Teriflunomide

About Teriflunomide

Teriflunomide blocks an enzyme cells use to make pyrimidines, building blocks of DNA and RNA; the label says exactly how it helps in multiple sclerosis is unknown but may involve fewer activated immune cells in the brain and spinal cord. It is labeled for relapsing forms of MS in adults at 7 or 14 mg once a day. Headache, diarrhea, nausea, hair thinning and a raised ALT liver enzyme are the most common side effects.

Its boxed warning covers liver injury, including liver failure needing a transplant, and harm to an unborn baby. Liver tests are done within six months before starting and ALT at least monthly for six months; it is not used in severe liver impairment. Pregnancy is ruled out first, women who could become pregnant use effective birth control, and it is stopped if pregnancy occurs. Men who want to father a child are advised to stop it and clear it first.

It leaves the body slowly, taking about eight months on average and up to two years to fall to a very low level. An accelerated elimination procedure, an 11-day course of cholestyramine or activated charcoal powder by mouth, removes most of it, and a blood test confirms a very low level before a planned pregnancy. It is also used if liver injury is suspected or pregnancy occurs.

A blood count, a tuberculosis test and a blood pressure check come before starting. It can raise the risk of infection, cause numbness or tingling in the hands or feet, raise blood pressure and rarely cause serious skin or lung reactions.

Taking Teriflunomide

How to take it

Once a day at about the same time, with or without food. Do not stop it without your prescriber. After stopping, it can stay in the blood for up to two years unless the accelerated elimination procedure is used.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and continue as usual.

Storage

At room temperature, tightly closed, away from excess heat and moisture, and out of reach of children.

Interactions to know about

It must not be taken with leflunomide, a related arthritis medicine. It can weaken warfarin, so the INR is watched; it raises levels of some birth control pills, rosuvastatin (kept to 10 mg a day at most) and drugs such as repaglinide and pioglitazone, and lowers levels of duloxetine, theophylline and tizanidine. Other medicines that can harm the liver add to the risk, and live vaccines are not recommended.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Teriflunomide differs from pharmacy to pharmacy

Generic teriflunomide comes from many makers while Aubagio is still sold. Pharmacies price generics in different ways, some starting from what they paid plus a fee and others from published list prices, so quotes for the same tablet can differ widely. A prescription that names Aubagio without allowing substitution can only be filled with the brand.

Some pharmacies need to order it in. Liver blood tests, monthly at first, are a separate cost from the medicine.

Ways to pay less for Teriflunomide without insurance

• Make sure the prescription allows generic substitution, so you are quoted for generic teriflunomide rather than Aubagio.
• Compare quotes from more than one pharmacy for the same strength and quantity.
• Ask for a ninety-day supply once you are settled on treatment.
• If you need the brand, ask its maker about patient assistance.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Teriflunomide

1. 1.Is this generic teriflunomide at my prescribed strength?
2. 2.When are my liver tests due?
3. 3.Which signs of liver trouble or infection need a call straight away?
4. 4.What should I know about birth control and planning a family?
5. 5.Does it interact with my warfarin, statin or birth control?

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