Multiple Sclerosis Treatments
MULTIPLE SCLEROSIS TREATMENTS
Generic Brand Strength Form Adult Dose
ORAL FORMS
cladribine Mavenclad 10mg tabs Give 3.5mg/kg cumulative dose divided into 2 yearly treatment courses (1.75mg/kg per treatment course). Each cycle: give 1–2 tabs once daily over 4–5 consecutive days. 1st course/1st cycle: start at any time; 1st course/2nd cycle: give 23–27 days after the last dose of 1st course/1st cycle. 2nd course/1st cycle: give ≥43wks after the last dose of 1st course/2nd cycle; 2nd course/2nd cycle: give 23–27 days after the last dose of 2nd course/1st cycle. 40–<50kg: 4 tabs per cycle; 50–<60kg: 5 tabs per cycle; 60–<70kg: 6 tabs per cycle; 70–<80kg: 7 tabs per cycle; 80–<90kg: 8 tabs in 1st cycle, then 7 tabs in 2nd cycle; 90–<100kg: 9 tabs in 1st cycle, then 8 tabs in 2nd cycle; 100–<110kg: 10 tabs in 1st cycle, then 9 tabs in 2nd cycle; ≥110kg: 10 tabs per cycle.
dimethyl
fumarate
Tecfidera 120mg, 240mg del-rel caps 120mg twice daily for 7 days, then increase to 240mg twice daily
fingolimod Gilenya 0.25mg, 0.5mg hard gel caps (>40kg): 0.5mg once daily; (≤40kg): 0.25mg once daily. First dose monitoring for bradycardia or re-initiation of therapy: see full labeling.
siponimod Mayzent 0.25mg, 2mg tabs Determine CYP2C9 genotype before initiation. CYP2C9 genotypes (*1/*1, *1/*2, or *2/*2): initially 0.25mg once daily on Day 1 and Day 2; 0.50mg once daily on Day 3; 0.75mg once daily on Day 4; then 1.25mg once daily on Day 5. Maintenance: 2mg once daily starting on Day 6. CYP2C9 genotypes (*1/*3 or *2/*3): initially 0.25mg once daily on Day 1 and Day 2; 0.50mg once daily on Day 3; then 0.75mg once daily on Day 4. Maintenance: 1mg once daily starting on Day 5. First dose 6hr monitoring for bradycardia, other abnormalities: see full labeling. Re-initiation of therapy after interruption for ≥4 days: start with Day 1 of titration regimen.
teriflun
omide
Aubagio 7mg, 14mg tabs 7mg or 14mg once daily
INJECTABLE FORMS
alemtuzumab Lemtrada 12mg/1.2mL soln for IV infusion after dilution ≥17yrs: Infuse over 4hrs. First course: 12mg daily for 5 consecutive days; Second course: 12mg daily for 3 consecutive days given 12mos after first course. May administer subsequent courses as needed (12mg daily for 3 consecutive days given ≥12mos after last dose of any prior courses). Premedications, herpetic prophylaxis: see drug monograph.
glatiramer acetate Copaxone 20mg/mL, 40mg/mL soln for SC inj 20mg SC once daily or 40mg SC three times weekly (at least 48hrs apart). The 20mg/mL and 40mg/mL injections are not interchangeable.
interferon β-1a Avonex 30mcg soln for IM inj 30mcg IM once weekly. May titrate dose to reduce severity of flu-like symptoms; give once weekly, IM: Week 1: 7.5mcg. Week 2: 15mcg. Week 3: 22.5mcg. Week 4: 30mcg.
Rebif 8.8mcg/0.2mL, 22mcg/0.5mL, 44mcg/0.5mL soln for SC inj 4.4mcg 3 times per week for 2wks, titrate to 22mcg 3 times per week by Week 5 OR 8.8mcg 3 times per week for 2wks, titrate to 44mcg 3 times per week by Week 5. Give by SC inj in PM at least 48hrs apart.
interferon β-1b Betaseron 0.3mg pwd for SC inj after reconstitution 0.0625mg (0.25mL) SC every other day; increase by 25% every 2wks to target dose of 0.25mg (1mL) every other day

Extavia
mitoxan
trone
2mg/mL soln for IV infusion after dilution 12mg/m² IV over approx. 5–15mins every 3mos. Patients with LVEF <50%, significant reduction in LVEF, cumulative lifetime dose of ≥140mg/m2: not recommended.
natalizumab Tysabri 300mg/15mL soln for IV infusion after dilution 300mg IV over 1hr every 4wks
ocrelizumab Ocrevus 30mg/mL soln for IV infusion after dilution Initially 300mg IV infusion, followed by a second 300mg infusion 2wks later, then 600mg infusion every 6mos thereafter. Premedicate with corticosteroid and antihistamine prior to each infusion; may consider antipyretic.
peginter
feron β‑1a
Plegridy 125mcg soln for SC inj Initially 63mcg on Day 1, increase to 94mcg on Day 15, then 125mcg on Day 29 and every 14 days thereafter. May give analgesics and/or antipyretics for flu‑like symptoms.
NOTES

Not an inclusive list of medications, dosing details and/or special considerations. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling.

(Rev. 6/2019)

This article originally appeared on MPR