Fumaric acid ester (prodrug of monomethyl fumarate)
Diroximel fumarate
Brand names: Vumerity
Adult dose
Dose: Start 231mg BD for 7 days, then 462mg BD
Route: Oral
Frequency: BD
Clinical pearls
- Relapsing-remitting MS — alternative to dimethyl fumarate with improved GI tolerability
- NICE TA evaluation; ABN MS-DMT guidance
- Same active metabolite (MMF) as dimethyl fumarate
Contraindications
- Severe lymphopaenia
- Active serious infection
- Severe renal/hepatic impairment
- Hypersensitivity
Side effects
- Flushing (less than dimethyl fumarate)
- GI events (less than dimethyl fumarate)
- Lymphopaenia
- PML (rare, JCV)
- Hepatotoxicity
Interactions
- Immunosuppressives
- Live vaccines
Monitoring
- FBC (lymphocytes)
- LFTs
- Renal
- JCV antibody if prolonged lymphopaenia
Reference: BNF; NICE TA evaluation; ABN MS-DMT; SmPC; https://bnf.nice.org.uk/drugs/diroximel-fumarate/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
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