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마이코페놀레이트 모페틸

Mycophenolate Mofetil

Mycophenolate mofetil (RS-61443)

면역억제제POIV개고양이

다른 이름: CellCept · Cellmune · Imuxgen · Munotras · Mycept · Myfortic · Refrat · RS-61443 · MMF · Mycophenolic acid (active metabolite) · MPA

VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료

12-17 mg/kg PO once daily or divided twice dailyPO· q12-24h
— 🐕

용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.

동물 종별 용량

🌎 NA — North America🌍 EU — Europe

개

적응증용량경로빈도기간지역
Immune-mediated hemolytic anemia (IMHA)12-17 mg/kg PO once daily or divided twice dailyPOq12-24h—🌎 NA
IMHA, myasthenia gravis or glomerulonephritis12-17 mg/kg PO once daily or divided twice dailyPOq12-24h—🌎 NA
Immune-mediated hemolytic anemia (IMHA)400-600 mg/m2 orally twice dailyPOq12h—🌎 NA
Adjunctive treatment of glomerulonephritis10-20 mg/kg PO q12hPOq12h3-4 weeks trial🌎 NA
Pemphigus foliaceous22-39 mg/kg/day divided into 3 daily dosesPOq8h—🌎 NA
Pemphigus foliaceous20-40 mg/kg/day PO divided q8hPOq8h—🌎 NA
Aplastic anemia10 mg/kg PO q12hPOq12h—🌎 NA
Rescue agent for generalized myasthenia gravis500 mg (15-20 mg/kg) diluted and given IV over 2-4 hoursIVq24h13 days🌎 NA
  • Immune-mediated hemolytic anemia (IMHA): Given with prednisolone (at 2 mg/kg q12-24h). Dogs also received ranitidine and sucralfate in the study.
  • IMHA, myasthenia gravis or glomerulonephritis: Given with prednisone (at 2.2 mg/kg q12-24h).
  • Immune-mediated hemolytic anemia (IMHA): Extrapolated from human medicine. Gastrointestinal side effects are common and dose limiting.
  • Adjunctive treatment of glomerulonephritis: Trial of single drug therapy for 3-4 weeks recommended.
  • Pemphigus foliaceous: Success rates of approx 50%; most dogs require glucocorticoids to control signs.
  • Pemphigus foliaceous: Steroid-sparing only.
  • Aplastic anemia: First effects observed 2 weeks later; complete remission in approx 3 weeks.
  • Rescue agent for generalized myasthenia gravis: Given daily IV until swallowing oral meds, then switched to 10-11 mg/kg PO q12h.

고양이

적응증용량경로빈도기간지역
IMHA10 mg/kg PO q12hPOq12h—🌎 NA
  • IMHA: Use with caution due to feline glucuronidation deficiency.

용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.

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개요

​마이코페놀레이트 모페틸(MMF)​은 강력한 ​면역억제제​로, 수의학에서 스테로이드 절약제 또는 중증 난치성 면역 매개 질환의 구제 요법으로 점점 더 많이 사용되고 있습니다.

주요 임상 적용 분야:

  • ​면역 매개성 용혈성 빈혈(IMHA)​
  • ​사구체신염​
  • ​중증 근무력증​
  • ​낙엽성 천포창​
  • 장기 이식 거부 반응 억제 프로토콜

염증성 장질환(IBD)에 대한 사용이 제안되기도 했으나, 개에서 이 약물의 주요 부작용이 위장관 증상(위염, 설사, 장염)이기 때문에 사용이 까다롭습니다. ​임상 팁:​ MMF는 작용 발현이 비교적 빠르기 때문에 일부 위급한 환자에서 아자티오프린보다 선호되는 경우가 많지만, 높은 비용과 심각한 위장관 부작용이 제한 요인이 될 수 있습니다. 고양이에서의 사용 경험은 매우 제한적이며, 고양이는 글루쿠론산 포합 대사 경로가 결핍되어 있으므로 극도로 주의하여 사용해야 합니다.

작용 기전

​Mycophenolate mofetil (MMF)​ is a prodrug that is rapidly hydrolyzed in vivo to its active form, ​mycophenolic acid (MPA)​.

  • MPA non-competitively and reversibly inhibits ​inosine monophosphate dehydrogenase (IMPDH)​.
  • IMPDH is the rate-limiting enzyme in the de novo synthesis of guanosine nucleotides.
  • Because T-lymphocytes and B-lymphocytes are highly dependent on this de novo purine synthesis pathway (and lack the purine salvage pathways utilized by other cell types), MPA selectively inhibits their proliferative responses.
  • This leads to → suppression of B-cell antibody formation and → inhibition of leukocyte recruitment to inflammatory sites and allotransplant tissues.

안전성·주의사항

금기사항

  • Documented hypersensitivity to mycophenolate
  • Pregnancy (teratogenic effects noted in animal models)
  • Caution in patients with severe renal dysfunction (dosage adjustment may be required)
  • Caution in cats (deficient in glucuronidation metabolism)
  • Pre-existing bone marrow suppression
  • Pre-existing infections

부작용

  • Diarrhea (can be severe)
  • Vomiting
  • Anorexia
  • Lethargy / reduced activity
  • Weight loss
  • Lymphopenia
  • Increased rates of dermal infections
  • Increased susceptibility to systemic infections
  • Potential increased risk of malignancy/lymphoma
  • Bone marrow suppression
  • Nausea
  • Diarrhoea
  • Increased incidence of infections (e.g., pyoderma, Malassezia)
  • Increased risk of lymphoma (reported in humans)
  • Headache (reported in humans)
  • Hypertension (reported in humans)
  • Peripheral oedema (reported in humans)
  • Confusion (reported in humans)
  • Coughs (reported in humans)
  • Tremors (reported in humans)

주의

​Black Box Warning:​ In humans, mycophenolate carries a warning regarding a potential increased risk for lymphoma and susceptibility to infections associated with its use.

