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<script type="text/javascript" src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.boots.min.js"> </script><title>Mycophenolate - Drugs and Lactation Database (LactMed®) - NCBI Bookshelf</title>
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<meta name="citation_inbook_title" content="Drugs and Lactation Database (LactMed®) [Internet]">
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<meta name="citation_title" content="Mycophenolate">
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<meta name="citation_publisher" content="National Institute of Child Health and Human Development">
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<meta name="citation_date" content="2023/08/15">
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<meta name="citation_pmid" content="30000699">
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<meta name="citation_keywords" content="mycophenolate mofetil">
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<meta name="citation_keywords" content="CellCept">
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<meta name="citation_keywords" content="Myfenax">
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<meta name="citation_keywords" content="Myfortic">
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<meta name="citation_keywords" content="128794-94-5">
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<meta name="citation_keywords" content="RS 61443">
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<meta name="citation_keywords" content="RS-61443">
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<meta name="citation_keywords" content="Mycophenolic acid morpholinoethyl ester">
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<meta name="citation_keywords" content="UNII-9242ECW6R0">
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<meta name="citation_keywords" content="HSDB 7436">
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<meta name="citation_keywords" content="9242ECW6R0">
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<meta name="citation_keywords" content="Mycophenolate mofetil">
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<meta name="citation_keywords" content="[2-Morpholinoethyl (E)-6-(4-hydroxy-6-methoxy-7-methyl-3-oxo-5-phthalanyl)-4-methyl-4-hexenoate">
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<meta name="citation_keywords" content="4-Hexenoic acid, 6-(1,3-dihydro-4-hydroxy-6-methoxy-7-methyl-3-oxo-5-isobenzofuranyl)-4-methyl-, 2-(4-morpholinyl)ethyl ester, (E)-">
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<meta name="citation_keywords" content="mycophenolic acid">
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<meta name="citation_keywords" content="Mycophenolate">
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<meta name="citation_keywords" content="Melbex">
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<meta name="citation_keywords" content="Myfortic">
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<meta name="citation_keywords" content="Mycophenolsaeure">
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<meta name="citation_keywords" content="Acido micofenolico">
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<meta name="citation_keywords" content="Micofenolico acido">
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<meta name="citation_keywords" content="Acide mycophenolique">
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<meta name="citation_keywords" content="Acidum mycophenolicum">
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<meta name="citation_keywords" content="Lilly-68618">
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<meta name="citation_keywords" content="UNII-HU9DX48N0T">
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<meta name="citation_keywords" content="CCRIS 5565">
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<meta name="citation_keywords" content="Micofenolico acido [Spanish]">
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<meta name="citation_keywords" content="HU9DX48N0T">
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<meta name="citation_keywords" content="Acido micofenolico [INN-Spanish]">
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<meta name="citation_keywords" content="NSC 129185">
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<meta name="citation_keywords" content="NSC-129185">
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<meta name="citation_keywords" content="Acide mycophenolique [INN-French]">
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<meta name="citation_keywords" content="Acidum mycophenolicum [INN-Latin]">
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<meta name="citation_keywords" content="Ly 68618">
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<meta name="citation_keywords" content="EINECS 246-119-3">
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<meta name="citation_keywords" content="Mycophenolic acid]">
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<meta name="citation_keywords" content="RS-61443 [AS MOFETIL]">
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<meta name="citation_keywords" content="EC 246-119-3">
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<meta name="citation_keywords" content="(E)-6-(4-Hydroxy-6-methoxy-7-methyl-3-oxo-5-phthalanyl)-4-methyl-4-hexenoic acid">
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<meta name="citation_keywords" content="4-Hexenoic acid, 6-(4-hydroxy-6-methoxy-7-methyl-3-oxo-5-phthalanyl)-4-methyl-, (E)-">
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<meta name="citation_keywords" content="4-Methyl-5-methoxy-7-hydroxy-6-(5-carboxy-3-methylpent-2-en-1-yl)-phthalide (E)-">
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<meta name="citation_keywords" content="6-(4-Hydroxy-6-methoxy-7-methyl-3-oxo-5-phthalanyl)-4-methyl-4-hexenoic acid (E)-">
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<meta name="citation_keywords" content="4-Hexenoic acid, 6-(1,3-dihydro-4-hydroxy-6-methoxy-7-methyl-3-oxo-5-isobenzofuranyl)-4-methyl-, (E)-">
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<link rel="schema.DC" href="http://purl.org/DC/elements/1.0/">
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<meta name="DC.Title" content="Mycophenolate">
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<meta name="DC.Publisher" content="National Institute of Child Health and Human Development">
