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Drug Interactions between diroximel fumarate and monomethyl fumarate

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

diroximel fumarate monomethyl fumarate

Applies to: diroximel fumarate and monomethyl fumarate

CONTRAINDICATED: Coadministration of monomethyl fumarate (MMF) or its prodrugs, dimethyl fumarate and diroximel fumarate, with one another or with other fumaric acid esters may result in elevated plasma concentrations of MMF and increase the risk of adverse effects such as lymphopenia, opportunistic infections (e.g., progressive multifocal leukoencephalopathy (PML), herpes zoster, herpes simplex, West Nile virus, cytomegalovirus, Candida, Aspergillus, Nocardia, Listeria monocytogenes, Mycobacterium tuberculosis), hepatotoxicity, and flushing. Both dimethyl fumarate and diroximel fumarate are metabolized to MMF, the primary active entity in the treatment of multiple sclerosis. Cases of Fanconi syndrome have been reported for a medicinal product containing dimethyl fumarate in combination with other fumaric acid esters.

MANAGEMENT: Coadministration of monomethyl fumarate, dimethyl fumarate, or diroximel fumarate with one another or with other fumaric acid esters is considered contraindicated. According to the prescribing information, treatment with monomethyl fumarate may be initiated the day following discontinuation of dimethyl fumarate or diroximel fumarate. Likewise, diroximel fumarate may be started the day after stopping dimethyl fumarate.

References (7)
  1. (2022) "Product Information. Vumerity (diroximel fumarate)." Biogen Australia Pty Ltd
  2. (2023) "Product Information. Tecfidera (dimethyl fumarate)." Biogen Idec Inc, SUPPL-29
  3. (2022) "Product Information. Tecfidera (dimethyl fumarate)." Biogen Idec Ltd
  4. (2022) "Product Information. Skilarence (dimethyl fumarate)." Almirall Ltd
  5. (2022) "Product Information. Vumerity (diroximel fumarate)." Biogen Idec Ltd
  6. (2023) "Product Information. Vumerity (diroximel fumarate)." Biogen Idec Inc, SUPPL-9
  7. (2022) "Product Information. Furatec (dimethyl fumarate)." Pharmacor Pty Ltd, 03

Drug and food interactions

Moderate

diroximel fumarate food

Applies to: diroximel fumarate

GENERALLY AVOID: Food does not significantly affect the oral bioavailability of diroximel fumarate. Administration of diroximel fumarate with a high-fat, high-calorie (900 to 1000 calories; 50% from fat) meal did not affect the systemic exposure (AUC) of its active metabolite, monomethyl fumarate (MMF), but decreased its peak plasma concentration (Cmax) by 44% and prolonged the time to reach peak concentration (Tmax) from 2.5 to 7.0 hours relative to administration in the fasted state. In comparison, administration of diroximel fumarate with low-fat, low-calorie (350 to 400 calories; 10 to 15 g fat) and medium-fat, medium-calorie (650 to 700 calories; 25 to 30 g fat) meals decreased the MMF Cmax by approximately 12% and 25%, respectively, while also leaving the AUC unaffected.

GENERALLY AVOID: Coadministration of diroximel fumarate with ethanol may reduce the plasma concentrations of monomethyl fumarate (MMF). The mechanism has not been reported. Following coadministration with 240 mL of 5% v/v and 40% v/v ethanol, the mean Cmax of MMF was reduced by 9% and 21%, respectively, relative to coadministration with water. The AUC of MMF was not significantly altered, indicating that ethanol did not induce dose dumping.

MANAGEMENT: Diroximel fumarate may be taken with or without food; however, high-fat, high-calorie meals or snacks should be avoided. The manufacturer recommends meals or snacks containing no more than 700 calories and no more than 30 grams of fat. Taking diroximel fumarate with food may improve tolerability for patients experiencing flushing or gastrointestinal adverse reactions. The manufacturer also recommends avoiding concomitant use of diroximel fumarate with ethanol.

References (3)
  1. (2022) "Product Information. Vumerity (diroximel fumarate)." Biogen Australia Pty Ltd
  2. (2022) "Product Information. Vumerity (diroximel fumarate)." Biogen Idec Ltd
  3. (2023) "Product Information. Vumerity (diroximel fumarate)." Biogen Idec Inc, SUPPL-9

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Fumaric acid

Therapeutic duplication

The recommended maximum number of medicines in the 'fumaric acid' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'fumaric acid' category:

  • diroximel fumarate
  • monomethyl fumarate

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer