Mavenclad 10mg Tabs (8) Pak
WARNING: This drug may lower the ability of the bone marrow to make blood cells that the body needs. If blood cell counts get very low, this can lead to bleeding problems, infections, or anemia. If you have questions, talk with the doctor.This drug may raise the risk of cancer. Do not take this drug to treat MS if you have cancer. If you have a risk for cancer or have ever had cancer, talk with your doctor.This drug may cause harm to the unborn baby if you take it while pregnant. Do not take this drug if you are pregnant, or if you are able to get pregnant but are not using birth control.If you are able to get pregnant, a pregnancy test will be done to show that you are NOT pregnant before starting this drug. Talk with your doctor.If you or your sex partner may become pregnant, you must use birth control while taking this drug and for 6 months after the last dose. Ask your doctor how long to use birth control and what kind of birth control to use. If you or your sex partner gets pregnant while taking this drug or within 6 months after stopping it, call the doctor right away. @ COMMON USES: It is used to treat MS (multiple sclerosis).
Drug Class
Immunomodulator
Pharmacologic Class
Purine nucleoside analog; Antimetabolite
Pregnancy Category
Not available
FDA Approved
Mar 2019
DEA Schedule
Not Controlled
Overview
What is this medicine?
Mavenclad is a medication used to treat certain types of multiple sclerosis (MS). It works by reducing the number of specific white blood cells (lymphocytes) that are thought to cause MS. It's taken as tablets for a short period each year over two years, and then no more treatment is needed for the next two years.
How to Use This Medicine
Taking Your Medication Correctly
To ensure you get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your medication and follow the instructions closely. You can take this medication with or without food. Swallow the tablet whole with a glass of water. Do not chew the tablet.
If you take other oral medications, take them at least 3 hours before or 3 hours after this medication. If this is not possible, consult your doctor for guidance.
Handling Your Medication
You will need to take special precautions when handling this medication. Consult your doctor or pharmacist for instructions on how to handle it safely. Only remove the medication from the blister pack when you are ready to take it, and take it immediately after opening the pack. Do not store the removed medication for future use. Make sure your hands are dry before touching the medication, and wash your hands after handling it.
Storing and Disposing of Your Medication
Store your medication in its original container at room temperature in a dry place. Avoid storing it in a bathroom. Keep all medications in a safe location, out of the reach of children and pets.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember on the same day. If you don't remember until the next day, take the missed dose and then take your next dose the day after. This will extend your treatment week by one day. Do not take two doses at the same time or take extra doses.
To ensure you get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your medication and follow the instructions closely. You can take this medication with or without food. Swallow the tablet whole with a glass of water. Do not chew the tablet.
If you take other oral medications, take them at least 3 hours before or 3 hours after this medication. If this is not possible, consult your doctor for guidance.
Handling Your Medication
You will need to take special precautions when handling this medication. Consult your doctor or pharmacist for instructions on how to handle it safely. Only remove the medication from the blister pack when you are ready to take it, and take it immediately after opening the pack. Do not store the removed medication for future use. Make sure your hands are dry before touching the medication, and wash your hands after handling it.
Storing and Disposing of Your Medication
Store your medication in its original container at room temperature in a dry place. Avoid storing it in a bathroom. Keep all medications in a safe location, out of the reach of children and pets.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember on the same day. If you don't remember until the next day, take the missed dose and then take your next dose the day after. This will extend your treatment week by one day. Do not take two doses at the same time or take extra doses.
Lifestyle & Tips
- Avoid live or live-attenuated vaccines during and after treatment until your doctor says it's safe (usually when lymphocyte counts recover).
- Practice good hygiene (frequent hand washing) to reduce infection risk.
- Report any signs of infection (fever, chills, rash, sore throat) immediately.
- Report any new or changing skin lesions or other signs of cancer.
- Use effective contraception during treatment and for at least 6 months after the last dose for both males and females.
