ponesimod at a glance
Medicine class
Sphingosine-1-phosphate receptor modulator
Licensed use
Active relapsing forms of multiple sclerosis in adults
Administration
Film-coated tablets taken by mouth, with or without food
Starting treatment
Treatment begins with a stepwise initiation pack because heart rate may fall temporarily
What is ponesimod used for?
The selected product is licensed for:
Treating adults with relapsing forms of multiple sclerosis when disease is active, shown by relapses or imaging features.
How does ponesimod work?
Ponesimod binds selectively to sphingosine-1-phosphate receptor 1 on lymphocytes. This retains T and B lymphocytes in lymph nodes, reducing the number available to enter the central nervous system and contribute to inflammatory damage in multiple sclerosis.
ponesimod preparations and strengths
Tablet
Route: Oral
Strengths: 10 mg, 20 mg
How to take ponesimod
Take the film-coated tablet by mouth and follow the prescribed initiation pack carefully. It may be taken with or without food. Do not start, restart or stop ponesimod without instructions from the specialist team.
Use the tablets in the initiation pack in their labelled order.
Tell the specialist team about any interruption before restarting.
Stopping can be followed by renewed or occasionally severe multiple-sclerosis activity.
ponesimod side effects
Common or expected effects
- Nose, throat or upper-respiratory infections
- Raised liver enzymes on blood tests
- Reduced lymphocyte count
- High blood pressure
- Dizziness, tiredness or sleep disturbance
- Urinary or chest infections
- Breathlessness or cough
- Indigestion, back pain or joint pain
Get urgent medical advice
- Serious infection, including shingles or pneumonia
- Slow heartbeat or impaired electrical conduction in the heart
- Macular oedema causing blurred, wavy or altered central vision
- Significant liver injury
- Seizure
- Sudden severe neurological symptoms that may indicate posterior reversible encephalopathy syndrome
- A severe allergic reaction
ponesimod in pregnancy
Ponesimod is contraindicated during pregnancy. A negative pregnancy test is required before treatment, and effective contraception is required during treatment and for at least one week after stopping. If pregnancy occurs or is suspected, ponesimod must be stopped and the specialist contacted promptly; stopping should be medically planned because disease activity can return.
ponesimod while breastfeeding
Ponesimod should not be used while breastfeeding. It is unknown whether it enters human milk, and a risk to the infant cannot be excluded.
ponesimod interactions
The prescriber should review all medicines and planned vaccinations before ponesimod is started.
Beta-blockers, verapamil, diltiazem, digoxin and other heart-rate-lowering medicines
Effects on heart rate can add together, particularly when ponesimod is started, so specialist review and monitoring may be needed.
Class Ia or III anti-arrhythmics and medicines that prolong the QT interval
These may increase arrhythmia risk; cardiology advice may be required before treatment.
Anticancer, immune-modulating or immunosuppressive treatments, including corticosteroids
Combined immune effects may increase infection or immunosuppression risks, including when switching therapies.
Common questions about ponesimod
Answers are fully visible for fast scanning and source review.
Why does ponesimod require an ECG before treatment?
Ponesimod can temporarily slow the heartbeat and delay electrical conduction when treatment begins. An ECG identifies conduction problems and helps determine whether observation or cardiology advice is needed.
Does ponesimod weaken the immune system?
It lowers circulating lymphocytes by retaining them in lymph nodes. This therapeutic effect can also increase susceptibility to infection.
Can vaccines be given while taking ponesimod?
Some vaccines may work less well, and live vaccines may cause infection. Vaccination plans should be reviewed with the specialist before treatment or vaccination.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.