Teriflunomide is a medication used to treat relapsing forms of multiple sclerosis (MS). Its primary indications include:

Relapsing-Remitting Multiple Sclerosis (RRMS):

Teriflunomide is approved for the treatment of RRMS, the most common form of MS characterized by periods of relapses or exacerbations followed by periods of remission.

Clinically Isolated Syndrome (CIS):

Teriflunomide may also be prescribed for individuals with CIS, which refers to the first episode of neurological symptoms caused by inflammation or demyelination in the central nervous system. It is used in cases where there is a high risk of developing clinically definite MS.

Active Secondary Progressive MS with Relapses:

In some cases, teriflunomide may be considered for individuals with active secondary progressive MS who continue to experience relapses.

Mechanism of Action:

Teriflunomide works by inhibiting the enzyme dihydroorotate dehydrogenase, which is involved in the synthesis of DNA. By interfering with this process, the medication reduces the proliferation of rapidly dividing cells, including activated immune cells. This, in turn, helps modulate the immune response, reducing the frequency of relapses and slowing down the progression of disability associated with MS.

Teriflunomide does not cure MS, but it aims to manage the disease and improve the overall quality of life for individuals with relapsing forms of the condition. As with any medication, it is important for individuals prescribed teriflunomide to closely follow their healthcare provider's instructions and report any concerns or side effects promptly.

Taking teriflunomide involves several important considerations, and it's crucial to follow your healthcare provider's instructions carefully. Here is a general guide on how to take teriflunomide:

Prescription and Dosage:

• Teriflunomide is available by prescription only, and your healthcare provider will determine the appropriate dosage for your specific condition.
• Follow the prescribed dosage and administration schedule exactly as directed.

Before Starting Teriflunomide:

• Inform your healthcare provider about any other medications, vitamins, or supplements you are currently taking, as some medications may interact with teriflunomide.
• Discuss your medical history, especially any history of liver problems.

Pregnancy Considerations:

• If you are a woman of childbearing age, discuss contraception methods with your healthcare provider, as teriflunomide can potentially harm a developing fetus.
• If you are planning to become pregnant or suspect you might be pregnant, inform your healthcare provider. They may recommend a washout procedure to eliminate teriflunomide from your system before conception.

Administration:

• Teriflunomide is usually taken orally, typically as a tablet, once a day.
• You can take teriflunomide with or without food, as directed by your healthcare provider.
• Swallow the tablet whole with water; do not crush or break it.

Regular Monitoring:

• Your healthcare provider may order regular blood tests to monitor your liver function while you are taking teriflunomide. This is important to detect and manage any potential side effects.

If you miss a dose of Teriflunomide, the general recommendation is to take the missed dose as soon as you remember, unless it's close to the time for your next scheduled dose. In that case, you should skip the missed dose and continue with your regular dosing schedule. It's important not to double up on doses to make up for a missed one.

Here are some general guidelines:

1. If you remember within 24 hours of the missed dose: Take the missed dose as soon as you remember.
2. If it's close to the time for your next scheduled dose: Skip the missed dose and take the next dose at the usual time.
3. Do not take a double dose: Do not take extra medication to make up for a missed dose. Taking more than the prescribed amount can increase the risk of side effects.

If you have questions or concerns about what to do if you miss a dose of Teriflunomide, it's important to contact your healthcare provider or pharmacist for guidance. They can provide personalised advice based on your specific medical situation.

Consistent and regular use of Teriflunomide is crucial for its effectiveness in managing multiple sclerosis. If you find that you frequently miss doses or have difficulty adhering to your medication schedule, discuss this with your healthcare provider. They may be able to provide additional support or suggest strategies to help you stay on track with your treatment plan.

In case of a suspected overdose of Teriflunomide, it's essential to seek immediate medical attention or contact a poison control centre. Overdosing on Teriflunomide can potentially lead to an increased risk of adverse effects.

Symptoms of an overdose of Teriflunomide may include :

1. Nausea and vomiting
2. Diarrhea
3. Liver problems
4. Decreased blood cell counts
5. Infection

It's important to note that there is no specific antidote for Teriflunomide, and treatment would typically involve supportive measures to manage symptoms and potentially remove the drug from the body. This may include activated charcoal or cholestyramine to hasten the elimination of Teriflunomide. If you suspect an overdose or experience severe side effects, seek emergency medical attention immediately. Do not wait to see if symptoms resolve on their own. As with any medication, it's crucial to take Teriflunomide exactly as prescribed by your healthcare provider. If you have concerns about your medication or experience side effects, contact your healthcare provider for guidance. Additionally, if you are taking other medications, make sure your healthcare provider is aware of them to prevent potential drug interactions.

Proper storage of medications is important to ensure their effectiveness and safety. Here are general guidelines for storing Teriflunomide:

1. Temperature: Store Teriflunomide at room temperature, typically between 20°C to 25°C.
2. Protect from Light: Keep Teriflunomide in its original packaging to protect it from light.
3. Keep the Container Closed: Store Teriflunomide in a tightly closed container to prevent moisture from affecting the medication.
4. Dry Environment: Store the medication in a dry place. Avoid areas with high humidity, such as bathrooms.
5. Keep Out of Reach of Children: Store Teriflunomide in a location that is out of reach of children and pets.

Always follow any specific storage instructions provided by your healthcare provider, pharmacist, or on the medication's packaging. If you have any doubts about the storage conditions, consult with your healthcare provider or pharmacist for guidance.

It's important to note that Teriflunomide is often prescribed for the long-term management of multiple sclerosis, so proper storage habits are crucial for maintaining the medication's stability and effectiveness over time. If you have concerns about the storage of your Teriflunomide or any other medication, do not hesitate to seek guidance from your healthcare provider or pharmacist.

Teriflunomide, like any medication, can cause side effects. It's important to be aware of potential side effects and to report any unusual or severe reactions to your healthcare provider. Common side effects may occur, but not everyone will experience them. Some of the potential side effects of Teriflunomide include:

1. Elevated Liver Enzymes: Teriflunomide can affect the liver, and routine monitoring of liver function is typically recommended. Your healthcare provider may perform blood tests to check liver enzyme levels.
2. Diarrhea: Diarrhea is a relatively common side effect of Teriflunomide. If persistent or severe, inform your healthcare provider.
3. Hair Loss: Some people may experience hair thinning or hair loss while taking Teriflunomide.
4. Nausea: Nausea can occur as a side effect of Teriflunomide. If you find this symptom bothersome, discuss it with your healthcare provider.
5. Headache: Headaches are reported by some individuals taking Teriflunomide.
6. Increased Blood Pressure: Teriflunomide may cause a slight increase in blood pressure. Regular blood pressure monitoring may be recommended.

It's important to note that this is not an exhaustive list, and individual responses to medications can vary. Some side effects may be temporary and mild, while others may require medical attention. If you experience severe or persistent side effects or if you have concerns about any symptoms, contact your healthcare provider.

Additionally, because Teriflunomide can have effects on the liver, your healthcare provider will likely monitor liver function regularly with blood tests during the course of treatment. If you have any questions about the side effects of Teriflunomide, it's recommended that you discuss them with your healthcare provider.

Teriflunomide, like many medications, can interact with other drugs, potentially affecting their efficacy or increasing the risk of side effects. It's important to inform your healthcare provider about all medications, supplements, and herbal products you are taking to minimise the risk of interactions. Here are some examples of potential interactions with Teriflunomide:

1. Other Immunosuppressive Drugs: Concurrent use of other immunosuppressive drugs, such as azathioprine or leflunomide, may increase the risk of immunosuppression-related side effects.
2. Live Vaccines: Teriflunomide may affect the immune response to live vaccines. It is generally recommended to avoid live vaccines while on Teriflunomide treatment.
3. Drugs Metabolised by CYP2C8 Enzyme: Teriflunomide is metabolised by the cytochrome P450 enzyme CYP2C8. Drugs that affect the activity of this enzyme may impact Teriflunomide levels. However, clinically significant interactions with CYP2C8 inhibitors or inducers are not well established.
4. Drugs that Affect the Liver: Teriflunomide can affect the liver, and drugs that also impact the liver may increase the risk of liver-related side effects. Close monitoring of liver function is typically recommended.
5. Cholestyramine: Cholestyramine is a drug that can be used to hasten the elimination of Teriflunomide from the body, particularly in cases where rapid removal is necessary, such as in the case of pregnancy planning.

Always consult with your healthcare provider before starting, stopping, or adjusting the dosage of any medication while taking Teriflunomide. Your healthcare provider will consider potential interactions and make adjustments to your treatment plan as needed. Additionally, they may monitor you for signs of side effects or toxicity, especially if you are taking other medications concurrently.

This information is not exhaustive, and individual cases may vary. Your healthcare provider is the best source for personalised advice regarding drug interactions based on your specific medical history and current medications.

How does Teriflunomide work?

Teriflunomide is an immunomodulatory drug that inhibits dihydroorotate dehydrogenase, an enzyme involved in the de novo pyrimidine synthesis pathway. By interfering with this pathway, Teriflunomide helps reduce the proliferation of activated lymphocytes, which play a role in the autoimmune response associated with MS.

Are there any specific monitoring requirements while on Teriflunomide?

Regular monitoring of liver function and blood cell counts is often recommended during treatment with Teriflunomide due to potential side effects on the liver and bone marrow.

Can Teriflunomide be used during pregnancy?

Teriflunomide is contraindicated in pregnancy due to the risk of fetal harm. Women of childbearing potential should use reliable contraception during and after treatment, and a drug elimination procedure with cholestyramine may be used to expedite the removal of Teriflunomide from the body if pregnancy is planned.

Ace provides accurate and independent information medically reviewed on prescription medications. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.