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Natalizumab: Comprehensive Multiple Sclerosis Treatment Guide
Summary or Key Points
Natalizumab is a prescription medication used to treat multiple sclerosis (MS) and Crohn’s disease. It works by preventing immune cells from causing inflammation in the nervous system and intestines. This medication is administered via infusion and is typically prescribed when other treatments have not been effective. Always consult a healthcare provider before starting or adjusting your dose. Our telemedicine providers are available to assist you.
Names of Medication
US Brand Name: Tysabri (Natalizumab)
The generic name refers to the active ingredient in the medication, while the brand name is assigned by the manufacturer. The generic name is listed in parentheses.
Pharmacologic Category
Selective Adhesion-Molecule Inhibitors
Natalizumab Dosage
Natalizumab is used to treat several conditions, with dosing varying based on the condition being treated. Always consult your healthcare provider before making any changes to your dose. Our telemedicine providers are available to help manage your treatment plan.
Multiple Sclerosis (MS) Treatment
Dosage: 300 mg by intravenous (IV) infusion every 4 weeks.
Crohn’s Disease
Dosage: 300 mg by IV infusion every 4 weeks. Treatment typically continues as long as the patient responds well to the medication.
Ulcerative Colitis
Dosage: 300 mg by IV infusion every 4 weeks. Consult your doctor for the appropriate treatment duration.
Rheumatoid Arthritis
Dosage: This medication is not commonly used for rheumatoid arthritis. Consult your healthcare provider for alternative treatments.
Psoriasis
Dosage: This medication is not typically used for psoriasis. Consult your healthcare provider for alternative treatments.
Ankylosing Spondylitis
Dosage: This medication is not commonly used for ankylosing spondylitis. Consult your healthcare provider for alternative treatments.
Systemic Lupus Erythematosus
Dosage: This medication is not typically used for lupus. Consult your healthcare provider for alternative treatments.
Myasthenia Gravis
Dosage: This medication is not commonly used for myasthenia gravis. Consult your healthcare provider for alternative treatments.
Vasculitis
Dosage: This medication is not typically used for vasculitis. Consult your healthcare provider for alternative treatments.
Scleroderma
Dosage: This medication is not commonly used for scleroderma. Consult your healthcare provider for alternative treatments.
Dosage Forms and Strengths
Intravenous (IV) infusion: 300 mg/15 mL solution
Natalizumab Infusion Process and Administration Instructions
Natalizumab is administered as an intravenous (IV) infusion, meaning it is delivered directly into a vein. The infusion typically lasts about one hour, and patients are monitored for side effects for at least one hour afterward. It is crucial to follow your healthcare provider’s instructions and attend all scheduled infusion appointments. If you miss a dose, contact your doctor immediately to reschedule.
Contraindications for Natalizumab
A contraindication is a specific condition or situation where a treatment or medication should not be used because it may cause harm. For Natalizumab, several important contraindications include:
- Progressive Multifocal Leukoencephalopathy (PML): Natalizumab is contraindicated in patients with a history of PML, a rare but serious brain infection caused by the JC virus. Natalizumab increases the risk of this life-threatening infection.
- Compromised Immune System: Patients with weakened immune systems (due to conditions like HIV or medications like chemotherapy) should not take Natalizumab, as it can further suppress immune function and increase infection risk.
- Hypersensitivity to Natalizumab: If you have had an allergic reaction to Natalizumab or any of its ingredients, you should not take this medication. Severe allergic reactions may include difficulty breathing, swelling, and rash.
- Active Infections: If you have an active infection, Natalizumab should be avoided until the infection is resolved, as it can impair your body’s ability to fight infections.
Drug-to-Drug Interactions with Natalizumab
Several medications can interact with Natalizumab, potentially increasing the risk of side effects or reducing the effectiveness of either drug. Always inform your healthcare provider about all medications you are taking, including over-the-counter drugs and supplements. Known interactions include:
- Immunosuppressants: Medications like azathioprine (Imuran), methotrexate (Trexall), or cyclosporine (Neoral) can increase the risk of infections when used with Natalizumab.
- TNF inhibitors: Drugs such as infliximab (Remicade), adalimumab (Humira), and etanercept (Enbrel) can increase the risk of serious infections when taken with Natalizumab.
- Corticosteroids: High doses of corticosteroids like prednisone (Deltasone) may increase the risk of infections when combined with Natalizumab.
Natalizumab in Pregnancy
Is it safe to take Natalizumab when pregnant?