- Discuss any planned pregnancies with your doctor well in advance.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
The recommended cumulative dose of Mavenclad is 3.5 mg/kg over 2 years, administered as 1.75 mg/kg per year. Each annual dose is divided into two treatment courses: one in Month 1 and one in Month 2 of the respective treatment year. Each treatment course consists of 4 or 5 tablets (10 mg each) taken once daily for 4 or 5 consecutive days, depending on body weight. The total number of tablets per course is rounded up to the nearest whole tablet. After the two treatment courses in Year 1, no cladribine is administered in Months 3-12. In Year 2, two additional treatment courses are administered in Month 13 and Month 14, similar to Year 1. No further cladribine treatment is required for Years 3 and 4.
Condition-Specific Dosing:
Relapsing Forms of Multiple Sclerosis (RMS):
See standard dosing. Dosing is based on body weight (mg/kg).
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established
Adolescent:
Not established. Safety and effectiveness in pediatric patients have not been established.
Dose Adjustments
Renal Impairment:
Mild:
No dose adjustment is recommended for mild renal impairment (CrCl 60-89 mL/min).
Moderate:
Mavenclad is not recommended for patients with moderate renal impairment (CrCl 30-59 mL/min) due to limited clinical experience.
Severe:
Mavenclad is contraindicated in patients with severe renal impairment (CrCl <30 mL/min).
Dialysis:
Contraindicated in patients requiring dialysis.
Hepatic Impairment:
Mild:
No dose adjustment is recommended for mild hepatic impairment (Child-Pugh A).
Moderate:
No dose adjustment is recommended for moderate hepatic impairment (Child-Pugh B).
Severe:
Mavenclad has not been studied in patients with severe hepatic impairment (Child-Pugh C) and is not recommended.
Confidence:
Medium
Pharmacology
Mechanism of Action
Cladribine is a purine nucleoside analog. It is a prodrug that is phosphorylated intracellularly by deoxycytidine kinase (DCK) to its active triphosphate form, 2-chloro-2'-deoxyadenosine triphosphate (Cd-ATP). Lymphocytes, particularly B and T cells, have high levels of DCK and low levels of 5'-nucleotidase (which dephosphorylates Cd-ATP), leading to selective accumulation of Cd-ATP in these cells. Cd-ATP interferes with DNA synthesis and repair, leading to DNA strand breaks, inhibition of DNA polymerase, and ultimately apoptosis of dividing and non-dividing lymphocytes. This results in a sustained reduction in lymphocyte counts, which is thought to be the primary mechanism by which cladribine exerts its therapeutic effects in MS.
Pharmacokinetics
Absorption:
Bioavailability:
Approximately 40% (oral)
Tmax:
0.5 to 1.5 hours
FoodEffect:
Food does not affect the bioavailability of cladribine tablets.
Distribution:
Vd:
Approximately 98 L (intravenous)
ProteinBinding:
Approximately 20%
CnssPenetration:
Yes (crosses blood-brain barrier)
Elimination:
HalfLife:
Approximately 24 hours (terminal half-life of cladribine in plasma)
Clearance:
Approximately 22.2 L/h (renal clearance is 8.7 L/h)
ExcretionRoute:
Renal (approximately 50% of the dose is excreted unchanged in urine)
Unchanged:
Approximately 50%
Pharmacodynamics
OnsetOfAction:
Lymphocyte reduction begins within days of administration.
PeakEffect:
Maximum lymphocyte reduction typically occurs 2-3 months after each treatment course.
DurationOfAction:
Sustained lymphocyte reduction for up to 2 years after the last dose of the two-year treatment regimen. Clinical efficacy observed for up to 4 years after the last dose.
Safety & Warnings
BLACK BOX WARNING
MALIGNANCY: Mavenclad may increase the risk of malignancy. Patients with a current malignancy should not be treated with Mavenclad. Prior to initiating Mavenclad, patients should be screened for malignancy. Follow standard cancer screening guidelines in patients treated with Mavenclad. LYMPHOPENIA: Mavenclad causes dose-dependent reductions in lymphocyte counts. Obtain a CBC with differential, including lymphocyte count, within 10 days prior to the first dose of each treatment course and at Month 2 and Month 6 of Year 1 and Year 2. If lymphocyte counts are <500 cells/mm³, delay Mavenclad until lymphocyte counts recover. Do not administer Mavenclad to patients with a lymphocyte count <800 cells/mm³.
