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Fingolimod Medication: Uses, Dosage, and Side Effects Explained
Summary of Key Points
Fingolimod is a prescription medication primarily used to treat multiple sclerosis (MS) and other autoimmune conditions that affect the nervous system. It works by reducing the immune system’s attack on the brain and spinal cord, helping to prevent relapses and slow the progression of the disease. Fingolimod is taken as a once-daily oral capsule. Always consult your healthcare provider before starting or making any changes to your medication regimen.
Names of Medication
US Brand Name: Gilenya
Generic Name: Fingolimod
The generic name refers to the active ingredient in the medication, while the brand name is assigned by the manufacturer. In this article, the generic name will be listed in parentheses for clarity.
Pharmacologic Category
Sphingosine 1-phosphate receptor modulator
Fingolimod Dosage Recommendations
Fingolimod is prescribed for several conditions related to the nervous system, particularly those where the immune system attacks the brain and spinal cord. Below are the dosing recommendations for adults. Always consult your doctor before making any adjustments to your dose. If you need further guidance, you can schedule a telemedicine appointment with one of our healthcare providers.
Fingolimod for Multiple Sclerosis (Relapsing Forms)
Dosage: 0.5 mg orally once daily
Length of Treatment: Long-term, as directed by your doctor
Fingolimod for Secondary Progressive Multiple Sclerosis
Dosage: 0.5 mg orally once daily
Length of Treatment: Long-term, as directed by your doctor
Fingolimod for Primary Progressive Multiple Sclerosis
Dosage: 0.5 mg orally once daily
Length of Treatment: Long-term, as directed by your doctor
Fingolimod for Neuromyelitis Optica
Dosage: 0.5 mg orally once daily
Length of Treatment: Long-term, as directed by your doctor
Fingolimod for Optic Neuritis
Dosage: 0.5 mg orally once daily
Length of Treatment: Long-term, as directed by your doctor
Fingolimod for Transverse Myelitis
Dosage: 0.5 mg orally once daily
Length of Treatment: Long-term, as directed by your doctor
Fingolimod for Acute Disseminated Encephalomyelitis
Dosage: 0.5 mg orally once daily
Length of Treatment: Long-term, as directed by your doctor
Fingolimod for Autoimmune Encephalitis
Dosage: 0.5 mg orally once daily
Length of Treatment: Long-term, as directed by your doctor
Fingolimod for Chronic Inflammatory Demyelinating Polyneuropathy
Dosage: 0.5 mg orally once daily
Length of Treatment: Long-term, as directed by your doctor
Dosage Forms and Strengths
Capsules: 0.5 mg
Fingolimod Administration Instructions
Fingolimod should be taken once daily, with or without food. Swallow the capsule whole with water. Do not crush, chew, or break the capsule. It’s important to take the medication at the same time each day to maintain consistent levels in your body. If you miss a dose, take it as soon as you remember. However, if it’s almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not take two doses at once.
Fingolimod Contraindications
A contraindication is a condition where a medication should not be used because it may cause harm. Fingolimod has several contraindications, meaning it may be unsafe for certain individuals. Below is a list of common contraindications for Fingolimod and the reasons why it is not recommended in these cases.
Recent heart attack or stroke: Fingolimod can slow the heart rate, which may worsen heart conditions, especially if you’ve had a heart attack or stroke within the last six months.
Severe heart failure: People with severe heart failure may experience worsening symptoms because Fingolimod can affect heart function.
Uncontrolled high blood pressure: Fingolimod can raise blood pressure, which could be dangerous for individuals whose blood pressure is not well-controlled.
Severe liver disease: Fingolimod is processed by the liver, and individuals with severe liver disease may not be able to metabolize the drug safely, leading to potential toxicity.
Severe infections: Fingolimod suppresses the immune system, which can make it harder for your body to fight off infections. If you have an active or severe infection, taking Fingolimod could worsen your condition.
Pregnancy: Fingolimod is not recommended during pregnancy because it may harm the developing fetus (more details in the pregnancy section below).
Fingolimod Drug Interactions
Fingolimod can interact with other medications, increasing the risk of side effects or reducing the effectiveness of either Fingolimod or the other drugs. It’s important to inform your healthcare provider about all the medications you are taking, including over-the-counter drugs and supplements. Some medications that may interact with Fingolimod include:
Ketoconazole (Nizoral): This antifungal medication can increase Fingolimod levels in your blood, raising the risk of side effects.
Beta-blockers (e.g., Metoprolol, Atenolol): These medications are used to treat high blood pressure and heart conditions. When taken with Fingolimod, they can further slow your heart rate.
Antiarrhythmics (e.g., Amiodarone, Sotalol): These drugs are used to treat irregular heartbeats. Combining them with Fingolimod may increase the risk of dangerous heart rhythm problems.
Immunosuppressants (e.g., Azathioprine, Cyclosporine): Since Fingolimod also suppresses the immune system, taking it with other immunosuppressants can increase the risk of infections.
Live vaccines: Fingolimod weakens the immune system, so live vaccines (such as the MMR or chickenpox vaccine) may not work as effectively or could cause an infection.
Fingolimod in Pregnancy
Is it Safe to Take Fingolimod When Pregnant?
No, Fingolimod is not considered safe during pregnancy. Research suggests it may harm the developing fetus, potentially leading to birth defects. If you are pregnant or planning to become pregnant, it is essential to discuss alternative treatment options with your healthcare provider. Women of childbearing age should use reliable contraception while taking Fingolimod and continue doing so for at least two months after discontinuing the medication.
Fingolimod While Breastfeeding
Is it Safe to Take Fingolimod While Breastfeeding?
Fingolimod is not recommended during breastfeeding. Although there is limited data on whether Fingolimod passes into breast milk, its immune-suppressing properties could potentially affect the baby’s immune system. If you are breastfeeding or planning to breastfeed, consult your healthcare provider to weigh the risks and benefits of continuing Fingolimod during this time.
Estimated Cost of Fingolimod Medication
The cost of a 30-day supply of Fingolimod without insurance can vary. With a GoodRx coupon, the price typically ranges between $6,000 and $7,000. Be sure to check GoodRx or other discount programs for the most up-to-date pricing. Additionally, speak with your healthcare provider about financial assistance programs that may be available to help manage the cost.
Possible Alternatives to Fingolimod
If Fingolimod is not suitable for you, or if you are exploring other treatment options, several alternatives are available depending on your specific condition. Always consult your healthcare provider before making any changes to your treatment plan. You can also schedule a telemedicine appointment with one of our providers to discuss your options in more detail.
Multiple Sclerosis (MS): Other disease-modifying therapies (DMTs) such as Ocrelizumab (Ocrevus), Dimethyl fumarate (Tecfidera), or Glatiramer acetate (Copaxone) may be considered. In addition to medication, lifestyle changes like regular exercise, a balanced diet, and stress management can help manage symptoms.
Relapsing Forms of MS: Medications such as Natalizumab (Tysabri) or Alemtuzumab (Lemtrada) may be viable alternatives. Physical therapy and cognitive rehabilitation can also play a role in managing symptoms and improving quality of life.
Secondary Progressive MS: Siponimod (Mayzent) or Cladribine (Mavenclad) are potential alternatives. Maintaining a healthy lifestyle, including quitting smoking and staying physically active, may help slow disease progression.
Primary Progressive MS: Ocrelizumab (Ocrevus) is currently the only FDA-approved treatment for primary progressive MS. Physical therapy and assistive devices may also help improve mobility and overall quality of life.
Neuromyelitis Optica: Rituximab (Rituxan) or Eculizumab (Soliris) are commonly used to treat this condition. Early treatment is crucial to prevent relapses and reduce the risk of long-term disability.
Optic Neuritis: High-dose corticosteroids are typically used to reduce inflammation and speed up recovery. Vision rehabilitation therapy may also be beneficial in restoring visual function.
Transverse Myelitis: Treatment often includes corticosteroids and plasma exchange. Physical therapy can help improve mobility and regain strength.
Acute Disseminated Encephalomyelitis (ADEM): High-dose corticosteroids are the first line of treatment. In more severe cases, intravenous immunoglobulin (IVIG) or plasma exchange may be considered.
Autoimmune Encephalitis: Treatment may involve corticosteroids, IVIG, or Rituximab (Rituxan). Supportive care, including physical and cognitive therapy, is also important for recovery.
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP): Common treatments include IVIG, corticosteroids, or plasma exchange. Physical therapy can help maintain muscle strength and improve mobility.
Recent Updates on Fingolimod Research
Recent studies on Fingolimod have focused on its long-term safety and effectiveness in treating relapsing forms of multiple sclerosis. A 2022 study published in the journal Multiple Sclerosis and Related Disorders found that patients who had been on Fingolimod for over 10 years experienced sustained reductions in relapse rates and slower progression of disability. However, the study also highlighted the importance of regular monitoring for potential side effects, particularly those affecting the heart and liver.
Ongoing research is also investigating Fingolimod’s potential use in other autoimmune conditions, such as neuromyelitis optica and autoimmune encephalitis. While early results are promising, more clinical trials are needed to confirm its effectiveness in these conditions.
If you are interested in learning more about the latest research or have questions about your treatment options, consider scheduling a telemedicine appointment with one of our providers today.
