Fumaric acid ester (immunomodulator)
Dimethyl fumarate
Brand names: Tecfidera, Skilarence (psoriasis)
Adult dose
Dose: MS: start 120mg BD for 7 days, then 240mg BD; Psoriasis: start 30mg/day, titrate per protocol to max 720mg/day
Route: Oral
Frequency: BD
Clinical pearls
- NICE TA320: relapsing-remitting MS; NICE TA475 psoriasis
- ABN MS-DMT prescribing guideline
- Monitor lymphocyte count; PML risk increases with prolonged severe lymphopaenia (<0.5)
- Diroximel fumarate is alternative with better GI tolerability
Contraindications
- Severe lymphopaenia
- Severe renal/hepatic impairment
- Active serious infection
- Pregnancy
- Hypersensitivity
Side effects
- Flushing (very common — give 30 min before with food, may co-administer aspirin 75mg)
- GI upset
- Lymphopaenia
- Progressive multifocal leukoencephalopathy (PML — JCV-associated)
- Hepatotoxicity
- Proteinuria
- Anaphylaxis (rare)
Interactions
- Other immunosuppressives
- Live vaccines
Monitoring
- FBC (especially lymphocytes)
- LFTs
- Renal function
- Urinalysis
- JCV antibody if prolonged lymphopaenia
- Pregnancy
Reference: BNF; NICE TA320; NICE TA475; ABN MS-DMT; SmPC; https://bnf.nice.org.uk/drugs/dimethyl-fumarate/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- PASI — Psoriasis Area and Severity Index · Diagnosis
- DLQI — Dermatology Life Quality Index · Diagnosis
- PASI Score (Psoriasis Area and Severity Index) · Psoriasis
- DLQI (Dermatology Life Quality Index) · Quality of Life
- Tumor Lysis Syndrome Risk (Cairo-Bishop) · Oncological Emergency
- Urine Anion Gap · Acid-Base
Pathways
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS