Comparative Pharmacology
Head-to-head clinical analysis: MYFORTIC versus NEORAL.
Peer-Reviewed Evidence
Head-to-head clinical analysis: MYFORTIC versus NEORAL.
MYFORTIC vs NEORAL
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Mycophenolic acid inhibits inosine monophosphate dehydrogenase (IMPDH), thereby depleting guanosine nucleotides in T and B lymphocytes, suppressing their proliferation and antibody production.
Cyclosporine, the active ingredient in Neoral, is a calcineurin inhibitor. It binds to cyclophilin, forming a complex that inhibits calcineurin, thereby preventing dephosphorylation and nuclear translocation of NF-AT (nuclear factor of activated T-cells). This inhibits transcription of interleukin-2 and other cytokines, reducing T-cell activation and proliferation.
720 mg orally twice daily, on an empty stomach, 1 hour before or 2 hours after meals.
Initial dose 10-15 mg/kg/day orally divided q12h, then taper by 5% weekly to maintenance of 3-5 mg/kg/day divided q12h. For psoriasis: 2.5 mg/kg/day orally divided q12h. For rheumatoid arthritis: 2.5-5 mg/kg/day orally divided q12h. Administer consistently with or without food.
None Documented
None Documented
Terminal elimination half-life is approximately 12-18 hours (mean 17 hours) in healthy volunteers; longer in hepatic impairment (up to 40 hours).
Terminal elimination half-life: 8.4 hours (range 6–24 hours) in healthy volunteers; prolonged in hepatic impairment (up to 20 hours).
Primarily renal (approximately 95% as metabolites, <3% as unchanged drug); biliary/fecal excretion accounts for <5%.
Primarily biliary/fecal (94%): 94% of dose eliminated in feces via bile, 6% in urine (0.1% unchanged). Minimal renal elimination of parent drug.
Category C
Category C
Immunosuppressant
Immunosuppressant