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Dimethyl Fumarate: Uses, Dosage, and Side Effects Overview
Summary of Key Points
Dimethyl fumarate is a medication commonly used to treat autoimmune conditions such as multiple sclerosis and psoriasis. It works by modulating the immune system to reduce inflammation and prevent tissue damage. Common side effects include flushing and gastrointestinal discomfort. Always consult your healthcare provider before starting or adjusting your dosage. Our telemedicine providers are available to assist with managing your treatment plan.
Names of the Medication
US Brand Name: Tecfidera
Generic Name: Dimethyl fumarate
The generic name refers to the active ingredient, while the brand name is assigned by the manufacturer. The generic name is often listed in parentheses.
Pharmacologic Category
Categories:
- Immunomodulator
- Fumaric acid ester
Dimethyl Fumarate Dosage
Multiple Sclerosis (Relapsing Forms): The recommended starting dose is 120 mg taken orally twice daily for 7 days, followed by 240 mg twice daily. Treatment is typically long-term and should be continued as directed by your healthcare provider.
Psoriasis: The usual starting dose is 30 mg once daily, gradually increased over several weeks to a maintenance dose of 240 mg twice daily. The duration of treatment varies based on individual response and should be monitored by your doctor.
Psoriatic Arthritis: Begin with 120 mg twice daily, increasing to 240 mg twice daily after 7 days. Treatment is ongoing and should be adjusted according to your healthcare provider’s recommendations.
Crohn’s Disease: The initial dose is 120 mg twice daily, increasing to 240 mg twice daily after 7 days. The length of treatment depends on the severity of the condition and your response to the medication.
Ulcerative Colitis: Start with 120 mg twice daily for 7 days, followed by 240 mg twice daily. Your doctor will determine the appropriate treatment duration based on your symptoms and response.
Rheumatoid Arthritis: The recommended dose is 120 mg twice daily, increasing to 240 mg twice daily after 7 days. Treatment is typically long-term, with adjustments made by your healthcare provider as needed.
Ankylosing Spondylitis: Start with 120 mg twice daily, increasing to 240 mg twice daily after 7 days. The duration of treatment will be determined by your doctor based on your condition.
Atopic Dermatitis: The initial dose is 120 mg twice daily, increasing to 240 mg twice daily after 7 days. Treatment is ongoing and should be monitored by your healthcare provider.
Systemic Lupus Erythematosus: Begin with 120 mg twice daily, increasing to 240 mg twice daily after 7 days. The length of treatment depends on individual response and should be managed by your doctor.
Hidradenitis Suppurativa: The recommended dose is 120 mg twice daily, increasing to 240 mg twice daily after 7 days. Treatment is long-term and should be adjusted based on your healthcare provider’s advice.
Always consult your healthcare provider before making any changes to your Dimethyl fumarate dosage. If you need assistance, our telemedicine providers are available to help manage your treatment plan.
Dosage Forms and Strengths
Available Forms:
- Delayed-release capsules: 120 mg, 240 mg
Administration Instructions for Dimethyl Fumarate
Take Dimethyl fumarate with food to reduce the risk of gastrointestinal side effects. Swallow the capsules whole; do not crush, chew, or open them. If you miss a dose, take it as soon as you remember, unless it’s almost time for your next dose. In that case, skip the missed dose and continue with your regular schedule. Do not take two doses at the same time.
Adverse Reactions and Side Effects of Dimethyl Fumarate
Flushing: A common side effect that may cause warmth, redness, or itching, usually in the face or chest. This is generally mild and tends to decrease over time.
Gastrointestinal issues: Diarrhea, nausea, vomiting, and abdominal pain are common, especially when starting treatment. Taking the medication with food can help alleviate these symptoms.
Decreased white blood cell count (lymphopenia): This can increase the risk of infections. Your doctor will monitor your blood counts regularly to ensure your safety.
Liver function abnormalities: In rare cases, Dimethyl fumarate can affect liver function. Your doctor may periodically check your liver enzymes to monitor for any issues.
Allergic reactions: Though rare, serious allergic reactions can occur. Symptoms may include rash, itching, swelling, or difficulty breathing. Seek medical attention immediately if you experience any of these symptoms.
Contraindications for Dimethyl Fumarate
A contraindication is a specific situation where a medication should not be used because it may cause harm. It’s important to know if any of these conditions apply to you before starting a new medication. Below are the contraindications for taking Dimethyl fumarate:
Allergic reaction to Dimethyl fumarate or its ingredients: If you’ve had an allergic reaction to Dimethyl fumarate or any of its components, taking this medication again could lead to serious allergic reactions, including rash, itching, swelling, or difficulty breathing.
Severe active infections: Dimethyl fumarate can weaken your immune system, making it harder for your body to fight infections. If you have a serious infection, your healthcare provider may advise against starting Dimethyl fumarate until the infection is under control.
Low white blood cell count (lymphopenia): Dimethyl fumarate can further lower your white blood cell count, increasing your risk of infections. If you already have low white blood cells, this medication may not be safe for you.
Drug to Drug Interactions with Dimethyl Fumarate
Dimethyl fumarate can interact with other medications, potentially increasing side effects or reducing the effectiveness of your treatment. It’s important to inform your healthcare provider about all the medications you are taking, including over-the-counter drugs and supplements. Below are some medications that may interact with Dimethyl fumarate:
- Ampyra (dalfampridine): Taking these together may increase the risk of seizures.
- Gilenya (fingolimod): Combining these medications may raise the risk of infections due to their effects on the immune system.
- Tecfidera (dimethyl fumarate): Avoid taking multiple forms of this medication, as it can lead to overdose or more severe side effects.
- Immunosuppressants (e.g., azathioprine, methotrexate): These can further suppress your immune system, increasing the risk of infections.
Dimethyl Fumarate in Pregnancy
Is it safe to take Dimethyl fumarate during pregnancy? The safety of Dimethyl fumarate during pregnancy has not been fully established. While animal studies have shown some risks, data on its effects in pregnant women is limited. If you are pregnant or planning to become pregnant, it’s essential to discuss the potential risks and benefits with your healthcare provider. They may recommend alternative treatments or closely monitor your condition if Dimethyl fumarate is deemed necessary.
Dimethyl Fumarate While Breastfeeding
Is it safe to take Dimethyl fumarate while breastfeeding? There is limited information on whether Dimethyl fumarate passes into breast milk or its potential effects on a nursing infant. Given the unknown risks, it’s important to consult your healthcare provider before using Dimethyl fumarate while breastfeeding. They can help you weigh the benefits and risks and may suggest alternative treatments if needed.
Estimated Cost of Dimethyl Fumarate Medication
The estimated cost of a 30-day supply of Dimethyl fumarate without insurance ranges from $6,000 to $7,000. However, using a GoodRx coupon, the price may drop to around $2,000 to $3,000, depending on the pharmacy. Prices can vary, so it’s advisable to compare costs at different pharmacies or online.
Possible Alternatives to Dimethyl Fumarate
Several alternative treatments and lifestyle changes may help manage the conditions for which Dimethyl fumarate is prescribed. Always consult your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are available to help you explore these options.
- Multiple sclerosis: Alternatives include interferon beta (Avonex, Rebif), glatiramer acetate (Copaxone), or lifestyle changes such as regular exercise and a balanced diet to manage symptoms.
- Psoriasis: Consider topical treatments, phototherapy, or systemic medications like methotrexate or cyclosporine. Stress management and moisturizing can also help reduce flare-ups.
- Psoriatic arthritis: NSAIDs, biologics like adalimumab (Humira), or physical therapy can be effective alternatives.
- Crohn’s disease: Alternatives include biologics like infliximab (Remicade) or lifestyle changes, such as a low-residue diet, to manage symptoms.
- Ulcerative colitis: Mesalamine (Asacol) or corticosteroids may be used, along with dietary changes to reduce inflammation.
- Rheumatoid arthritis: DMARDs like methotrexate or biologics such as etanercept (Enbrel) are common alternatives.
- Ankylosing spondylitis: NSAIDs, biologics, or physical therapy can help manage symptoms.
- Atopic dermatitis: Topical corticosteroids, moisturizers, and avoiding triggers like allergens or harsh soaps can be effective alternatives.
- Systemic lupus erythematosus: Hydroxychloroquine (Plaquenil) or corticosteroids are common alternatives, along with lifestyle changes like sun protection and stress management.
- Hidradenitis suppurativa: Antibiotics, biologics, or surgical interventions may be considered, along with weight management and smoking cessation.
Recent Updates on Dimethyl Fumarate Research
Recent studies on Dimethyl fumarate have focused on its long-term safety and effectiveness in treating multiple sclerosis. A 2022 study found that patients using Dimethyl fumarate for over 10 years continued to experience reduced relapse rates and slower disease progression. Researchers are also investigating its potential use in other autoimmune conditions, such as psoriasis and Crohn’s disease. Ongoing trials are exploring whether Dimethyl fumarate can be combined with other therapies to improve outcomes in multiple sclerosis patients.
As research continues, staying informed about new developments is crucial. If you have questions or concerns about your treatment, our telemedicine providers are available to discuss the latest findings and how they may impact your care.
