SUMMARY OF SHARED CARE PROTOCOL FOR MYCOPHENOLATE MOFETIL (MMF)

Transcription

1 SUMMARY OF SHARED CARE PROTOCOL FOR MYCOPHENOLATE MOFETIL (MMF) Please refer to Chester Rheumatology shared care protocol for MMF and separate responsibilities document for full details. Responsibilities Primary care team Agree to prescribe and monitor MMF as per dose recommended by the rheumatology team. Monitor: FBC weekly until dose stable for 4 weeks then fortnightly for 2 months. Monthly once stable. Record the blood results in the shared care booklet. If there are abnormalities, get in touch with the rheumatology team Rheumatology team Confirm diagnosis and baseline tests Provision of advice line for patients and the primary care team. Patient responsibilities: To comply with the treatment, attend for monitoring and clinic appointments with the rheumatologists. Contacts (Countess of Chester Hospital) (Consultant Rheumatologists) Tel: (01244) / Fax: (01244) coc-tr.coch-rheumatology-consultants@nhs.net GP queries should be directed to the Rheumatology consultants. Emma Mulvey and Cath Brownsell (Rheumatology Specialist Nurses) Patient advice line: (01244) rheumatology.specialistnurse@nhs.net Patient queries should be directed to the Rheumatology Specialist Nurses.

2 CHESTER RHEUMATOLOGY SHARED CARE PROTOCOL FOR MYCOPHENOLATE MOFETIL (MMF) Pre-treatment assessment (under taken in rheumatology clinic) Dose Time to response Monitoring Interactions Infections Vaccinations Alcohol Pregnancy and breast feeding Malignancies FBC, U+E, LFTs. Typically 1-2g/day (maximum 3g/day). Starting dose: 500mg od for 1 st week, 500mg bd 2 nd week then increase gradually by 500mg every week until optimal or maximum tolerated dose reached, as prescribed by Always prescribe by brand as products are not bio-equivalent weeks FBC weekly until dose stable for 4 weeks then fortnightly for 2 months. Monthly once stable. Please refer to latest BNF or SPC for a full list of potential drug interactions. Antacids: containing aluminium / magnesium hydroxide reduce absorption and bioavailability of MMF. Iron: absorption of MMF reduced by oral iron. Cholestyramine: may reduce absorption of MMF. Probenecid: increases plasma concentration of MMF. Aciclovir: causes increase in concentration of MMF and aciclovir only of significance in renal impairment. It is recommended that MMF should be stopped during active infection and restarted after the infection has resolved. In patients who develop shingles or chickenpox, stop the drug and treat with aciclovir. Establish immunity to measles and chickenpox; if nonimmune and exposed to measles or chickenpox refer to rheumatology for consideration of IVIG. Pneumovax and annual flu vaccination are recommended Avoid live vaccines. Inactivated polio may be used but suboptimal response may be seen. There is no specific interaction between MMF and alcohol, however, for general health reasons <14units/week for women and <21units/week for men is recommended. Contra-indicated in pregnancy and breast feeding. Continue to use contraception for 6 weeks after stopping MMF. Possible increased risk of lymphomas due to oncogenic viruses (e.g., EBV) and skin tumours.

3 Main side effects and actions to be taken WCC < 3.5 x 10 9 /l (see below) Neutrophils <2.0 x 10 9 /l Platelets<150 x 10 9 /l Abnormal bruising with or without sore throat Nausea, vomiting, abdominal pain, diarrhoea, dyspepsia Any rapid fall or consistent downward trend in any indices Immediate FBC and withhold until result available. Monitor carefully and discuss with Contacts (Countess of Chester Hospital) (Consultant Rheumatologists) Tel: (01244) / Fax: (01244) coc-tr.coch-rheumatology-consultants@nhs.net GP queries should be directed to the Rheumatology consultants. Emma Mulvey and Cath Brownsell (Rheumatology Specialist Nurses) Patient advice line: (01244) rheumatology.specialistnurse@nhs.net Patient queries should be directed to the Rheumatology Specialist Nurses.

4 CHESTER RHEUMATOLOGY PATIENT S DRUG INFORMATION SHEET ON MYCOPHENOLATE MOFETIL (MMF) WHAT DOES MMF LOOK LIKE? MMF is supplied as 250mg capsules or 500mg tablets. It is also available as a suspension. HOW DOES MMF WORK? MMF is used in the treatment of several different types of rheumatic disease, including systemic lupus erythematosus (SLE) and diseases in which there is inflammation of blood vessels ('vasculitis'). MMF reduces the activity of the body's immune system (the body's own defence system), to reduce inflammation caused by these conditions. HOW SHOULD MMF BE TAKEN? It is usually taken in capsule form twice a day. The capsules should be taken with a glass of water. Do not crush or chew the capsules. They should be swallowed whole. If you forget to take a dose, miss the dose out and take your next dose at the normal time. Do not double up the next dose. It does not work straight away and may take up to 3 months before you notice any benefit. WHAT ARE THE POSSIBLE RISKS OR SIDE EFFECTS? The most common side-effects of MMF are sickness, diarrhoea, vomiting or stomach pain. It can also affect your blood count (one of the effects is that fewer blood cells are made) and can make you more likely to develop infections. If you develop a sore throat or other infection, a fever, unexplained bruising or bleeding or if you develop any other unexpected new symptoms after starting MMF, you should report to your doctor or rheumatology nurse specialist immediately. If any of these symptoms are severe, you should stop the MMF. If you have a moderate or severe infection requiring antibiotic therapy you should withhold the MMF until the infection has been treated. If you have not had chickenpox or measles but come into contact with someone who has chickenpox/ shingles or measles, or if you develop chickenpox/ shingles or measles, you should stop MMF and see your doctor immediately as you may need special treatment. There is a small increase in risk of skin cancer with MMF so you should avoid exposure to strong sunlight and protect your skin with sunblock or sunscreen. Rarely, people may be allergic to MMF. If this is the case with you, the drug will have to be stopped. Symptoms of allergy include rash, wheezing, shortness of breath, and swelling of the face, lips, tongue or throat.

5 DO I NEED ANY REGULAR BLOOD TESTS? You will need to have a blood test before you start treatment and then regular blood checks while on MMF. This is very important. You will be asked to keep a record booklet with your blood test results. Bring this with you when you visit your general practitioner or the hospital. You must not take MMF unless you are having regular checks. CAN I DRINK ALCOHOL? You should not drink any more than the NHS recommended guidelines which is 14 units of alcohol per week for women and 21 units of alcohol for men. ARE THERE ANY MEDICINES I SHOULD NOT TAKE? You may take other medicines that your GP prescribes for you or that you buy from the chemist. However, some drugs interact with MMF so always remind your doctor that you are taking MMF and always tell the pharmacist before you buy any medicines or herbal remedies. MMF is not a painkiller, so you may need to continue to take painkillers, unless your doctor advises otherwise. CAN I HAVE IMMUNISATIONS WHILST ON MMF? Pneumovax and yearly flu vaccines are safe and recommended. It is recommended that you should not be immunised with 'live' vaccines such as yellow fever. However, in certain situations a live vaccine may be necessary (for example rubella immunisation in women of childbearing age), in which case your doctor will discuss the possible risks and benefits of the immunisation with you. PREGNANCY AND BREAST FEEDING You should not take MMF whilst pregnant and you should not become pregnant for 6 weeks after stopping MMF. If you are planning a family or if you become pregnant on MMF, you should discuss this with your doctor as soon as possible. You should not breast feed whilst on MMF as the drug could pass through to the baby. KEEP ALL MEDICINES OUT OF THE REACH OF CHILDREN