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
Allergic Reaction: Rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, difficulty breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat.
Infection: Fever, chills, severe sore throat, ear or sinus pain, cough, increased or discolored sputum, painful urination, mouth sores, or a wound that won't heal.
Shingles: Pain, itching, or tingling, fever, muscle aches, or a rash (with or without blisters).
Bleeding: Vomiting or coughing up blood, coffee ground-like vomit, blood in the urine, black, red, or tarry stools, gum bleeding, abnormal vaginal bleeding, unexplained bruises or bruises that enlarge, or uncontrollable bleeding.
Severe Skin Reaction (Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis): Red, swollen, blistered, or peeling skin (with or without fever), red or irritated eyes, or sores in the mouth, throat, nose, or eyes.
Extreme Fatigue or Weakness: Feeling very tired or weak.
Respiratory Problems: Shortness of breath, significant weight gain, or swelling in the arms or legs.
Cardiac Issues: Rapid or abnormal heartbeat.
High Blood Pressure: Severe headache, dizziness, fainting, or changes in vision.
Depression: Mood changes or feelings of sadness.
Progressive Multifocal Leukoencephalopathy (PML): A rare and potentially fatal brain condition. Seek immediate medical attention if you experience confusion, memory problems, depression, changes in behavior, uneven strength, speech or thinking difficulties, balance problems, or vision changes.
Liver Problems: Sometimes life-threatening, liver issues may cause dark urine, fatigue, decreased appetite, stomach upset or pain, light-colored stools, vomiting, or yellow skin and eyes. Contact your doctor right away if you notice any of these symptoms.
Other Possible Side Effects
While many people may not experience side effects or only have mild ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms, contact your doctor for guidance:
Common cold symptoms
Upset stomach
Headache
Back pain
Joint pain
Sleep disturbances
* Hair thinning or loss
This is not an exhaustive list of potential side effects. If you have questions or concerns, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or visit https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
Allergic Reaction: Rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, difficulty breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat.
Infection: Fever, chills, severe sore throat, ear or sinus pain, cough, increased or discolored sputum, painful urination, mouth sores, or a wound that won't heal.
Shingles: Pain, itching, or tingling, fever, muscle aches, or a rash (with or without blisters).
Bleeding: Vomiting or coughing up blood, coffee ground-like vomit, blood in the urine, black, red, or tarry stools, gum bleeding, abnormal vaginal bleeding, unexplained bruises or bruises that enlarge, or uncontrollable bleeding.
Severe Skin Reaction (Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis): Red, swollen, blistered, or peeling skin (with or without fever), red or irritated eyes, or sores in the mouth, throat, nose, or eyes.
Extreme Fatigue or Weakness: Feeling very tired or weak.
Respiratory Problems: Shortness of breath, significant weight gain, or swelling in the arms or legs.
Cardiac Issues: Rapid or abnormal heartbeat.
High Blood Pressure: Severe headache, dizziness, fainting, or changes in vision.
Depression: Mood changes or feelings of sadness.
Progressive Multifocal Leukoencephalopathy (PML): A rare and potentially fatal brain condition. Seek immediate medical attention if you experience confusion, memory problems, depression, changes in behavior, uneven strength, speech or thinking difficulties, balance problems, or vision changes.
Liver Problems: Sometimes life-threatening, liver issues may cause dark urine, fatigue, decreased appetite, stomach upset or pain, light-colored stools, vomiting, or yellow skin and eyes. Contact your doctor right away if you notice any of these symptoms.
Other Possible Side Effects
While many people may not experience side effects or only have mild ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms, contact your doctor for guidance:
Common cold symptoms
Upset stomach
Headache
Back pain
Joint pain
Sleep disturbances
* Hair thinning or loss
This is not an exhaustive list of potential side effects. If you have questions or concerns, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or visit https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Signs of infection: fever, chills, body aches, sore throat, painful skin rash (especially blistering), cough, burning urination.
- Signs of malignancy: unexplained weight loss, persistent fatigue, new or changing moles/skin lesions, persistent cough, unexplained bleeding.
- Signs of liver problems: yellowing of skin or eyes (jaundice), dark urine, severe stomach pain, nausea, vomiting.
