title: Is a standard fixed dose of mycophenolate mofetil ideal for all patients?
abstract: BACKGROUND
  A standard fixed dose of 2 g/day of mycophenolate mofetil (MMF), irrespective of total body weight (TBW), is recommended when used in combination with cyclosporine and corticosteroids in renal transplantation.
  
  
  METHODS
  To determine the optimal MMF dose in a population with wide variation in TBW, steady-state pharmacokinetics of mycophenolic acid (MPA) was performed in 53 Asian (Chinese, Malay, Indian, Eurasian) renal transplant recipients (RTX) receiving MMF [250-1000 mg twice daily (BD)] for at least 3 months. Blood samples were collected at 0, 0.5, 1, 1.5, 2 and 6 h after the MMF dose and total MPA quantified using HPLC.
  
  
  RESULTS
  Drug exposure, as evaluated by AUC(ss, 0-12), demonstrated a significant positive correlation with TBW-adjusted MMF dose (outliers omitted: r(2) = 0.49, P < 0.0005). An AUC(ss, 0-12) of 45 mg h/l could be attained with an MMF dose of 12 mg/kg BD.
  
  
  CONCLUSIONS
  This study proposes that MMF should be dosed based on TBW rather than a fixed dose regimen in RTX.
authors.affiliation: Department of Pharmacy, Faculty of Science, National University of Singapore, 18 Science Drive 4, Singapore 117543, Republic of Singapore.
authors.forename: Wai-Ping
authors.initials: WP
authors.lastname: Yau
authors.forename: Anantharaman
authors.initials: A
authors.lastname: Vathsala
authors.forename: Huei-Xin
authors.initials: HX
authors.lastname: Lou
authors.forename: Eli
authors.initials: E
authors.lastname: Chan
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D044466:Asian People; D001835:Body Weight; D016572:Cyclosporine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D016030:Kidney Transplantation; D008297:Male; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D011446:Prospective Studies
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid