Zeposia is a brand-name prescription medication. It’s FDA-approved to treat certain forms of relapsing multiple sclerosis (MS) in adults. “Relapsing” means becoming worse over time.

MS causes your immune system to mistakenly damage nerves that help your brain and body communicate. Exactly how MS affects the body varies from person to person. Some people don’t have any symptoms, while others can have chronic pain, weakness, or trouble walking.

To be specific, Zeposia is used to treat the following conditions:

  • Relapsing-remitting MS. With relapsing-remitting MS (RRMS), you have episodes of new or worsening symptoms, and then periods of very few or no MS symptoms.
  • Active secondary progressive MS. With active secondary progressive disease (SPMS), your MS symptoms steadily become worse, and you no longer have periods with few or no MS symptoms. RRMS can progress to SPMS over time.
  • Clinically isolated syndrome. Clinically isolated syndrome (CIS) isn’t actually a form of MS. With CIS, you typically have symptoms similar to those of MS for 24 hours or longer. CIS doesn’t always progress to MS.

Drug details

Zeposia contains the active drug ozanimod. Zeposia is in a class of medications known as immune modulators, which acts on the immune system. (A class of medications is a group of drugs that work in a similar way.)

Zeposia comes as a capsule that you swallow. It’s available in three strengths: 0.23 milligrams (mg), 0.46 mg, and 0.92 mg. You’ll likely take Zeposia once per day.

FDA approval

Zeposia was approved by the Food and Drug Administration (FDA) in March 2020.

Effectiveness

Clinical studies looked at people with relapsing MS who took either Zeposia or interferon beta-1a (Rebif) for 12 or 24 months. The Zeposia group had significantly lower relapse rates than the interferon beta-1a group.

For more information on the effectiveness of Zeposia, see the “Zeposia uses” section below.

Zeposia is available only as a brand-name medication. It’s not currently available in generic form.

A generic drug is an exact copy of the active drug in a brand-name medication. Generics usually cost less than brand-name drugs.

Zeposia contains the active drug ozanimod.

Zeposia can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Zeposia. These lists don’t include all possible side effects.

For more information on the possible side effects of Zeposia, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Zeposia, you can do so through MedWatch.

Mild side effects

Mild side effects of Zeposia can include:*

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

* This is a partial list of mild side effects from Zeposia. To learn about other mild side effects, talk with your doctor or pharmacist, or visit Zeposia’s Medication Guide.

Serious side effects

Serious side effects from Zeposia aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

  • Eye swelling. Symptoms can include:
    • blurry vision
    • vision loss
    • seeing faded or washed out colors
  • Posterior reversible encephalopathy syndrome (swelling in the brain). Symptoms can include:
    • vision loss
  • Cancer, such as breast cancer and melanoma. Symptoms can include:
    • lump or thickened skin in the breast or armpit (for breast cancer)
    • breast skin that’s pitted like an orange peel (for breast cancer)
    • a mole that changes in shape, color, or size (for melanoma)
    • a sore or spot that begins to bleed or doesn’t heal (for melanoma)
  • Allergic reaction.*
  • Upper respiratory infection, such as bronchitis.*
  • Infection, such as shingles.*
  • Increased levels of liver enzymes, which can be a sign of liver damage.*
  • High blood pressure.*
  • Decreased heart rate.*
  • Breathing problems, such as trouble breathing.*

* For more information on these side effects, see “Side effect details” below.

Side effect details

You may wonder how often certain side effects occur with this drug. Here’s some detail on certain side effects this drug may cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Zeposia. However, it’s not known how often allergic reactions occurred in Zeposia clinical studies.

Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (warmth and redness in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing

Call your doctor right away if you have a severe allergic reaction to Zeposia. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Upper respiratory infection

Upper respiratory infections (URIs), such as bronchitis, can occur with Zeposia use. Clinical studies looked at people with relapsing MS who took either Zeposia or interferon beta-1a (Rebif). In the Zeposia group, 26% of people developed a URI. This was compared with 23% of people in the interferon beta-1a group.

Zeposia can decrease the level of lymphocytes (white blood cells that fight infections). With fewer lymphocytes, you may be at an increased risk for infections, some which can be serious. URIs were the most common type of infection seen in clinical studies. Symptoms of URIs can include:

If you have any symptoms of a URI while taking Zeposia, tell your doctor. They may be able to recommend treatments to help you feel more comfortable.

Other infections

Zeposia can also cause other types of infections. Examples of these infections and their symptoms include:

In one clinical study of people with relapsing MS, infection occurred in 35% of people who took Zeposia and in 34% of people who took interferon beta-1a.

In a second clinical study of people with relapsing MS, serious infection occurred in 1% of people who took Zeposia and in 0.8% of people who took interferon beta-1a.

If you have any symptoms of the infections mentioned above, call your doctor right away. They may want to see you to determine whether or not you need treatment for the infection.

Increased levels of liver enzymes

Zeposia can increase the levels of liver enzymes, which can be a sign of liver damage.

In clinical studies of people with relapsing MS, increased levels of liver enzymes occurred in:

  • 10% of people who took Zeposia
  • 5% of people who took interferon beta-1a

Symptoms of liver problems can include:

  • nausea and vomiting
  • yellowing of the skin or the white of the eyes
  • urine that’s a dark color

If you have any symptoms of liver problems, call your doctor right away. They may test your blood to help determine whether there has been any damage to your liver. If the levels of liver enzymes become too high, your doctor may have you stop taking Zeposia.

High blood pressure

An increase in blood pressure can occur with Zeposia use. In clinical studies of people with relapsing MS, 4% of people who took Zeposia had high blood pressure. This was compared with 2% of people who took interferon beta-1a.

Also, eating foods that contain tyramine during your Zeposia treatment may cause a hypertensive crisis (a sudden, dangerous increase in blood pressure). For more information, see “Zeposia and foods” in the “Zeposia interactions” section below.

Many people won’t have any symptoms of high blood pressure. However, symptoms can include:

  • sweating
  • chest pain
  • dizziness
  • headache

While you take Zeposia, your doctor typically monitors your blood pressure at regular check-ups. If you have any questions, reach out to them.

Decreased heart rate

A decreased heart rate can occur with Zeposia use, especially when treatment is first started.

In clinical studies of people with relapsing MS, on the first day of treatment, a decreased heart rate occurred in:

  • 0.6% of people who took Zeposia
  • 0% of people who took interferon beta-1a

After the first day of treatment, a decreased heart rate occurred in:

  • 0.8% of people who took Zeposia
  • 0.7% of people who took interferon beta-1a

Your doctor might observe a decrease in your heart rate during an office visit. But symptoms you might notice can include:

  • fatigue (lack of energy)
  • weakness
  • dizziness or lightheadedness
  • confusion
  • shortness of breath

To help prevent a decreased heart rate with Zeposia, your doctor will typically start you on a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. (For details, see the “Zeposia dosage” section below.) This can help your body get used to the drug.

If you’re concerned about a decreased heart rate while taking Zeposia, talk with your doctor.

Breathing problems

Breathing problems or shortness of breath can occur with Zeposia use. This is because the drug can decrease your absolute forced expiratory volume (FEV). The FEV is the amount of air you can force out of your lungs in 1 second.

In clinical studies of people with relapsing MS, they took either Zeposia or interferon beta-1a. At 12 months of treatment, the FEV of people who took Zeposia declined an average of 60 milliliters more than people who took interferon beta-1a.

If you’re taking Zeposia and have trouble breathing or shortness of breath, immediately call 911 or your local emergency number, or go to the nearest emergency room. These side effects may be due to Zeposia, but they could be signs of a serious allergic reaction. If you have a decline in lung function while taking Zeposia, your doctor can help determine whether you should keep taking the medication.

As with all medications, the cost of Zeposia can vary. To find current prices for Zeposia capsules in your area, check out WellRx.com.

The cost you find on WellRx.com is what you may pay without insurance. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

It’s important to note that you’ll have to get Zeposia at a specialty pharmacy. This type of pharmacy is authorized to carry specialty medications. These are drugs that may be expensive or may require help from healthcare professionals to be used safely and effectively.

Before approving coverage for Zeposia, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide if the drug will be covered.

If you’re not sure if you’ll need to get prior authorization for Zeposia, contact your insurance company.

Financial and insurance assistance

If you need financial support to pay for Zeposia, or if you need help understanding your insurance coverage, help is available.

Celgene Corporation, the manufacturer of Zeposia, offers a program called Zeposia 360 Support, a $0 co-pay offer, and a reimbursement option. For more information and to find out if you’re eligible, call 833-ZEPOSIA (833-937-6742) or visit the drug website and click “Zeposia Support and Savings.”

Generic version

Zeposia isn’t available in a generic form. A generic drug is an exact copy of the active drug in a brand-name medication. Generics tend to cost less than brand-name drugs.

