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Sphingosine-1-phosphate receptor 1 modulator

Ponesimod

Brand names: Ponvory

Adult dose

Dose: Day 1–14 dose-titration pack from 2mg OD up to 20mg OD
Route: PO
Frequency: OD

Clinical pearls

  • Active relapsing MS
  • Pre-treatment ECG, ophthalmic, VZV, LFTs; first-dose monitoring

Contraindications

  • Recent (≤6mo) MI/stroke/severe HF
  • Mobitz II or higher AV block without pacemaker
  • Severe untreated sleep apnoea
  • Pregnancy

Side effects

  • First-dose bradycardia/AV block
  • Hepatotoxicity
  • Macular oedema
  • Infections
  • Reduced FEV1

Interactions

  • β-blockers
  • Antiarrhythmics
  • Live vaccines

Monitoring

  • LFTs
  • FBC
  • BP
  • Ophthalmic
  • ECG

Reference: BNF; NICE TA767; SmPC; https://bnf.nice.org.uk/drugs/ponesimod/. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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