Colesevelam and Mycophenolate Mofetil: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Colesevelam
Mycophenolate Mofetil
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Reduced exposure of mycophenolic acid (MPA) and reduced efficacy of mycophenolate mofetil
Interaction Deep Dive
Exposure to mycophenolate mofetil may be reduced with concomitant administration of a bile acid sequestrant (BAS). The AUC of mycophenolic acid (MPA), the active metabolite of mycophenolate mofetil, was decreased by about 40% with a single dose of mycophenolate mofetil 1.5 g after being pretreated with cholestyramine 4 g 3 times daily for 4 days. This decrease was consistent with interruption of enterohepatic recirculation, possibly due to intestinal binding by cholestyramine of recirculating MPAG (an inactive metabolite that is reconverted to MPA). Monitor patients for alterations in efficacy or mycophenolate mofetil-related adverse effects when these drugs are coadministered. Obtaining MPA plasma levels before and after the initiation or discontinuation of concomitant medications may be necessary to ensure MPA levels remain stable12.
Why it happens (mechanism)
Interference with enterohepatic recirculation of mycophenolic acid, by altering the gastrointestinal flora
Literature reports
1 report — tap to read
a) The AUC of mycophenolic acid (MPA) was decreased by about 40% during a study in 12 healthy volunteers who received a single dose of mycophenolate mofetil 1.5 g after being pretreated with cholestyramine 4 g 3 times daily for 4 days 1.
Common questions
Can I take Colesevelam and Mycophenolate Mofetil together?
Reduced exposure of mycophenolic acid (MPA) and reduced efficacy of mycophenolate mofetil Always confirm with your pharmacist or prescriber before making any change.
How serious is the Colesevelam and Mycophenolate Mofetil interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Colesevelam or Mycophenolate Mofetil need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (2)
- Product Information: CELLCEPT(R) oral capsules, oral tablets, oral suspension, intravenous injection, mycophenolate mofetil oral capsules, oral tablets, oral suspension, intravenous injection. Genentech USA Inc (per FDA), South San Francisco, CA, 2022. DailyMed
- Product Information: MYHIBBIN oral suspension, mycophenolate mofetil oral suspension. Azurity Pharmaceuticals, Inc.(per Manufacturer), Woburn, MA, 2024. DailyMed
Keep reading about Colesevelam
Keep reading about Mycophenolate Mofetil
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