Besides Zeposia, other drugs are available for the treatment of relapsing multiple sclerosis (MS) and clinically isolated syndrome (CIS).

Some of the alternative medications may be a better fit for you than others. If you’re interested in finding an alternative to Zeposia, talk with your doctor. They can tell you about other drugs that may work well for you.

Examples of other drugs that are used to treat relapsing forms of MS and CIS include:

You may wonder how Zeposia compares with other medications that are prescribed for similar uses. Here we look at how Zeposia and Gilenya are alike and different.

Ingredients

Zeposia contains the active drug ozanimod and is in a class of medications known as immune modulators. (A class of medications is a group of drugs that work in a similar way.)

Gilenya contains the active drug fingolimod and is in a class of medications called disease-modifying therapies.

Uses

The Food and Drug Administration (FDA) has approved Zeposia and Gilenya to treat certain forms of relapsing multiple sclerosis (MS). Zeposia is approved for use in adults. Gilenya is approved for use in adults as well as children ages 10 years and older.

To be specific, the drugs are used to treat the following conditions:*

* For details on Zeposia’s uses for these conditions, see the “Zeposia uses” section below.

Drug forms and administration

Both Zeposia and Gilenya come as a capsule that you swallow. Either drug is typically taken once per day.

Side effects and risks

Zeposia and Gilenya are both used to treat certain forms of relapsing MS. Therefore, these medications can cause very similar side effects, but some different ones as well. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with each drug, or with both Zeposia and Gilenya (when taken individually).

Serious side effects

These lists contain examples of serious side effects that can occur with Zeposia, with Gilenya, or with both drugs (when taken individually).

Effectiveness

These drugs haven’t been directly compared in clinical studies, but studies have found both Zeposia and Gilenya to be effective for treating certain forms of relapsing MS.

Costs

According to estimates on WellRx.com, costs of Zeposia and Gilenya may vary depending on your treatment plan. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Zeposia and Gilenya are both brand-name drugs. Zeposia doesn’t have a generic form. Gilenya does have a generic form called fingolimod. Brand-name medications usually cost more than generics.

Like Gilenya (above), the drug Tecfidera has uses similar to those of Zeposia. Here’s a comparison of how Zeposia and Tecfidera are alike and different.

Ingredients

Zeposia contains the active drug ozanimod and is in a class of medications known as immune modulators. (A class of medications is a group of drugs that work in a similar way.)

Tecfidera contains the active drug dimethyl fumarate and is in a class of medications called disease-modifying therapies.

Uses

The Food and Drug Administration (FDA) has approved Zeposia and Tecfidera to treat certain forms of relapsing multiple sclerosis (MS) in adults. To be specific, the drugs are used to treat the following conditions:*

* For details on Zeposia’s uses for these conditions, see the “Zeposia uses” section below.

Drug forms and administration

Zeposia comes as a capsule that you swallow. It’s typically taken once per day.

Tecfidera also comes as a capsule that you swallow. It’s typically taken twice per day.

Side effects and risks

Zeposia and Tecfidera are both used to treat certain forms of relapsing MS. Therefore, these medications can cause very similar side effects, but some different ones as well. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with each drug, or with both Zeposia and Tecfidera (when taken individually).

Serious side effects

These lists contain examples of serious side effects that can occur with Zeposia, with Tecfidera, or with both drugs (when taken individually).

Effectiveness

These drugs haven’t been directly compared in clinical studies, but studies have found both Zeposia and Tecfidera to be effective for treating certain forms of relapsing MS.

Costs

According to estimates on WellRx.com, the costs of Zeposia and Tecfidera may vary depending on your treatment plan. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Zeposia and Tecfidera are both brand-name drugs. Zeposia doesn’t have a generic form. Tecfidera does have a generic form called dimethyl fumarate. Brand-name medications usually cost more than generics.

The Food and Drug Administration (FDA) approves prescription drugs such as Zeposia to treat certain conditions. Zeposia may also be used off-label for other conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Zeposia for relapsing-remitting MS

Zeposia is FDA-approved to treat certain forms of relapsing multiple sclerosis (MS) in adults. The drug is used to treat relapsing-remitting MS (RRMS).

When you relapse, you have a sudden onset of new or worsening symptoms. Sometimes a relapse is referred to as a “flare-up” or “episode.” With RRMS, you have episodes of new or worsening symptoms, and then periods of very few or no MS symptoms. Your relapse eventually goes into remission (a time when your symptoms ease or completely go away). RRMS can progress to secondary progressive disease over time.