- Signs of PML: new or worsening weakness on one side of your body, clumsiness, vision changes, changes in thinking or memory, confusion, personality changes.
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances. Be sure to describe the allergic reaction and its symptoms.
Existing health conditions, such as kidney disease or liver disease.
Infections like hepatitis B, hepatitis C, HIV, or tuberculosis (TB).
Any prescription or over-the-counter medications, natural products, or vitamins you are taking, as some may interact with this medication. Specifically, certain drugs used to treat hepatitis C, HIV, infections, and other conditions should not be taken with this medication.
A diagnosis of clinically isolated syndrome (CIS).
If you are breast-feeding, as you should not breast-feed while taking this medication. Your doctor will advise you on whether to avoid breast-feeding for a period after your last dose.
This list is not exhaustive, and it is crucial to discuss all your medications, health problems, and concerns with your doctor and pharmacist to ensure safe use. Do not start, stop, or change the dosage of any medication without consulting your doctor first.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances. Be sure to describe the allergic reaction and its symptoms.
Existing health conditions, such as kidney disease or liver disease.
Infections like hepatitis B, hepatitis C, HIV, or tuberculosis (TB).
Any prescription or over-the-counter medications, natural products, or vitamins you are taking, as some may interact with this medication. Specifically, certain drugs used to treat hepatitis C, HIV, infections, and other conditions should not be taken with this medication.
A diagnosis of clinically isolated syndrome (CIS).
If you are breast-feeding, as you should not breast-feed while taking this medication. Your doctor will advise you on whether to avoid breast-feeding for a period after your last dose.
This list is not exhaustive, and it is crucial to discuss all your medications, health problems, and concerns with your doctor and pharmacist to ensure safe use. Do not start, stop, or change the dosage of any medication without consulting your doctor first.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
While taking this drug, you may be at a higher risk of developing infections, some of which can be severe or even life-threatening. To minimize this risk, practice good hygiene by washing your hands frequently and avoid close contact with individuals who have infections, colds, or flu.
Additionally, this medication may increase your likelihood of bleeding easily. To reduce the risk of injury, exercise caution in your daily activities and use a soft toothbrush and an electric razor for personal grooming.
Regular monitoring of your blood work and other laboratory tests is crucial, as directed by your doctor. If you are not up to date with all recommended vaccinations, consult with your doctor, as you may need to receive certain vaccines before starting treatment with this drug.
Before receiving any vaccinations during treatment, discuss the potential risks and benefits with your doctor, as some vaccines may increase the risk of infection or reduce their effectiveness when used in conjunction with this medication.
If you have taken this drug and are scheduled to receive a blood transfusion, inform your doctor, as they may order an MRI scan before initiating treatment.
There is a risk of developing herpes zoster (shingles) while taking this medication. Consult with your doctor to determine if a vaccine is necessary before starting treatment.
Furthermore, cases of hepatitis and tuberculosis (TB) have been reported in patients taking this drug, and in some instances, these conditions have been fatal. As a precautionary measure, you will undergo testing for hepatitis and TB before the first and second treatment courses to assess your risk and take appropriate preventive measures.
While taking this drug, you may be at a higher risk of developing infections, some of which can be severe or even life-threatening. To minimize this risk, practice good hygiene by washing your hands frequently and avoid close contact with individuals who have infections, colds, or flu.
Additionally, this medication may increase your likelihood of bleeding easily. To reduce the risk of injury, exercise caution in your daily activities and use a soft toothbrush and an electric razor for personal grooming.
Regular monitoring of your blood work and other laboratory tests is crucial, as directed by your doctor. If you are not up to date with all recommended vaccinations, consult with your doctor, as you may need to receive certain vaccines before starting treatment with this drug.
Before receiving any vaccinations during treatment, discuss the potential risks and benefits with your doctor, as some vaccines may increase the risk of infection or reduce their effectiveness when used in conjunction with this medication.
If you have taken this drug and are scheduled to receive a blood transfusion, inform your doctor, as they may order an MRI scan before initiating treatment.
There is a risk of developing herpes zoster (shingles) while taking this medication. Consult with your doctor to determine if a vaccine is necessary before starting treatment.