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<meta name="DC.Date" content="2023/08/15">
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<meta name="description" content="Information from 3 patients on the excretion of mycophenolate into milk is inconsistent. A few infants have reportedly been breastfed during mycophenolate therapy, with no adverse effects reported. Because little information is available on the use of mycophenolate during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.">
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<meta name="og:description" content="Information from 3 patients on the excretion of mycophenolate into milk is inconsistent. A few infants have reportedly been breastfed during mycophenolate therapy, with no adverse effects reported. Because little information is available on the use of mycophenolate during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.">
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class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><div class="fm-sec"><h1 id="_NBK501638_"><span class="title" itemprop="name">Mycophenolate</span></h1><p class="fm-aai"><a href="#_NBK501638_pubdet_">Publication Details</a></p><p><em>Estimated reading time: 3 minutes</em></p></div></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><p>CASRN: 24280-93-1</p><a href="https://pubchem.ncbi.nlm.nih.gov/substance/388369430" title="View this structure in PubChem" class="img_link" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem"><img src="https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?t=l&sid=388369430" alt="image 388369430 in the ncbi pubchem database" /></a><div id="LM739.Drug_Levels_and_Effects"><h2 id="_LM739_Drug_Levels_and_Effects_">Drug Levels and Effects</h2><div id="LM739.Summary_of_Use_during_Lactation"><h3>Summary of Use during Lactation</h3><p>Information from 3 patients on the excretion of mycophenolate into milk is inconsistent. A few infants have reportedly been breastfed during mycophenolate therapy, with no adverse effects reported. Because little information is available on the use of mycophenolate during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.</p></div><div id="LM739.Drug_Levels"><h3>Drug Levels</h3><p><i>Maternal Levels.</i> A woman was treated for lupus nephritis with delayed-release mycophenolate (Myfortic) in a dose of 720 mg in the morning and evening and 360 mg midday for a total of 21.6 mg/kg daily. Steady-state milk samples before and at 2 and 4 hours after a morning dose of 720 mg contained 35 mg/L, 80 mg/L, and 28 mg/L, respectively.[<a class="bibr" href="#LM739.REF.1" rid="LM739.REF.1">1</a>,<a class="bibr" href="#LM739.REF.2" rid="LM739.REF.2">2</a>] An exact relative infant dosage cannot be calculated from these data points, but the value lies between 19% and 56% (probably closer to 19%) of the mother’s weight-adjusted dosage using the standard milk intake of 150 mL/kg daily.</p><p>One woman with lupus nephritis was receiving mycophenolate mofetil 500 mg twice daily, which was increased to 1000 mg twice daily. A second woman with a kidney transplant was receiving enteric-coated mycophenolate sodium 720 mg twice daily. Milk samples were obtained at 0, 1, 2, 4, 6, 8, 10, and 12 hours from the women. In the first woman, the average milk concentrations were 16.3 and 38.7 mcg/L at the 500 mg and 1000 mg dosages, respectively. These translated into a relative infant dosage of 0.02% at both dosages. In the second woman, the drug was undetectable (<60 ng/L) in milk at any time. Interactions with concurrent medications sevelamer and pantoprazole could have decreased the serum and hence milk levels, but patient nonadherence and other factors could have played a role.[<a class="bibr" href="#LM739.REF.3" rid="LM739.REF.3">3</a>]</p><p><i>Infant Levels.</i> Relevant published information was not found as of the revision date.</p></div><div id="LM739.Effects_in_Breastfed_Infants"><h3>Effects in Breastfed Infants</h3><p>The National Transplantation Pregnancy Registry (renamed Transplant Pregnancy Registry International) collected information on 6 mothers (5 kidney and 2 heart transplants) who breastfed 7 infants while taking a mycophenolate product. The maximum time that any of the infants was breastfed was 14 months. None of the infants had any reported adverse reactions.[<a class="bibr" href="#LM739.REF.4" rid="LM739.REF.4">4</a>] Another case series from the Transplant Pregnancy Registry International reported women who received heart transplants reported that 3 women breastfed their infants while taking mycophenolate. Durations of breastfeeding and infant outcomes were not reported.[<a class="bibr" href="#LM739.REF.5" rid="LM739.REF.5">5</a>] It is possible that some of these women were the same as those in the case series above.</p><p>In case series of 77 patients from the UK who received either a liver or cardiothoracic transplant, 9 took mycophenolate mofetil throughout pregnancy. Overall, 60% breastfed their infants, although the exact number who breastfed with mycophenolate or their outcomes were not reported.[<a class="bibr" href="#LM739.REF.6" rid="LM739.REF.6">6</a>]</p><p>An Australian case series reported 3 women with heart transplants who had a total of 5 infants, all of whom were breastfed (extent not stated). Two of the women took mycophenolate mofetil postpartum, one in a dosage of 720 mg twice daily and the other woman in a dosage of 1 gram twice daily. No adverse infant effects were reported up to the times of hospital discharge.[<a class="bibr" href="#LM739.REF.7" rid="LM739.REF.7">7</a>]</p></div><div id="LM739.Effects_on_Lactation_and_Breastmil"><h3>Effects on Lactation and Breastmilk</h3><p>Relevant published information was not found as of the revision date.</p></div><div id="LM739.Alternate_Drugs_to_Consider"><h3>Alternate Drugs to Consider</h3><p><a href="/books/n/lactmed/LM20/?report=reader">Azathioprine</a>, <a href="/books/n/lactmed/LM78/?report=reader">Cyclosporine</a>, <a href="/books/n/lactmed/LM249/?report=reader">Tacrolimus</a></p></div><div id="LM739.References"><h3>References</h3><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="LM739.REF.1">Huerta
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A, Caballero Bermejo
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AF, de Villa
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LF, et al.