Effectiveness for relapsing-remitting MS

Two clinical studies looked at the effectiveness of Zeposia in adults with relapsing MS. The people were given Zeposia or a different MS drug called interferon beta-1a (Avonex, Rebif)

In the 1-year clinical study:

  • Of the people who took Zeposia, 78% didn’t have any relapses.
  • Of the people who took interferon beta-1a, 66% didn’t have any relapses.
  • People who took Zeposia had about a 48% reduction in relapses each year compared with people who took interferon beta-1a.

In the 2-year clinical study:

  • Of the people who took Zeposia, 76% of didn’t have any relapses.
  • Of the people who took interferon beta-1a, 64% didn’t have any relapses.
  • People who took Zeposia had about a 38% reduction in relapses each year compared with people who took interferon beta-1a.

Zeposia for active secondary progressive MS

Zeposia is FDA-approved to treat certain forms of relapsing multiple sclerosis (MS) in adults. The drug is used to treat active secondary progressive disease (SPMS).

“Active” means that you currently have symptoms. When you relapse, you have a sudden onset of new or worsening symptoms. Sometimes a relapse is referred to as a “flare-up” or “episode.” With SPMS, your MS symptoms steadily become worse, and you no longer have periods with few or no MS symptoms.

Effectiveness for active secondary progressive MS

For information on the effectiveness for active SPMS, see “Effectiveness for relapsing-remitting MS” above.

Zeposia for clinically isolated syndrome

Zeposia is FDA-approved to treat certain forms of relapsing multiple sclerosis (MS) in adults. The drug is used to treat clinically isolated syndrome (CIS).

When you relapse, you have a sudden onset of new or worsening symptoms. Sometimes a relapse is referred to as a “flare-up” or “episode.”

CIS isn’t actually a form of MS. With CIS, you typically have symptoms similar to those of MS for 24 hours or longer. CIS doesn’t always progress to MS.

Effectiveness for clinically isolated syndrome

For information on the effectiveness for CIS, see “Effectiveness for relapsing-remitting MS” above.

Off-label uses for Zeposia

In addition to the uses listed above, Zeposia may be used off-label for other purposes. Off-label drug use is when a drug that’s approved for one or more use(s) is prescribed for a different one that’s not approved. Below is an example of an off-label use for Zeposia.

Zeposia for ulcerative colitis, a form of IBD (under study)

Inflammatory bowel disease (IBD) includes ulcerative colitis, which can cause inflammation and ulcers in your digestive tract.

Zeposia isn’t FDA-approved to treat ulcerative colitis. But the drug is currently being studied for the treatment of moderate to severe forms of the disease. Although the full study results haven’t been officially released yet, some early reports show that Zeposia may be effective for treating ulcerative colitis.

However, more information needs to be collected, and more studies need to be done, to determine whether it’s safe to use Zeposia for ulcerative colitis.

If you have questions about using Zeposia or other treatments for ulcerative colitis, talk with your doctor.

Zeposia and children

It’s not known whether Zeposia is safe and effective for use in children.

The Zeposia dosage your doctor prescribes will depend on several factors. These include:

  • how well you tolerate Zeposia
  • other medical conditions you may have

Typically, your doctor will start you on a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. This is known as titration, and it’s done to help prevent side effects. (For more about side effects, see the “Zeposia side effects” section above.)

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Zeposia comes as a capsule that you swallow. It’s available in three strengths: 0.23 milligrams (mg), 0.46 mg, and 0.92 mg.

Dosage for relapsing MS

Zeposia is approved to treat certain forms of relapsing multiple sclerosis (MS) in adults. To be specific, Zeposia is used to treat the following conditions:

Zeposia is normally started with a titration over 7 days. This helps ensure that you can tolerate the medication before you reach the target dose.

Below is the recommended titration schedule for people who have relapsing MS:

  • day 1 to 4: 0.23 mg once per day
  • day 5 to 7: 0.46 mg once per day
  • day 8: 0.93 mg once per day

After day 8, you’ll likely keep taking 0.93 mg once per day.

What if I miss a dose?

If you miss a dose in the first 2 weeks of treatment, your doctor may need to restart your titration. It’s important to tell your doctor if you miss a dose when you first start taking the drug.

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm on your phone or downloading a reminder app. A kitchen timer can work, too.

Will I need to use this drug long term?

Zeposia is meant to be used as a long-term treatment. If you and your doctor determine that Zeposia is safe and effective for you, you’ll likely take it long term.

