etrasimod arginine: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
etrasimod arginine: clinical details
Prescribing considerations
- Initiate under a clinician experienced in ulcerative colitis management.
- Review cardiac history, current infection, immune status, liver disease, respiratory disease, malignancy risk, vaccination status and interacting medicines.
- Use caution in older people because clinical experience is limited, and in adolescents with low body weight because exposure may be increased.
- Assess pregnancy status and provide contraception counselling where relevant.
- Consider protected sun exposure advice and investigate suspicious skin lesions promptly.
Contraindications and cautions
- Hypersensitivity to etrasimod or an excipient
- Immunodeficient state
- Recent myocardial infarction, unstable angina, stroke, transient ischaemic attack or specified severe heart failure
- Mobitz type II or third-degree AV block, sick sinus syndrome or sinoatrial block without a functioning pacemaker
- Severe active or active chronic infection, including active hepatitis or tuberculosis
- Active malignancy
- Severe hepatic impairment
- Pregnancy or childbearing potential without effective contraception
Monitoring
- Obtain a baseline ECG; selected cardiac patients require monitored treatment initiation.
- Check a recent full blood count including lymphocytes and repeat periodically.
- Check transaminases and bilirubin before and during treatment.
- Monitor blood pressure.
- Arrange ophthalmic assessment for patients at increased risk and assess all new visual symptoms.
- Remain alert for infection, neurological symptoms and suspicious skin lesions.
Clinical pharmacology
Etrasimod selectively modulates S1P receptors 1, 4 and 5, reversibly reducing lymphocyte egress from lymphoid organs. It is extensively metabolised through CYP2C8, CYP2C9 and CYP3A4 and eliminated mainly through hepatic pathways.
Formulation and product differences
- The selected UK product is a green, round film-coated tablet that must be swallowed whole.
- It contains tartrazine, which may cause allergic reactions.
- It is essentially sodium-free and may be supplied in blister or bottle packaging.
etrasimod arginine preparations and strengths
Tablet
Route: Oral
Strengths: 2 mg
etrasimod arginine interactions
The specialist and pharmacist should review prescription, non-prescription and herbal products before treatment.
Fluconazole or combined moderate-to-strong inhibitors of CYP2C8, CYP2C9 and CYP3A4
Inhibition of two or more relevant enzymes can increase etrasimod exposure, so combined use is not recommended.
Rifampicin, enzalutamide or combined moderate-to-strong CYP enzyme inducers
Induction of two or more relevant enzymes can reduce etrasimod exposure and is not recommended.
Beta blockers, rate-limiting calcium-channel blockers and medicines that prolong QT or slow cardiac conduction
Heart-rate and conduction effects may be additive; treatment review and sometimes cardiology advice are needed.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.