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Ozanimod

Generic Name: ozanimod (oh ZAN i mod)
Brand Name: Zeposia
Dosage Forms: oral capsule (0.23 mg-0.46 mg; 0.23 mg-0.46 mg-0.92 mg; 0.92 mg)

Medically reviewed by Philip Thornton, DipPharm. Last updated on March 29, 2021.

What is ozanimod?

Ozanimod is used to treat relapsing forms of multiple sclerosis in adults (including clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease).

Ozanimod is used only if you have a specific genotype. Your doctor will test you for this genotype.

It is not known if Ozanimod is safe and effective in children.

Warnings

You should not use ozanimod if you have a serious heart condition such as "AV block" or sick sinus syndrome and no pacemaker, or if you've recently had heart failure, a heart rhythm disorder, chest pain, heart attack, or stroke. You also should not use ozanimod if you have severe untreated sleep apnea.

Do not use ozanimod if you have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine. Wait at least 14 days after stopping an MAO inhibitor before you take this medicine.

Ozanimod can slow your heart rate when you start taking it. Tell your doctor if you have slow heartbeats, chest pain, shortness of breath, feeling like your heart is skipping beats.

You may get infections more easily, even serious or fatal infections. Call your doctor if you have a fever, chills, aches, tiredness, cough, rash, painful and frequent urination, confusion, neck stiffness, or increased sensitivity to light. Your risk of infection could last for 3 months after you stop taking this medicine.

Before taking this medicine

You should not use ozanimod if you are allergic to it, or if you have certain serious heart conditions, especially:

  • recent (within the past 6 months) heart failure, heart attack, stroke, "mini-stroke" or TIA, chest pain (unstable angina), or other serious heart problem;

  • "AV block" or sick sinus syndrome (unless you have a pacemaker); or

  • severe untreated sleep apnea (breathing stops during sleep).

Do not use ozanimod if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others. Wait at least 14 days after stopping an MAO inhibitor before you take ozanimod.

Some heart rhythm medications can cause unwanted or dangerous effects when used with ozanimod. Your doctor may change your treatment plan if you also use: amiodarone, disopyramide, dofetilide, dronedarone, flecainide, ibutilide, procainamide, propafenone, quinidine, or sotalol.

Before you take ozanimod, tell your doctor if you have never had chickenpox or if you have never received a varicella vaccine (Varivax). You may need to receive the vaccine and then wait 1 month before taking ozanimod.

Tell your doctor if you have received any vaccine within the past 30 days, or if you are scheduled to receive a vaccine.

Tell your doctor if you have a fever or infection, or if you have ever had:

Tell your doctor if you are pregnant or you plan to become pregnant. Ozanimod may harm an unborn baby. Use effective birth control to prevent pregnancy while you are using this medicine, and for at least 3 months after your last dose. Tell your doctor if you become pregnant during this time.

It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk.

How should I take ozanimod?

Take ozanimod exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.

Ozanimod can slow your heart rate when you start taking it. Before your first dose, your heart function will be checked using an electrocardiograph or ECG (sometimes called an EKG).

Ozanimod comes in a 7-day Starter pack containing capsules of different strengths. Taking these capsules as directed will increase your dose gradually during the first week.

You may take ozanimod with or without food. Avoid foods high in tyramine (aged, fermented, cured, smoked and pickled foods). Eating these foods while taking this medicine can raise your blood pressure.

You may get infections more easily, even serious or fatal infections. Call your doctor if you have symptoms such as fever, tiredness, cough, painful and frequent urination, neck stiffness, or increased sensitivity to light. Your risk of infection could last for 3 months after you stop taking ozanimod.

If you have get an infection, further doses may be delayed until your infection clears up.

If you stop taking ozanimod or miss a dose during the first 2 weeks, ask your doctor before you start taking the medicine again. You may need to use a 7-day Starter pack again, to gradually increase your dose.

Store at room temperature away from moisture and heat.