Furthermore, cases of hepatitis and tuberculosis (TB) have been reported in patients taking this drug, and in some instances, these conditions have been fatal. As a precautionary measure, you will undergo testing for hepatitis and TB before the first and second treatment courses to assess your risk and take appropriate preventive measures.
Overdose Information
Overdose Symptoms:
- Severe myelosuppression (very low white blood cell counts, red blood cell counts, and platelet counts)
- Severe lymphopenia
- Increased risk of infection
What to Do:
There is no specific antidote for cladribine overdose. Management involves careful monitoring of blood counts and supportive care, including transfusions if necessary, and appropriate anti-infective therapy if infections occur. Call 1-800-222-1222 (Poison Control) or seek immediate medical attention.
Drug Interactions
Contraindicated Interactions
- Immunosuppressants (e.g., methotrexate, cyclosporine, azathioprine) - due to additive immunosuppressive effects and risk of myelosuppression.
- Chronic concomitant use of myelosuppressive agents (e.g., carbamazepine, zidovudine) - due to additive myelosuppressive effects.
Major Interactions
- Live or live-attenuated vaccines - risk of vaccine-induced infection (should not be administered during and after cladribine treatment until lymphocyte counts recover).
- Other disease-modifying therapies for MS (e.g., interferon beta, glatiramer acetate, natalizumab, fingolimod, ocrelizumab, teriflunomide, dimethyl fumarate) - due to potential for additive immunosuppression; a washout period may be required.
- Drugs that affect lymphocyte counts (e.g., corticosteroids, other immunosuppressants) - potential for additive effects on lymphocyte counts.
Moderate Interactions
- Strong BCRP (Breast Cancer Resistance Protein) inhibitors (e.g., eltrombopag, cyclosporine, gefitinib, lapatinib, ritonavir) - may increase cladribine exposure. Use with caution.
- Strong BCRP inducers (e.g., rifampin, St. John's Wort) - may decrease cladribine exposure. Use with caution.
- Nucleoside transport inhibitors (e.g., dilazep, nifedipine, nimodipine, reserpine, verapamil) - may alter cladribine cellular uptake and efficacy/toxicity. Use with caution.
Minor Interactions
- Not available
Monitoring
Baseline Monitoring
Complete Blood Count (CBC) with differential
Rationale: To establish baseline lymphocyte count and identify pre-existing lymphopenia, which is a contraindication or requires careful consideration.
Timing: Within 10 days prior to the first dose of each treatment course (Year 1 and Year 2).
Tuberculosis (TB) screening
Rationale: To rule out active or latent TB infection, as cladribine can reactivate latent infections.
Timing: Prior to initiation of Mavenclad.
Hepatitis B and C virus screening
Rationale: To rule out active infection, as cladribine can reactivate viral infections.
Timing: Prior to initiation of Mavenclad.
Varicella Zoster Virus (VZV) serology
Rationale: To assess immunity; vaccination should be considered for seronegative patients prior to treatment.
Timing: Prior to initiation of Mavenclad.
Liver function tests (LFTs)
Rationale: To establish baseline liver function and identify pre-existing hepatic impairment.
Timing: Prior to initiation of Mavenclad.
Pregnancy test
Rationale: To ensure patient is not pregnant, as cladribine is contraindicated in pregnancy.
Timing: Prior to initiation of Mavenclad in females of reproductive potential.
Routine Monitoring
Complete Blood Count (CBC) with differential
Frequency: Before each treatment course (Year 1 and Year 2), and at Months 2 and 6 of Year 1 and Year 2. More frequently if clinically indicated.
Target: Lymphocyte count should be ≥ 800 cells/mm³ before starting each treatment course. If <800 cells/mm³, delay treatment.
Action Threshold: If lymphocyte count is <500 cells/mm³ at Month 2 or 6, monitor closely until recovery. If <200 cells/mm³, consider prophylactic antiviral therapy for herpes zoster.
Signs and symptoms of infection (especially herpes zoster)
Frequency: Regularly throughout treatment and follow-up.
Target: N/A
Action Threshold: Prompt evaluation and treatment of any suspected infection.
