Uses

Indicated for the treatment of relapsing forms of multiple sclerosis in adults, including clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease.

Do not use if

Contraindicated in patients with CYP2C9*3/*3 genotype; recent (within 6 months) myocardial infarction, unstable angina, stroke, TIA, decompensated heart failure, or Class III/IV heart failure; Mobitz type II second-degree or third-degree AV block; sick sinus syndrome or sinoatrial block without a pacemaker; and baseline QTc interval ≥500 msec.

Side effects

Common adverse effects include increased risk of infections, bradyarrhythmia and AV conduction delays at treatment initiation, macular edema, elevated liver enzymes, and respiratory effects. Progressive multifocal leukoencephalopathy has been reported.

Warnings

Obtain CYP2C9 genotyping before initiation. Monitor heart rate and rhythm for at least 6 hours after the first dose. Do not initiate in patients with active infection. Monitor for signs of macular edema, hepatic injury, and skin cancer. Withhold treatment if PML is suspected.

How it works

Siponimod is a sphingosine 1-phosphate (S1P) receptor modulator that binds with high affinity to S1P receptors 1 and 5. It blocks lymphocyte egress from lymph nodes, reducing peripheral lymphocyte counts and limiting CNS inflammatory infiltration.

Storage

Store at room temperature between 20°C and 25°C. Keep in the original blister packaging to protect from moisture.