If you take mycophenolate mofetil (CellCept) or mycophenolic acid (Myfortic) — also known as mycophenolate — your doctor or pharmacist has likely told you to take it on an empty stomach. However, if your stomach gets upset when you take the drug, you might wonder if you can take it with food.

One MyLupusTeam member asked, “I take two tablets of mycophenolate two times a day, one hour before or two hours after I eat. My doctor specified that I have to take the pills without food, but after researching the pill, I found that a lot of people eat food with the pill to settle their stomachs. If you’re on the medication, how do you take them?”

You should understand why it’s recommended that you take mycophenolate on an empty stomach and when to talk to your doctor about how you take it.

What Is Mycophenolate?

The U.S. Food and Drug Administration (FDA) has approved formulations of mycophenolate to prevent organ rejection after an organ transplant. The drug isn’t FDA approved to treat systemic lupus erythematosus (SLE), the most common form of lupus. However, doctors commonly prescribe it to treat people with lupus nephritis, a kidney disease caused by SLE. Mycophenolate is often used in combination with other medications — such as corticosteroids (steroids), so the dose of steroids can be decreased.

An immunosuppressant medication, mycophenolate works by blocking certain cells of your immune system — called white blood cells (WBCs) — from growing. This can fight the inflammation and damage caused by an overactive immune system in people with lupus.

How Should You Take Mycophenolate?

Take mycophenolate exactly as instructed by your health care provider. It’s available as a capsule, tablet, or suspension (liquid) you take by mouth. Many people take 2,000 to 3,000 milligrams (mg) per day divided into two doses — in the morning and the evening, about 12 hours apart. Depending on your dose, you may have to take multiple pills at once because the strongest tablet available is 500 mg. Health experts recommend that you take your doses at the same time each day.

Swallow the pills whole without crushing or chewing them. If you’re taking capsules, do not open them. If you have trouble swallowing the pills, talk to your doctor about switching to the liquid. The drug is also available as an intravenous infusion (delivered directly into a vein).

You should take mycophenolate on an empty stomach — one hour before or two hours after a meal unless your doctor gives you different instructions. You should also avoid taking mycophenolate at the same time as antacids that contain magnesium or aluminum, such as Maalox or Mylanta.

If you’re taking the liquid, don’t mix it with other medications.

Why Should You Take Mycophenolate on an Empty Stomach?

Food can affect how mycophenolate is absorbed from your gut into your bloodstream. If you take mycophenolate with food, it can decrease the amount of the drug in your bloodstream by up to 40 percent. When there is less of the drug in your bloodstream, it might not work as well, and your lupus symptoms may get worse.

The reason you need to take mycophenolate one hour before a meal or two hours after has to do with a process called gastric emptying — the speed at which food and liquids move through your stomach. If you take mycophenolate with only water, your stomach can break down the medication in about an hour. Then, you can eat food without it decreasing the medication’s effectiveness.

It takes a longer amount of time — usually about two to three hours — for your stomach to empty food, especially higher-calorie meals. This is why you need to wait at least two hours after you eat before taking mycophenolate.

What Are the Stomach-Related Side Effects of Mycophenolate?

Nausea is a common side effect of mycophenolate. Other stomach-related side effects include:

• Stomach pain
• Vomiting
• Diarrhea
• Gas

Researchers don’t know why mycophenolate causes stomach-related side effects, but it might be because mycophenolate irritates the lining of your gut. Researchers have found that women might be more likely than men to experience these side effects.

Serious stomach problems, such as stomach or intestinal bleeding, can also occur while taking mycophenolate. Talk to your doctor right away if you notice any of the following symptoms:

• Black-colored or tarry stool (poop)
• Red blood mixed in your stool
• Vomit that looks like coffee grounds
• Red blood in your vomit
• Severe stomach cramps
• Dizziness, fatigue, or weakness
• Paleness

Other Side Effects of Mycophenolate

Other possible side effects of mycophenolate in addition to the stomach-related side effects include:

• Swelling in your lower legs, ankles, or feet
• Pain (including muscle, back, and joint pain)
• Headache
• High blood pressure
• Tremor (involuntary shaking movements)
• Trouble falling asleep or staying asleep
• Feeling of tingling or burning on the skin

Mycophenolate can cause serious side effects like low blood counts affecting your white blood cells, red blood cells (RBCs), and platelets. If you have low WBCs, you might have an increased risk of infections. With low RBCs, your blood may not be able to carry enough oxygen around your body, resulting in severe anemia. If your platelets are low, you might have problems with blood clotting.

Mycophenolate can also increase your risk of some cancers, such as lymphoma and skin cancer. It’s important to limit your time in the sun and use sunscreen with SPF of at least 30 while you’re taking mycophenolate.

Managing Stomach-Related Side Effects of Mycophenolate

Your doctor will monitor you closely for side effects while you’re taking mycophenolate. It’s also important to talk to them about how you’re feeling. If you experience nausea or other stomach-related side effects of mycophenolate, talk to your doctor about your treatment options.

One option to help decrease nausea is taking mycophenolate with food, which is OK in some cases. However, you should never take it with food unless you get approval from your doctor first.

You might also consider talking to your doctor about when you take your medication. One MyLupusTeam member suggested, “I take mine early in the morning and before bed. You could probably ask your doctor what they think if you’re getting stomach distress.”

Talk With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, more than 222,000 members come together to ask questions, give advice, and share their stories with others who understand life with lupus.

Have you taken mycophenolate for lupus? Did you take it on an empty stomach or with food? Share your experience in the comments below, or start a conversation by posting on your Activities page.