Oral antibiotics lower mycophenolate mofetil drug exposure by interfering with the enterohepatic recirculation: a case series

Abstract

Mycophenolate mofetil has an important role as immunosuppressive agent in solid organ transplant recipients. Exposure to the active mycophenolic acid (MPA) can be monitored using therapeutic drug monitoring. We present three cases in which MPA exposure severely decreased after oral antibiotic co-administration. By diminishing gut bacteria β-glucuronidase activity, oral antibiotics seem to prevent deglucuronidation of the inactive MPA-7-O-glucuronide metabolite to MPA and thereby prevent its enterohepatic recirculation. This pharmacokinetic interaction could result in rejection, which makes it clinically relevant in solid organ transplant recipients, especially when therapeutic drug monitoring frequency is low. Routine screening for this interaction, preferably supported by clinical decision support systems, is advised.

Pharmacology of drugs used in autoimmune dermatopathies in cats and dogs: A narrative review

“…omeprazole) and certain antibiotics (e.g. ciprofloxacin and amoxicillin/clavulanic acid) with MMF reduces the oral bioavailability of MMF, 145–147 yet this has not been recognised in animals.…”