SIPONIMOD

Siponimod is an oral selective sphingosine-1-phosphate receptor modulator. It works by retaining certain white blood cells in lymph nodes, reducing their migration into the central nervous system. This action helps to decrease the inflammation and damage associated with multiple sclerosis.

Indications

Treatment of relapsing forms of multiple sclerosis (MS), including secondary progressive multiple sclerosis (SPMS) with active disease.

Dosage

- Initial dose titration is recommended to reduce the risk of heart-related side effects. - Typical maintenance dose: 2 mg once daily (adjusted based on patient response and tolerability). - Dose adjustments may be needed for patients with liver impairment, CYP2C9 genetic variants, or other concomitant medications.

Contra-Indications

- History of serious heart conditions (e.g., recent myocardial infarction, unstable angina, heart failure). - Severe liver impairment. - Immunocompromised patients or active infections. - Pregnancy and breastfeeding unless clearly necessary. - Hypersensitivity to siponimod or any of its components.

Special Precautions

- Monitor heart rate and ECG during initiation. - Screen for varicella zoster virus (VZV) immunity before starting. - Monitor blood pressure, liver function, and blood counts periodically. - Avoid live vaccines during treatment. - Caution in patients with macular edema, lung disease, or seizures.

Side Effects

- Common: headache, high blood pressure, liver enzyme elevation, fatigue, dizziness, diarrhea. - Serious: bradycardia, infections, macular edema, liver injury, skin cancer risk, heart rhythm disturbances.

Drug Interactions

- CYP2C9 and CYP3A4 inhibitors/inducers can affect drug levels. - Other immunosuppressants may increase infection risk. - Anti-arrhythmic drugs may increase risk of heart rhythm problems.