Sphingosine-1-phosphate receptor modulator
Fingolimod
Brand names: Gilenya
Adult dose
Dose: 0.5mg PO OD
Route: PO
Frequency: OD
Clinical pearls
- Highly active relapsing-remitting MS
- Mandatory 6h cardiac monitoring after first dose; pre-treatment ECG, ophthalmic, VZV serology, LFTs
Contraindications
- Recent (≤6mo) MI/stroke/severe HF
- High-grade AV block without pacemaker
- Severe untreated sleep apnoea
- Active malignancy
- Pregnancy
- Severe hepatic impairment
Side effects
- Bradycardia/AV block (first-dose)
- Macular oedema
- Hepatotoxicity
- Hypertension
- Increased infection risk (incl. PML, cryptococcal meningitis, herpes)
- Reduced FEV1
Interactions
- β-blockers/CCBs (additive bradycardia)
- Live vaccines
- QT-prolonging drugs
- Other immunosuppressants
Monitoring
- LFTs
- FBC
- BP
- Ophthalmic
- ECG
- Pregnancy testing
Reference: BNF; NICE TA254; SmPC; https://bnf.nice.org.uk/drugs/fingolimod/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
Drugs
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