How do you counsel patients who experience diarrhea from mycophenolate mofetil (Cellcept)?

1. I have them stop the drug, and when their bowels are back to normal (usually just a couple of days), I resume with 1 tablet bid of mycophenolate mofetil (MMF, CellCept), then a few days later go up to 1 tab tid, a few days later 2 tabs bid... etc. I instruct them to go down to the most recent dose ...

While not uniformly the case, mycophenolic acid is much better tolerated with regard to GI symptoms than than the mycophenolate salt; absorption of mycophenolic acid is likely better as well for patients with constitutional or drug induced (PPI Rx associated) achlorhydria.