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Measurement of the passage of mycophenolic acid into breast milk in a patient with lupus nephritis.
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Kidney Int
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2021;100:711. [<a href="https://pubmed.ncbi.nlm.nih.gov/34420668" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34420668</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="LM739.REF.2">Ruiz‐Antorán B. Personal communication. August 26 & 30, 2021.</div></dd></dl><dl class="bkr_refwrap"><dt>3.</dt><dd><div class="bk_ref" id="LM739.REF.3">Krutsch
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K, Burkham
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J, Datta
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P, Hale
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TW. Transfer of mycophenolic acid into human milk.
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J Nephrol
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2023;36:1715-7. [<a href="https://pubmed.ncbi.nlm.nih.gov/37285005" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 37285005</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>4.</dt><dd><div class="bk_ref" id="LM739.REF.4">Constantinescu
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S, Pai
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A, Coscia
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LA, et al.
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Breast-feeding after transplantation.
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Best Pract Res Clin Obstet Gynaecol
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2014;28:1163-73. [<a href="https://pubmed.ncbi.nlm.nih.gov/25271063" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25271063</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>5.</dt><dd><div class="bk_ref" id="LM739.REF.5">Punnoose
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LR, Coscia
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LA, Armenti
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DP, et al.
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Pregnancy outcomes in heart transplant recipients.
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J Heart Lung Transplant
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2020;39:473-80. [<a href="https://pubmed.ncbi.nlm.nih.gov/32201090" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32201090</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>6.</dt><dd><div class="bk_ref" id="LM739.REF.6">Mohamed-Ahmed
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O, Nelson-Piercy
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C, Bramham
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K, et al.
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Pregnancy outcomes in liver and cardiothoracic transplant recipients: A UK national cohort study.
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PLoS One
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2014;9:e89151. [<a href="/pmc/articles/PMC3929648/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3929648</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24586554" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24586554</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>7.</dt><dd><div class="bk_ref" id="LM739.REF.7">Boyle
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S, Sung-Him Mew
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T, Lust
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K, et al.
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Pregnancy following heart transplantation: A single centre case series and review of the literature.
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Heart Lung Circ
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2021;30:144-53. [<a href="https://pubmed.ncbi.nlm.nih.gov/33162367" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33162367</span></a>]</div></dd></dl></dl></div></div><div id="LM739.Substance_Identification"><h2 id="_LM739_Substance_Identification_">Substance Identification</h2><div id="LM739.Substance_Name"><h3>Substance Name</h3><p>Mycophenolate</p></div><div id="LM739.CAS_Registry_Number"><h3>CAS Registry Number</h3><p>128794-94-5; 24280-93-1</p></div><div id="LM739.Drug_Class"><h3>Drug Class</h3><p>Breast Feeding</p><p>Lactation</p><p>Milk, Human</p><p>Immunosuppressive Agents</p></div></div><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_top_margin"><p><b>Disclaimer: </b>Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.</p></p></div></dd></dl></dl></div><div id="bk_toc_contnr"></div></div></div><div class="fm-sec"><h2 id="_NBK501638_pubdet_">Publication Details</h2><h3>Publication History</h3><p class="small">Last Revision: <span itemprop="dateModified">August 15, 2023</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a><p class="small"><b>Attribution Statement:</b> LactMed is a registered trademark of the U.S. Department of Health and Human Services.</p></div></div><h3>Publisher</h3><p><a href="https://www.nlm.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Child Health and Human Development</a>, Bethesda (MD)</p><h3>NLM Citation</h3><p>Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Mycophenolate. [Updated 2023 Aug 15].<span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"><a href="/books/n/lactmed/LM548/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a></div><div class="small-screen-next"><a href="/books/n/lactmed/LM192/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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