Signs and symptoms of malignancy
Frequency: Regularly throughout treatment and follow-up.
Target: N/A
Action Threshold: Prompt evaluation of any suspected malignancy.
Symptom Monitoring
- Signs of infection (fever, chills, sore throat, unusual fatigue, skin lesions, painful rash, cough, dysuria)
- Signs of malignancy (unexplained weight loss, persistent fatigue, new or changing moles/skin lesions, persistent cough, unexplained bleeding)
- Signs of liver injury (jaundice, dark urine, abdominal pain, nausea, vomiting)
- Signs of progressive multifocal leukoencephalopathy (PML) (new or worsening neurological symptoms, cognitive changes, visual disturbances, weakness, speech difficulties)
Special Patient Groups
Pregnancy
Contraindicated in pregnant women and women of reproductive potential not using effective contraception. Cladribine can cause fetal harm. Women of childbearing potential must use effective contraception during cladribine treatment and for at least 6 months after the last dose. Men must use effective contraception during cladribine treatment and for at least 6 months after the last dose.
Trimester-Specific Risks:
First Trimester:
High risk of fetal harm due to cladribine's mechanism of action (DNA synthesis inhibition).
Second Trimester:
High risk of fetal harm.
Third Trimester:
High risk of fetal harm.
Lactation
Contraindicated. Cladribine is excreted in human milk and has the potential for serious adverse reactions in breastfed infants. Women should not breastfeed during cladribine treatment and for at least 10 days after the last dose.
Infant Risk:
L5 (Contraindicated - high risk of serious adverse effects due to immunosuppression and potential for malignancy in the infant).
Pediatric Use
Safety and effectiveness in pediatric patients have not been established. Not recommended for use in patients under 18 years of age.
Geriatric Use
Clinical studies of Mavenclad did not include sufficient numbers of patients aged 65 and over to determine whether they respond differently from younger patients. Use with caution, generally no specific dose adjustment is needed based on age alone, but consider age-related decline in renal function and increased susceptibility to infections.
Clinical Information
Clinical Pearls
- Mavenclad is a high-efficacy MS therapy with a unique short-course oral dosing regimen over two years, providing sustained benefit for up to four years without continuous daily dosing.
- Strict adherence to the monitoring schedule for lymphocyte counts is crucial due to the risk of severe lymphopenia and associated infections.
- Patients must be screened for active infections (TB, hepatitis, HIV) and malignancy prior to initiation.
- Vaccination with live or live-attenuated vaccines should be avoided during and after treatment until lymphocyte counts recover.
- Counsel patients extensively on contraception requirements for both males and females due to teratogenicity and genotoxicity concerns.
- The risk of malignancy is a significant concern; regular cancer screening should be emphasized.
- Herpes zoster reactivation is a common infection; consider antiviral prophylaxis for severe lymphopenia.
Alternative Therapies
- Interferon beta (e.g., Avonex, Betaseron, Rebif, Plegridy)
- Glatiramer acetate (e.g., Copaxone, Glatopa)
- Fingolimod (Gilenya)
- Natalizumab (Tysabri)
- Ocrelizumab (Ocrevus)
- Alemtuzumab (Lemtrada)
- Dimethyl fumarate (Tecfidera)
- Teriflunomide (Aubagio)
- Siponimod (Mayzent)
- Ozanimod (Zeposia)
- Ponesimod (Ponvory)
- Diroximel fumarate (Vumerity)
Cost & Coverage
Average Cost:
Highly variable, typically very expensive (e.g., tens of thousands of USD per course) per 10mg tablet (8 tablets per pak for one course)
Insurance Coverage:
Specialty Tier (requires prior authorization, often subject to step therapy and quantity limits)
General Drug Facts
If your symptoms or health issues persist or worsen, it is essential to contact your doctor promptly. To ensure safe use, never share your medication with others or take someone else's medication. This medication is accompanied by a Medication Guide, which provides crucial information for patients. Please read this guide carefully and review it again whenever you receive a refill of this medication. If you have any questions or concerns about this medication, consult your doctor, pharmacist, or other healthcare provider for guidance. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When reporting the incident, be prepared to provide details about the medication taken, the quantity, and the time it occurred.