Always ask your doctor before you stop taking ozanimod for any reason. When you stop taking this medicine, your MS symptoms may return. In rare cases, some people who stopped taking ozanimod had MS symptoms that were worse than before or during treatment with this medicine. Watch for signs of worsening MS, and tell your doctor if you have any new or worsening symptoms.

Dosing information

Usual Adult Dose for Multiple Sclerosis:

DOSE TITRATION REGIMEN:
-Days 1 through 4: 0.23 mg orally once a day
-Days 5 through 7: 0.46 mg orally once daily
-Day 8 and thereafter: 0.92 mg orally once a day
MAINTENANCE DOSE: 0.92 mg orally once daily starting on Day 8

Use: For the treatment of relapsing forms of multiple sclerosis (MS), including clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease

What happens if I miss a dose?

Call your doctor for instructions. If you miss 1 or more doses in the first 2 weeks of treatment, you may need to start a new 7-day Starter pack.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking ozanimod?

Avoid getting a vaccine without first asking your doctor. While you are taking ozanimod, some vaccines may not work as well and may not fully protect you from disease.

Receiving a "live" vaccine while using ozanimod may cause you to develop an infection. Live vaccines include measles, mumps, rubella (MMR), polio, rotavirus, typhoid, yellow fever, varicella (chickenpox), zoster (shingles), and nasal flu (influenza) vaccine.

You should not receive a live vaccine within 1 month before taking ozanimod, while taking it, and for at least 3 months after you stop taking it.

Ozanimod side effects

Get emergency medical help if you have signs of an allergic reaction to ozanimod: hives, rash; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • slow heartbeats, chest pain, shortness of breath, feeling like your heart is skipping beats;

  • a light-headed feeling, like you might pass out;

  • cough, new or worsening shortness of breath;

  • sudden confusion, severe headache, or vision loss;

  • a seizure;

  • pounding in your neck or ears;

  • liver problems - nausea, vomiting, upper stomach pain, loss of appetite, dark urine, jaundice (yellowing of the skin or eyes);

  • changes in vision - blurred vision, increased sensitivity to light, seeing an unusual color in your vision, or having a blind spot or shadows in the center of your vision; or

  • symptoms of infection - fever, tiredness, cough, rash, increased urination, pain or burning when you urinate, neck stiffness, increased sensitivity to light.

Common ozanimod side effects may include:

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect ozanimod?

Ozanimod can cause a serious heart problem. Your risk may be higher if you also use certain other medicines for infections, asthma, heart problems, high blood pressure, depression, mental illness, cancer, malaria, or HIV.

Tell your doctor about all your other medicines, especially:

  • alemtuzumab, clopidogrel, eltrombopag, gemfibrozil, rifampin;

  • an antidepressant;

  • drugs that weaken the immune system such as cancer medicine, steroids, and medicines to prevent organ transplant rejection;

  • heart rhythm medicine;

  • medicine to treat Parkinson's disease; or

  • opioid pain medicine.

This list is not complete and many Other drugs interact with ozanimod. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Ozanimod can have long lasting effects on your body, especially on your immune system. For 3 or 4 weeks after your last dose, tell any doctor who treats you that you have used this medicine.

Popular FAQ

Ozanimod is a not a biologic it is a small-molecule S1P receptor modulator that binds specifically to two S1P receptors and is thought to block the ability of lymphocytes to escape out of the lymph nodes reducing their numbers in the blood, CNS, and inflamed tissue. Continue reading

The reason ozanimod may slow down your heart rate temporarily when you first start taking it is thought to be due to the action of ozanimod binding to one of the S1P receptors' subunits, S1P1R, which also has an effect of potassium channels in cardiac muscle cells. This reduces how responsive the cardiac cells are and reduces their firing rate, which slows down the heart. Continue reading

Ozanimod (Zeposia) works quickly, within a few months, although it may take up to a year for the full effects of significantly less disease progression, fewer relapses, and less brain atrophy than standard care to be seen. Continue reading

More FAQ

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use ozanimod only for the indication prescribed.

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