Amoxicillin; Clavulanate with Mycophenolate Mofetil Interaction Details
Brand Names Associated with Mycophenolate Mofetil
- CellCept®
- Mycophenolate
- Myfortic®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 15, 2023
Interaction Effect
Decreased mycophenolic acid plasma exposure
Interaction Summary
Median trough mycophenolic acid (MPA; active metabolite of mycophenolate mofetil) concentration was reduced by about 50% from baseline at 3 days after introduction of amoxicillin/clavulanic acid. The reduction in exposure diminished within 14 days of antimicrobial therapy and ceased within 3 days of discontinuation of the antibiotic. When coadministration of mycophenolate mofetil plus amoxicillin/clavulanic acid is required, monitor patients for alterations in efficacy or mycophenolate mofetil-related adverse reactions. Obtaining MPA plasma levels before and after the initiation or discontinuation of concomitant medications may be necessary to ensure MPA levels remain stable.
Severity
Major
Onset
Rapid
Evidence
Established
How To Manage Interaction
Concomitant use of amoxicillin/clavulanic acid and mycophenolic acid (MPA) may lead to decreased exposure to the active metabolite mycophenolic acid and decreased efficacy of mycophenolate mofetil. When such coadministration is required, monitor patients for alterations in efficacy or mycophenolate mofetil-related adverse reactions. Obtaining MPA plasma levels before and after the initiation or discontinuation of concomitant medications may be necessary to ensure MPA levels remain stable.
Mechanism Of Interaction
Inhibition of enterohepatic recirculation of mycophenolic acid by amoxicillin/clavulanic acid
Literature Reports
A) In a study of kidney transplant recipients (N=64), ciprofloxacin 500 mg orally twice daily and amoxicillin with clavulanic acid 375 mg 3 times daily were administered to two groups of patients (group 1 received 7 days of antibiotics; group 2 received at least 14 days of antibiotics). There was a significant decrease in MPA levels in both groups within 3 days of starting antibiotics (median day 3 level, 46% to 48% of baseline) with no further decrease in MPA level by day 7. In group 1, levels returned to normal 3 days after the completion of antibiotic therapy; in group 2, MPA levels on day 14 were significantly higher than on day 3 or day 7 (median day 14 level, 79% of baseline). No dosage adjustments of mycophenolate mofetil were done in either group. There was no significant difference in the effect on MPA levels between ciprofloxacin or amoxicillin with clavulanic acid. There were no deaths, graft losses, acute rejection episodes, or gastrointestinal adverse effects during antibiotic therapy .
Mycophenolate Mofetil Overview
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Mycophenolate (CellCept) is used with other medications to help prevent transplant organ rejection (attack of the transplanted organ by the immune system of the person receiving the organ) in adults and children 3 months of age and older who have received kidney, heart, or liver transplants. Mycophenolate (Myfortic) is used with other medications to help prevent the body from rejecting kidney transplants in adults and children 5 years of age and older. Mycophenolate is in a class of medications called immunosuppressive agents. It works by weakening the body's immune system so it will not attack and reject the transplanted organ.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
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Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
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