It’s not known whether it’s safe to drink alcohol while taking Zeposia. However, both alcohol and Zeposia can cause damage to the liver.

Talk with your doctor about whether it’s safe to drink alcohol during your Zeposia treatment.

Zeposia can interact with several other medications. It can also interact with certain supplements as well as certain foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase the number of side effects or make them more severe.

Zeposia and other medications

Below are some of the medications that can interact with Zeposia. This section doesn’t contain all drugs that may interact with Zeposia.

Before taking Zeposia, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Zeposia and alemtuzumab

Both Zeposia and alemtuzumab (Lemtrada) can weaken the immune system, decreasing your ability to fight off infection. In fact, alemtuzumab’s effects on your immune system can last for years. Because of this, it’s not recommended that you take Zeposia if you’re using or have used alemtuzumab.

If you’re taking alemtuzumab or took it in the past, ask your doctor to recommend a medication other than Zeposia.

Zeposia and other immunosuppressive medications

It’s not recommended that you take Zeposia with other medications that can weaken your immune system. (These are called immunosuppressive drugs.) Doing so can make it hard for your body to fight off infection.

Examples of immunosuppressive medications include:

Before starting Zeposia treatment, make sure your doctor is aware of all of the medications you’re taking. You should ask them if any of the drugs can suppress your immune system. Your doctor can then determine whether it’s safe for you to take Zeposia.

Zeposia and certain medications that control your heart rate

It’s possible to have changes in your heart rhythm while taking Zeposia. That’s why it’s not recommended that you use Zeposia if you’re already taking a medication that affects your heart rate. Doing so can put you at risk for developing an abnormal heart rhythm.

Examples of medications used to control heart rate include:

  • amiodarone (Pacerone, Nexterone)
  • sotalol (Betapace)
  • quinidine (Qualaquin)

If you’re taking a medication to help control your heart rate, talk with your doctor about whether Zeposia is right for you.

Zeposia and MAOIs

Certain medications inhibit (block the action of) monoamine oxidase, an enzyme that works on chemicals in your brain. These medications are called monoamine oxidase inhibitors (MAOIs).

Taking Zeposia with MAOIs can decrease the level of Zeposia in your body. It can also lead to a hypertensive crisis (a dangerous increase in blood pressure). It’s recommended that you wait at least 14 days after stopping Zeposia treatment before you start using an MAOI.

Examples of MAOIs include:

  • selegiline (Zelapar)
  • linezolid (Zyvox)
  • phenelzine (Nardil)

If you have questions about Zeposia, MAOIs, or when to take them, talk with your doctor.

Zeposia and antidepressants

Because of the way Zeposia breaks down in the body, taking Zeposia with antidepressants can cause changes in blood pressure.

Examples of antidepressants include:

It’s important to make sure your doctor is aware of all of the medications you’re taking before you start Zeposia treatment. If you’re using an antidepressant, they may want to monitor you closely for side effects when you start taking Zeposia.

Zeposia and medications that block the action of the breast cancer resistance protein

Certain medications block the action of the breast cancer resistance protein (BRCP). These drugs are called BRCP inhibitors. Taking Zeposia with these medications can increase the level of Zeposia in your body and increase the severity of side effects. (To learn about side effects, see the “Zeposia side effects” section above.)

Examples of medications that are BRCP inhibitors include:

Make sure your doctor is aware of all of the medications you’re taking before you start Zeposia treatment. If you’re using a BRCP inhibitor, they may want to monitor you closely for any side effects when you start taking Zeposia.

Zeposia and certain medications that can increase the level of Zeposia in your body

Zeposia is broken down by an enzyme (protein) in your body called CYP2C8. Some medications inhibit (reduce the level of) CYP2C8. This makes CYP2C8 less effective than usual at breaking down drugs in your system.

If Zeposia is taken with these medications, Zeposia may not be broken down properly. This can lead to an increased level of Zeposia in the body.

Examples of medications that inhibit CYP2C8 include:

  • gemfibrozil (Lopid)
  • clopidogrel (Plavix)

Make sure your doctor is aware of all of the medications you’re taking before you start using Zeposia. If you’re taking a drug that can increase the level of Zeposia, they may monitor you for side effects or suggest changing your medication.

Zeposia and certain medications that can decrease the level of Zeposia in your body

Zeposia is broken down by an enzyme (protein) in your body called CYP2C8. Some medications increase the level of CYP2C8. This makes CYP2C8 more effective than usual at breaking down drugs in your system.

