(FDA approved in bold)

• Prophylaxis of organ rejection in patients with allogenic renal, cardiac or hepatic transplants
  
• Myasthenia gravis (MG)
  
• Refractory uveitis
  
• Churg-Straus syndrome
  
• Diffuse proliferative lupus nephritis
  
• Psoriasis

• Prodrug that is actively metabolized to mycophenolic acid, a selective inhibitor of inosine monophosphate dehydrogenase, an important enzyme in de nova synthesis of guanine nucleotide. This alters purine metabolism, which preferentially affects T and B lymphocytes that depend on this pathway
  
• Inhibits proliferation of T and B lymphocytes and suppresses antibody formation
  
• May inhibit recruitment of leukocytes into sites of inflammation and graft rejection
  
• Does not affect production of interleukins

• In as little as 2–3 weeks, and usually within 2 months

• Usually used as a steroid-sparing agent. May allow reduction in dose or discontinuation of corticosteroids. Most MG patients require long-term treatment, but occasionally may remit allowing careful discontinuation

• Usually used as an adjunctive agent in conjunction with corticosteroids in MG. Azathioprine, cyclosporine, cyclophosphamide, plasma exchange, and intravenous immune globulin are alternative long-term treatments. Thymectomy may also be effective for selected patients

• Generally combined with prednisone or other corticosteroids for treatment of MG, allowing eventual decrease in dose, and occasionally combined with other immunosuppressive agents

• Obtain a CBC when initiating treatment, then weekly in the first month, twice monthly in months 2–3, and monthly through the first year