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Sphingosine-1-phosphate receptor 1/5 modulator

Siponimod

Brand names: Mayzent

Adult dose

Dose: Days 1-5 dose-titration pack to maintenance (1 or 2mg OD per CYP2C9 genotype)
Route: PO
Frequency: OD

Clinical pearls

  • Active secondary progressive MS
  • CYP2C9 genotype before; first-dose ECG monitoring

Contraindications

  • CYP2C9 *3/*3 genotype
  • Recent MI/stroke/severe HF (≤6mo)
  • Mobitz II / 3rd-degree AV block without pacemaker
  • Severe hepatic impairment
  • Pregnancy

Side effects

  • First-dose bradycardia/AV block
  • Macular oedema
  • Hepatotoxicity
  • Hypertension
  • Infections (incl. PML)
  • Reduced FEV1

Interactions

  • β-blockers
  • Antiarrhythmics
  • Live vaccines
  • CYP2C9/3A4 modulators

Monitoring

  • LFTs
  • FBC
  • BP
  • Ophthalmic
  • ECG

Reference: BNF; NICE TA656; SmPC; https://bnf.nice.org.uk/drugs/siponimod/. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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