Many people with lupus say fatigue is their most bothersome symptom. Fatigue is more than just being tired. It’s a constant feeling of tiredness or weakness that may not get better after sleeping.

If you already experience fatigue, you may not want to take a medication that might also cause fatigue. A MyLupusTeam member who recently started taking mycophenolate mofetil (CellCept) asked, “Ever since I started CellCept a few weeks ago, my fatigue has gotten so much worse. This stuff is supposed to help me get better, and I feel drained and crappy all the time!”

Fatigue and weakness might occur as side effects of mycophenolate mofetil, though other medications or lupus itself may also contribute. Keep reading to find out possible ways the medication may cause this troublesome symptom.

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Is Fatigue a Common Side Effect of Mycophenolate Mofetil?

Fatigue isn’t a common side effect of mycophenolate mofetil, but it can occur. This unusual tiredness or weakness might occur as a direct side effect of the medication or as a symptom of complications from taking the medication.

Many people with lupus experience fatigue, regardless of what medications they take. It can be hard to tell if how you’re feeling is a side effect of a medication or a symptom of your illness. As one MyLupusTeam member said, “I have so many health issues and take so many tablets, I don’t even know what’s side effects and what’s illness anymore.”

“I have so many health issues and take so many tablets, I don’t even know what’s side effects and what’s illness anymore.”

— A MyLupusTeam member

What Are the Common Side Effects of Mycophenolate Mofetil?

More common side effects of mycophenolate mofetil include:

• Nausea and vomiting
• Stomach pain
• Diarrhea or constipation
• Headaches or dizziness
• Low blood cell counts, including white blood cells, red blood cells, and platelets
• Frequent infections
• Tremors or shaking

Less frequently, mycophenolate mofetil can cause serious side effects, such as ulcers or progressive multifocal leukoencephalopathy, a rare but serious infection of the brain.

If you’re pregnant or planning to become pregnant, mycophenolate mofetil should generally be avoided because it can increase the risk of miscarriage and serious birth defects. Talk with your healthcare team about safer treatment options and contraception if you could become pregnant.

What Are the Long-Term Side Effects of Mycophenolate Mofetil?

Researchers are still studying the long-term side effects of mycophenolate mofetil, especially in those who take the medication off-label for lupus or other autoimmune conditions. Some long-term risks of mycophenolate mofetil include infections and certain cancers.

How Does Mycophenolate Mofetil Cause Fatigue?

Although fatigue isn’t a very common side effect of mycophenolate mofetil, it can occur as a direct side effect in some cases. It can also be a consequence of other side effects or complications caused by the medication.

Trouble Sleeping

Insomnia is a recognized side effect of mycophenolate. If you have trouble falling asleep or staying asleep, you may feel more tired during the day.

In clinical trials for people taking mycophenolate with other immunosuppressants after heart or liver transplants, between 40 percent and 52 percent of people experienced insomnia. A small clinical trial found that 20 percent of people taking mycophenolate mofetil for autoimmune conditions, including SLE, experienced insomnia.

Participants in both trials also took other medications, like cyclosporine and corticosteroids. Any reported insomnia may not have been caused by mycophenolate mofetil alone.

Anemia

In rare cases, mycophenolate mofetil can cause a condition known as pure red cell aplasia. This is a bone marrow disorder that prevents people from making enough red blood cells, causing anemia. Red blood cells deliver oxygen to all of the tissues around your body.

Fatigue can be a symptom of pure red cell aplasia because your body isn’t getting the oxygen it needs to function properly. Doctors recommend regular blood tests while you take mycophenolate mofetil. These tests can detect anemia and other blood cell changes that may lead your healthcare provider to order more testing for pure red cell aplasia.

Cancer

Fatigue can be an early warning sign of many different types of cancer, including lymphoma. People who take mycophenolate and other medicines that suppress the immune system have an increased risk of lymphoma and some other cancers, especially skin cancer.

However, fatigue while taking mycophenolate mofetil can have many other explanations, and cancer is uncommon.

Infections

If you get frequent infections from taking mycophenolate mofetil, you may feel more fatigued than usual. Call your healthcare provider if you notice any signs of infection, such as sore throat, runny nose, chills, or fever, while you’re taking mycophenolate.

Other Causes of Fatigue With Lupus

Studies show between 67 percent and 90 percent of people with lupus report feeling fatigue. Several aspects of lupus can result in you feeling more tired than usual.

Disease Activity

People with more active lupus may be more likely to experience fatigue. This is because your body has to use extra energy to cope with increased inflammation, leaving you feeling tired. However, fatigue can also occur between lupus flares because of other factors, such as medications, vitamin deficiencies, or sleep problems.

Pain

Pain caused by lupus can cause insomnia. Pain can also make it harder for you to stay active. Both of these factors can make your fatigue worse, while poor sleep and lack of exercise can also increase pain.

Associated Conditions

Several medical conditions frequently associated with lupus, also known as comorbidities, can cause fatigue. These include hypothyroidism (low thyroid hormone) and fibromyalgia.

Depression

Many people with lupus experience depression. Fatigue is a common symptom of depression and anxiety. Additionally, some antidepressants used to treat depression can cause fatigue as a side effect.

Other Lupus Medications

The side effects of some lupus medications can cause fatigue or make it harder for you to sleep. These include:

• Corticosteroids, like prednisone
• Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen
• Azathioprine (Imuran)
• Methotrexate

Tips for Managing Fatigue With Lupus

“Unfortunately, fatigue comes with the territory. Give yourself permission to get the rest you need,” a MyLupusTeam member recommended. Here are other ways to help you manage your fatigue from mycophenolate mofetil or other causes:

• Plan activities for the times of day when you usually have the most energy
• Eat a healthy diet
• Stay as active as you can
• Practice good sleeping habits, like sleeping in a dark, quiet room and engaging only in relaxing activities before bed
• Talk to your doctor about whether you need vitamin D testing or supplements. Vitamin D may be recommended if your level is low, but it’s not proven to reliably improve lupus-related fatigue

If you’re worried about how your medication side effects or lupus symptoms are affecting your quality of life, get medical advice from a healthcare professional about the best way to manage fatigue.