Saturday, June 3, 2017

Upping my CellCept Dose, Some Information I Found Interesting

In my last Clinic Update, I mentioned that the team increased my immunosuppressent medications.  I now take 1750 mg of CellCept and 1.5 mg of Prograf twice/day.  That's the highest dose of CellCept I've been on.

We also agreed to reduce my Protonix (a PPI) from 40 to 20 mg/day.

Since I'm on this high a dose of CellCept, I spent some time last night going back over dosing recommendations and side effects of the med.

One of the side effects that I knew about, and the reason I take the Protonix, is the damage that the med can do to my digestive system:
Because CellCept has been associated with an increased incidence of digestive system adverse events, including infrequent cases of gastrointestinal tract ulceration, hemorrhage, and perforation,
One thing I learned last night, that I don't remember reading when I studied CellCept in the past, is that PPI's  have a negative effect on the efficiency of CellCept:
Proton Pump Inhibitors (PPIs) Coadministration of PPIs (e.g., lansoprazole, pantoprazole) in single doses to healthy volunteers and multiple doses to transplant patients receiving CellCept has been reported to reduce the exposure to mycophenolic acid (MPA). An approximate reduction of 30 to 70% in the Cmax and 25% to 35% in the AUC of MPA has been observed, possibly due to a decrease in MPA solubility at an increased gastric pH. The clinical impact of reduced MPA exposure on organ rejection has not been established in transplant patients receiving PPIs and CellCept. Because clinical relevance has not been established, PPIsshould be used with caution when coadministered to transplant patients being treated with CellCept
Basically MPA is the active metabolite that does the work of suppressing my immune system.

So... we've increased my dose of CellCept, and reduced my PPI.  My labs next week are going to be interesting.

I'm glad we are doing this at this time of year, less viruses spreading in the wild so safer for me to be out and about.

The above information was taken from the CellCept prescribing literature.

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