Mycophenalate is used in lupus nephritis (first line), diffuse SS but also indicated for the prophylaxis of organ rejection in patients undergoing allogeneic renal, hepatic, or cardiac transplants. In transplant patients it should be used with cyclosporine/tacrolimus and corticosteroids. Mycophenolate has a preferential inhibition of IMPDH II the rate limiting step in the de novo synthesis of guanine nucleotide from IMP in B and T lymphocytes.