Myfortic: what are the precautions during use? Does SUS provide?

Drugs or non-surgical treatments are not always available for some conditions. Sometimes, it is necessary to resort to transplants to obtain a cure or a good quality of life. This is the case for people with advanced chronic kidney disease who need to have a kidney transplant.

The procedure, while bringing hope to people, involves a process that is not always easy. And that already starts in the queue.

According to data from the Brazilian Transplantation Registry (RBT), between January and September 2019, a total of 4617 kidney transplants were performed, with 799 donations from living people and another 3,818 from deceased people.

Although donation rates have, in general, grown gradually, the numbers are still low in relation to the size of the queue.

After obtaining a donation, the transplanted person needs to maintain medical care and monitoring, especially to reduce the risk of organ rejection.

Among the drugs that can be used in these cases is Novartis’ Myfortic. Learn more about its action and indications:


What is Myfortic?

Myfortic is a medicine for oral use, presented in coated tablets, which is part of the drug class of immunosuppressants, indicated for people undergoing kidney transplantation.

Immunosuppressants work by reducing the body’s reactions to foreign bodies or agents. As the body understands the transplanted organ as a foreign element, there is a tendency for a combat response to occur.

This action can be immediate or later, that is, shortly after surgery or years later. However, the use of immunosuppressive drugs is necessary indefinitely, with the adjustment of doses, change of medication and continuity of use at medical discretion.

Myfortic is the reference medicine, being manufactured by the pharmaceutical company Novartis. Currently, there are two tablet presentations, namely:

  • 180mg: containing 180mg of mycophenolic acid equivalent to 192.4mg of mycophenolate sodium. And the excipients starch, povidone, crospovidone, lactose, silicon dioxide, magnesium stearate, hypromellose phthalate, titanium dioxide, yellow ferric oxide and indigotine.
  • 360mg: with 360mg of mycophenolic acid equivalent to 384.8mg of mycophenolate sodium. In addition to the excipients starch, povidone, crospovidone, lactose, silicon dioxide, magnesium stearate, hypromellose phthalate, titanium dioxide, yellow ferric oxide and red ferric oxide.

What are immunosuppressive drugs?

The immune system is responsible for protecting the body, fighting foreign agents and possibly harmful to health. When a person undergoes a transplant of organs or tissues, the organism identifies those cells as external, initiating mechanisms to fight them.

There are, in general, 3 types of rejection, being the hyperacute (immediate to the transplant, which can still occur during surgery), the acute (when it occurs weeks or months after the transplant) and the chronic (rejection that progresses slowly, manifesting itself years after transplant).

The risk of rejection is that it damages the transplanted organ, putting the person’s health and life at risk.

In such cases, drugs called immunosuppressants are used. They reduce the body’s responses to foreign agents, preventing defense cells from rejecting the new organ. However, this drop in the immune response increases the risk of infections, as it affects the immune system in general.

In addition to transplantation, immunosuppressive drugs can be used in other health conditions, such as multiple sclerosis, for example.

Initially, in the first days after the transplant, the dosages tend to be higher, but as time goes by, if the medical team deems it possible or necessary, there is a reduction in dosage or adaptation of the medication (maintenance immunosuppression).

This ensures that the body is less vulnerable to the adverse effects of immunosuppressants or to potentially harmful external agents, such as viruses and bacteria.

What is Myfortic for?

Myfortic is an immunosuppressant indicated to reduce the risk of rejection of the transplanted kidney. Its use must be associated with other drugs containing cyclosporine and corticosteroids, which are other drugs to reduce or reverse a transplant rejection.

The combination of substances aims to find a less aggressive and harmful way to the body, aiming to reduce adverse effects. Thus, it is used to block immune activation by different mechanisms of action, making it safer and more effective.

This also allows it to be possible to reduce the quantity of each medication, moving away from the toxicity limit, both immediately after the transplant and in maintenance therapy.

Mycophenolate sodium and mycophenolate mofetil

Mycophenolate sodium is very similar to the substance mycophenolate mofetil, being used for medical treatments according to the indication of professionals.

Both, after being absorbed, are quickly converted to mycophenolic acid in the liver.

However, it is up to the medical team to assess which drug is most appropriate, and there can be no substitution of substances without indication from specialists.

After conversion, mycophenolic acid selectively inhibits the synthesis of purine (which are cellular components). This causes a specific inhibition of T and B cells, related to immunity and, therefore, to organ rejection.

What is sodium mycophenolate coated or gastro-resistant?

Mycophenolate sodium is the pre-active substance in Myfortic. The coating or gastroresistance makes the medicine pass through the stomach intact, resisting the action of stomach juice, and is released in the small intestine.

How does the package insert indicate using Myarttic from Novartis?

Myfortic is a coated tablet, made to resist the action of stomach juice and reach the intestine, where it will be released. So it is very important that the pills are not broken or broken. Nor should you eat those that are crushed, broken or fragmented.

The medicine should be taken with water and on an empty stomach, 1 hour before eating or at least 2 hours after a meal.

As for the dosage, the package insert indicates the daily dose of 1440mg, taken in 2 separate doses. Thus, it is 720mg in the morning and 720mg at night. However, who is going to define exactly the dosage and the times of ingestion of the medication is the doctor in charge.

In general, the first administration of Myfortic should occur within the first 48 hours after transplantation.

