Table 2.

Immunomodulator considerations for use

Immunomodulator	Considerations
	Hepatic	Renal	Other
Methotrexate [48]	• Avoid in preexisting liver disease • Toxic interaction with alcohol • Monitor CBCs and LFTs	• Dose adjustment for renal impairment	• Contraindicated with pregnancy
Leflunomide [49]	• Contraindicated with hepatic impairment • Liver function monitoring	• Patients with a history of renal failure or transplant may already be taking this medication	• Contraindicated with pregnancy
Mycophenolate mofetil [50]	• Dose adjustment for adult transplant patients • Monitor CBCs and LFTs	• Patients with a history of renal transplant or lupus nephritis may already be taking this medication	• Potential for severe and limiting GI, glucose, and cholesterol side effects • Contraindicated with pregnancy
Azathioprine [47]	• Potentially hepatotoxic in transplant patients • Monitor CBCs and LFTs	• Dose adjustment for renal impairment	• Drug–drug interaction with allopurinol • Prescreen for TPMT

CBC complete blood cell count; GI, gastrointestinal, LFT liver function test, TPMT thiopurine S-methyltransferase