  • ​Intravenous Administration:​ Must be administered over at least two hours. ​Do NOT give as an IV bolus or via rapid IV infusion.​
  • ​Feline Patients:​ The active metabolite (MPA) is primarily excreted as a glucuronide metabolite. Cats are deficient in this metabolic process; use with extreme caution.
  • ​Pregnancy:​ Teratogenic (increased resorptions and malformations). Avoid use during pregnancy.
  • ​Handling:​ Due to teratogenic risks, tablets or capsules should not be crushed, split, or opened. Personnel and owners should wear gloves when handling.

약물 상호작용

Acyclovir

Increased serum concentrations of acyclovir and the phenolic glucuronide of mycophenolic acid

Antacids (aluminum or magnesium containing)

Decreased absorption of mycophenolate; separate dosing by at least 2 hours

Aspirin (or other salicylates)

Potentially increased concentrations of free mycophenolic acid

Azathioprine

Increased risk for bone marrow suppression; use together not recommended in humans

Iron (oral)

Decreased absorption of mycophenolate; separate dosing by at least 2 hours

Probenecid

Potentially increased serum levels of mycophenolic acid and the phenolic glucuronide of mycophenolic acid

Vaccines (live virus)

May be less effective; avoid use

Drugs undergoing active renal tubular secretionModerate

Competes for secretion, resulting in increased concentrations of either drug

Antacids (e.g., omeprazole)Moderate

Concomitant administration may decrease the absorption of mycophenolate

모니터링

  • Clinical efficacy (resolution of immune-mediated disease signs)
  • Complete Blood Count (CBC) for bone marrow suppression
  • Renal and hepatic function panels
  • Serum electrolytes
  • Gastrointestinal effects (monitor weight, appetite, and client reports of vomiting/diarrhea)
  • Complete Blood Count (CBC) to monitor for bone marrow suppression
  • Gastrointestinal signs (nausea, vomiting, diarrhea)
  • Signs of secondary infections (e.g., skin lesions, lethargy, fever)

약동학

반감기

개~8 hours (±4 hours)

흡수

Absorbed orally but with wide inter-patient and inter-dose variation. Bioavailability in dogs ranges from 54-87%. In humans, oral bioavailability averages 94%, but food reduces peak levels of MPA by up to 40%.

분포

Volume of distribution at steady-state in dogs is approximately 5 L/kg, with wide inter-patient variability (±4.5).

대사

Rapidly hydrolyzed in vivo to the active form, mycophenolic acid (MPA). MPA is primarily metabolized via glucuronidation (cats are deficient in this pathway).

배설

Primarily excreted in the urine, both unchanged (approx. 5%) and as the glucuronide metabolite (approx. 90%).

과다투여

In oral acute studies performed in mice and monkeys, no deaths occurred in dosages up to 4,000 mg/kg and 1,000 mg/kg, respectively. In small animals, acute gastrointestinal disturbances (severe vomiting, diarrhea) could be expected. Treatment should be symptomatic and supportive.

제품

제형

  • Oral capsules
  • Oral tablets
  • Lyophilized powder for injection
  • 250 mg capsule
  • 500 mg tablet
  • 1 g/5 ml powder for oral suspension
  • 180 mg tablet
  • 360 mg tablet
  • 500 mg powder for reconstitution and slow i.v. infusion

인용의약품

  • Mycophenolate Mofetil Oral Capsules: 250 mg (CellCept®)
  • Mycophenolate Mofetil Oral Tablets: 500 mg (CellCept®)
  • Mycophenolate Mofetil Powder for Oral Suspension: 200 mg/mL (reconstituted) (CellCept®)
  • Mycophenolate Mofetil Lyophilized Powder for Injection: 500 mg in 20 mL vials (CellCept®)
  • CellCept (250 mg capsule, 500 mg tablet, 1 g/5 ml oral suspension)
  • Myfortic (180 mg, 360 mg tablets)
  • 500 mg powder for injection

규제 현황

European Union✓ 승인됨처방전의약품EMA

Human-approved product used off-label in veterinary medicine under the cascade. POM status.

United Kingdom✓ 승인됨처방전의약품VMD

Human-approved product used off-label in veterinary medicine under the cascade. POM status.

규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU

보관·안정성

Tablets and capsules: Store between 15-30°C and protect from light. Oral suspension: Store powder between 15-30°C. Once reconstituted, store at room temperature or refrigerate (do not freeze); discard unused portion after 60 days. Injectable: Store between 15-30°C. Reconstitute with 5% dextrose. Do not mix with other medications. Administer within 6 hours of dilution.

보호자 정보

  • ​투여 방법:​ 가급적 빈속에 투여하십시오. 그러나 구토나 식욕 부진이 발생하면 음식과 함께 투여하여 내성이 개선되는지 확인해 볼 수 있습니다.
  • ​취급 주의사항:​ 이 약물은 선천적 결함을 유발할 수 있으므로 ​캡슐이나 정제를 부수거나 쪼개거나 열지 마십시오​. 임산부는 이 약물의 취급을 피해야 합니다. 투여 후에는 손을 깨끗이 씻으십시오.
  • ​부작용:​ 위장관 장애가 가장 흔한 부작용입니다. ​설사가 지속되거나 심해지거나 반려동물이 먹이를 먹지 않으면 즉시 수의사에게 연락하십시오.​
  • ​감염 위험:​ 이 약물은 면역 체계를 억제합니다. 반려동물을 아픈 동물과 격리하고, 감염 징후(무기력, 발열, 새로운 피부 병변)가 보이면 수의사에게 알리십시오.

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