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Mycophenolate induced diarrhoea
Ashwinikumar Aiyangar1, Prashant Rajput, Bharat V Shah
1Lilavati Hospital, Mumbai.
The Journal of the Association of Physicians of India
|September 21, 2010
Summary
Mycophenolate mofetil (MMF) can cause chronic diarrhea, potentially due to low inosine monophosphate dehydrogenase (IMPDH) enzyme levels. Discontinuing MMF and adding folic acid improved symptoms in patients, suggesting a link between MMF and gastrointestinal issues.
Area of Science:
- Immunology
- Pharmacology
- Gastroenterology
Background:
- Mycophenolate mofetil (MMF) is a key immunosuppressant.
- Gastrointestinal disturbances, particularly diarrhea, and bone marrow suppression are primary MMF side effects.
- The exact mechanism of MMF-induced diarrhea remains unclear.
Observation:
- Three patients on MMF presented with chronic diarrhea.
- Diagnostic evaluations included complete blood count, stool analysis, cultures, endoscopy, and biopsy.
- Histopathology revealed villous atrophy in all three patients.
Findings:
- Discontinuation of MMF and supplementation with folic acid led to symptom resolution.
- This suggests a direct relationship between MMF use and the observed diarrhea.
- The complication's rarity may indicate a genetic predisposition, possibly linked to lower inosine monophosphate dehydrogenase (IMPDH) enzyme levels.
Implications:
- MMF-induced diarrhea might be linked to the drug's mechanism of action involving IMPDH.
- Lower IMPDH levels could predispose individuals to this specific side effect.
- This finding warrants further investigation into genetic factors influencing MMF tolerance and adverse effects.
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