); increased risk of serious infections.
Absolute contraindication. Women of reproductive age: two contraception forms from 4 weeks before start, during therapy, and 6 weeks after. Men: barrier contraception during therapy and 90 days after.
Contraindicated during lactation.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Mycophenolate mofetil is evaluated for the following indications with varying evidence strength: Organ transplant rejection prevention (evidence tier A), Anti-aging and longevity (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Mycophenolate mofetil (≥ 1 in 100): Nausea and vomiting, Diarrhea, Leukopenia and thrombocytopenia, Anemia, Infections (especially CMV, herpes zoster), Abdominal pain. See the Safety section for uncommon and serious reactions.
FDA category D. Absolute contraindication. Women of reproductive age: two contraception forms from 4 weeks before start, during therapy, and 6 weeks after. Men: barrier contraception during therapy and 90 days after.
Contraindicated during lactation.
Mycophenolate mofetil is contraindicated in: Mycophenolate hypersensitivity; Pregnancy – absolute contraindication; Active infections; Lactation. Full list in the Safety section.
FDA boxed warning: embryo-fetal toxicity (marked teratogenicity – cleft lip/palate, ear and cardiac defects; T1 spontaneous abortion risk up to 45%); increased risk of malignancies (especially lymphoma and skin); increased risk of serious infections.