Necessary care during and after using Myfortic

The use of Myfortic should be prescribed by professionals specialized in transplants and with knowledge of the clinical condition of the person being treated.

After starting use, patients should report any symptoms or occurrences to the medical team. In addition, the package insert points out some conditions that deserve attention, namely:

Avoid or reduce sun exposure

Myfortic can increase the risk of skin cancer as it works by reducing the body’s defenses. So it is very important to use features that protect your skin from UV rays.

Specific sun protection clothes, high SPF protectors and keeping out of sunlight are some of the measures that must be adopted.

Perform periodic checkups for Hepatitis and other infections

People who have already had hepatitis B or C with the use of Myfortic are at greater risk of re-manifesting the infection. Therefore, periodic examinations and attention to the manifestation of symptoms are fundamental measures.

Seek medical advice before vaccines and medications

It is necessary to inform the doctor about any need to take vaccines, as well as any medication, especially:

  • Azathioprine or any other immunosuppressive medication;
  • Cholestyramine (medicine used to treat high blood cholesterol levels);
  • Acyclovir (medicine used to treat herpes);
  • Antacids containing magnesium and aluminum;
  • Ganciclovir (medicine used to treat cytomegalovirus infection);
  • Oral contraceptives.

Use contraceptive methods

Men and women who are fertile and at risk of pregnancy should use contraception while using Myfortic. Women, in general, are instructed to use contraceptives before and during treatment with the drug, continuing for 6 weeks after stopping Myfortic.

Men need to use condoms during treatment and for an additional 13 weeks after completion of use. In addition, your partners must also protect themselves for the same period.

What are the side effects of Myfortic?

Any medication can trigger adverse effects, but that will not necessarily occur in all people being treated. In addition, their frequency and intensity can be quite variable, according to the responses and adaptation of the organism.

When presenting any collateral symptoms, it is necessary to communicate to the doctor or physician accompanying the treatment.

In the package insert, the adverse reactions indicated as the most common to occur are:

  • Low level of white blood cells;
  • Reduced calcium level in the blood, sometimes with colic (hypocalcaemia);
  • Muscle weakness, muscle spasms, abnormal heart rhythm (which may be related to hypokalemia);
  • High level of uric acid in the blood (hyperuricemia);
  • Headache, dizziness (may be manifestations due to increased blood pressure);
  • Dizziness, delirium (may be related to the drop in blood pressure);
  • Diarrhea.

In addition, other treatment-related adverse reactions may occur, which are listed as common symptoms and occur between 1% and 10% of people on medication:

  • Hemorrhage or bruising more easily than normal (signs of low platelets in the blood);
  • Muscle spasms, abnormal heart rhythm (may be related to a high level of potassium in the blood);
  • Low level of magnesium in the blood (hypomagnesemia);
  • Anxiety symptoms;
  • Dizziness;
  • Headache;
  • Cough;
  • Severe symptoms of high blood pressure (worsening hypertension);
  • Shortness of breath, shortness of breath (possible symptoms of dyspnoea or dyspnea on exertion);
  • Pain (for example, in the abdomen, stomach);
  • Cold;
  • Indigestion;
  • Flatulence
  • Soft stools;
  • Sickness;
  • Vomiting;
  • Tiredness;
  • Fever;
  • Abnormal results on the liver or kidney function test;
  • Joint pain (arthralgia);
  • Weakness (asthenia);
  • Muscle pain (myalgia);
  • Swelling in the hands, ankles or feet (possible symptoms of peripheral edema).

Price: where to buy Myfortic cheaper?

People with a medical indication for using Myfortic , from Novartis, can turn to special physical pharmacies and also online pharmacies to compare prices and find the best deals.

On average, Myfortic 360mg, box with 120 coated tablets , is priced between R $ 2190 and R $ 2700 *.

The 180mg dosage , box with 120 coated tablets , can vary between R $ 1090 and R $ 1400 *.

* Average prices consulted in December 2019. Prices may change.

Does SUS provide mycophenolate sodium?

Yes. Mycophenolate sodium is part of RENAME 2020, the National List of Essential Medicines, being provided through the Specialized Component of Pharmaceutical Assistance (CEAF) for patients who meet the criteria for assistance.

Thus, the process for obtaining the medication, after the medical indication is, in theory, easier.

However, if the medication is not available in the SUS or any other difficulty in obtaining the medication, it is recommended that a legal process be opened for the cost of treatment.

Thus, patients can count on the advice of quotation of high-cost drugs, from Consulta Remédios.

As the judicial route requires the submission of quotes from 3 different pharmacies, the budget team can assist in this survey, in a quick and personalized way.

To do this, simply access the link and fill out the form.

Kidney transplantation is indicated for people who suffer from advanced chronic kidney disease. The organ can be donated by both living and deceased people. In the latter case, brain death and the permission of family members of the deceased must be noted.

When transplantation is successful, in relation to non-transplanted people, the Brazilian Society of Nephrology indicates that patients who receive the kidney have a higher survival rate, in addition to a better quality of life.

Despite this, it is necessary that medications be taken indefinitely, usually for life. The goal is to keep drug dosages as low as possible, so that the adverse effects of immunosuppression are as small as possible.

Among these drugs is Myfortic, from Novartis, used in combination with other substances.

To learn more about kidney health, transplants and medications, follow the Healthy Minute and keep an eye on the information!