The safety of Natalizumab during pregnancy is not fully understood. Some research suggests that the medication may cross the placenta and potentially affect the developing baby, particularly during the third trimester. However, in certain situations, the benefits of continuing Natalizumab may outweigh the risks, especially for individuals with severe multiple sclerosis or Crohn’s disease. It is essential to have a thorough discussion with your healthcare provider to weigh the risks and benefits before starting or continuing Natalizumab during pregnancy. If you are pregnant or planning to become pregnant, our telemedicine providers are available to help you make an informed decision.
Natalizumab While Breastfeeding
Is it safe to take Natalizumab while breastfeeding?
There is limited information on whether Natalizumab passes into breast milk. Some studies suggest that small amounts of the drug may be present in breast milk, but the potential effects on a breastfeeding infant are not well understood. If you are breastfeeding or planning to breastfeed, it is important to carefully consider the potential risks and benefits with your healthcare provider. Our telemedicine team can offer personalized guidance on whether to continue Natalizumab while breastfeeding, based on your specific circumstances.
Estimated Cost of Natalizumab
The estimated cost of a 30-day supply of Natalizumab (typically administered as an infusion every 4 weeks) without insurance can range from $6,000 to $8,000. However, using a GoodRx coupon may help reduce the cost. It is important to check with your pharmacy for the most accurate pricing, as costs can vary.
Possible Alternatives to Natalizumab
If Natalizumab is not the right option for you, there are alternative treatments and lifestyle modifications that may help manage your condition. Always consult your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are available to help you explore these alternatives.
Multiple Sclerosis Treatment Alternatives
Alternative treatments include medications such as interferon beta (Avonex, Rebif), glatiramer acetate (Copaxone), or oral therapies like dimethyl fumarate (Tecfidera). In addition, lifestyle changes such as regular exercise, a balanced diet, and stress management can also help alleviate symptoms.
Crohn’s Disease Treatment Alternatives
Alternative options include medications like infliximab (Remicade), adalimumab (Humira), or ustekinumab (Stelara). Dietary adjustments, such as reducing dairy and high-fiber foods, may also help manage symptoms.
Ulcerative Colitis Treatment Alternatives
Alternatives include mesalamine (Asacol), infliximab (Remicade), or vedolizumab (Entyvio). Dietary modifications and stress management techniques may also provide symptom relief.
Rheumatoid Arthritis Treatment Alternatives
Alternative treatments include methotrexate (Trexall), leflunomide (Arava), or biologics like etanercept (Enbrel). Regular physical activity and a healthy diet can also help reduce inflammation and improve overall well-being.
Psoriasis Treatment Alternatives
Alternatives include topical treatments such as corticosteroids, phototherapy, or biologics like secukinumab (Cosentyx). Maintaining a healthy weight and avoiding triggers like stress and smoking can also help manage symptoms.
Ankylosing Spondylitis Treatment Alternatives
Alternative treatments include NSAIDs like ibuprofen (Advil), biologics such as adalimumab (Humira), and physical therapy. Regular exercise and maintaining good posture can also help alleviate symptoms.
Systemic Lupus Erythematosus Treatment Alternatives
Alternatives include hydroxychloroquine (Plaquenil), corticosteroids, or immunosuppressants like azathioprine (Imuran). Sun protection and stress management are also important lifestyle changes that can help manage the condition.
Myasthenia Gravis Treatment Alternatives
Alternative treatments include medications like pyridostigmine (Mestinon), corticosteroids, or immunosuppressants such as azathioprine (Imuran). Regular rest and avoiding overexertion can also help manage symptoms.
Vasculitis Treatment Alternatives
Alternatives include corticosteroids, immunosuppressants like cyclophosphamide (Cytoxan), or biologics such as rituximab (Rituxan). Managing stress and avoiding smoking can also improve outcomes.
Scleroderma Treatment Alternatives
Alternative treatments include medications like methotrexate (Trexall), mycophenolate mofetil (CellCept), or vasodilators. Physical therapy and maintaining a consistent skin care routine can also help manage symptoms.
Recent Updates on Natalizumab Research
Recent studies on Natalizumab have focused on its long-term safety and effectiveness, particularly in treating multiple sclerosis (MS). Ongoing research is exploring ways to reduce the risk of progressive multifocal leukoencephalopathy (PML), a serious brain infection associated with Natalizumab use. Some studies are investigating biomarkers that could help identify patients at higher risk for PML, allowing for more personalized treatment plans. Additionally, research is being conducted to determine whether extending dosing intervals (e.g., every 6 weeks instead of every 4 weeks) may reduce the risk of side effects while maintaining the drug’s effectiveness. If you are interested in learning more about these updates, our telemedicine providers can discuss how the latest research may impact your treatment plan.