If Zeposia is taken with these medications, Zeposia may be broken down too quickly. This can lead to a decreased level of Zeposia in the body.

Examples of medications that can increase the level CYP2C8 include:

  • rifampin (Rifadin)
  • phenytoin (Dilantin, Phenytek)

Make sure your doctor is aware of all of the medications you’re taking before you start using Zeposia. If you’re taking a drug that can lower the level of Zeposia, they may monitor you for side effects or suggest changing your medication.

Zeposia and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Zeposia. However, you should still check with your doctor or pharmacist before using any of these products while taking Zeposia.

Zeposia and foods

Because of the way Zeposia is broken down and absorbed in the body, it may interact with foods that contain tyramine. This interaction can cause a hypertensive crisis (a sudden, dangerous increase in blood pressure).

Food that contain tyramine include:

  • pickled foods
  • smoked foods
  • aged or fermented cheese

For more examples of foods that contain tyramine, visit the drug manufacturer’s website.

It’s recommended that you avoid foods that contain tyramine while you’re taking Zeposia. If you have any questions about eating certain foods with Zeposia, talk with your doctor or pharmacist.

Zeposia and vaccines

You should avoid getting live vaccines at certain times before, during, and after your Zeposia treatment.

Live vaccines have a weakened form of the bacteria or virus they’re meant to help prevent. When your immune system is healthy, live vaccines usually don’t cause infection. But if your immune system isn’t healthy, your body may not be able to fight the weakened bacteria or virus in the live vaccine. This could lead to infection, and the vaccine may be less effective.

Because Zeposia use may weaken your immune system, you shouldn’t get any live vaccines:

  • 1 month before starting Zeposia treatment
  • while taking Zeposia
  • at least 3 months after stopping Zeposia treatment

Examples of live vaccines include measles, mumps, rubella (MMR), yellow fever, and rotavirus.

Before you start taking Zeposia, ask your doctor if your vaccines are up to date.

You should take Zeposia according to your doctor’s or healthcare provider’s instructions.

Zeposia comes as a capsule that you swallow.

When to take

You’ll likely take Zeposia once per day at the same time each day.

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm on your phone or downloading a reminder app. A kitchen timer can work, too.

Taking Zeposia with food

You can take Zeposia with or without food. But it’s important to note that some foods can interact with Zeposia. For more information, see “Zeposia and foods” in the “Zeposia interactions” section above.

Can Zeposia be crushed, split, or chewed?

You should swallow Zeposia capsules whole. You shouldn’t crush, split, or chew them. Doing so can alter how the medication is released and absorbed in your body.

Zeposia is approved to treat certain forms of relapsing multiple sclerosis (MS), as well as clinically isolated syndrome (CIS). CIS isn’t actually a form of MS. With CIS, you typically have symptoms similar to those of MS for 24 hours or longer.

MS causes your immune system to mistakenly damage nerves that help your brain and body communicate. Specifically, the immune system targets the myelin sheath (the covering of nerves). As a result, the myelin sheath becomes inflamed (damaged and swollen). Damage to the sheath can result in sclerosis (a scar).

It’s not known exactly how Zeposia works to treat relapsing forms of MS. However, the drug does bind to a molecule called sphingosine 1-phosphate (S1P). It’s thought that by binding to S1P, Zeposia prevents lymphocytes from moving into the central nervous system and attacking the nerve cells. (Lymphocytes are white blood cells that fight infections.)

How long does it take to work?

It can take a few weeks or months for you to notice that your MS symptoms are easing. This is because your doctor will typically start you on a low dosage of Zeposia. Then they’ll adjust it over time to reach the amount that’s right for you.

How quickly Zeposia works to help control MS symptoms varies from person to person.

It’s not known whether Zeposia is safe to use during pregnancy. In studies of pregnant animals given the drug, the offspring had birth defects and, in some cases, died. However, animal studies don’t always predict what will happen in humans.

If you’re pregnant or thinking about becoming pregnant, talk with your doctor before taking Zeposia. They can help determine whether the drug is right for you.

It’s not known whether Zeposia is safe to use during pregnancy. Because of the potential risks, the use of birth control is recommended.

For women using Zeposia

If you’re able to become pregnant, you should use birth control while taking Zeposia. You should keep using birth control for at least 3 months after stopping Zeposia treatment.

For men using Zeposia

If you’re a man taking Zeposia and your sexual partner can become pregnant, you should use birth control during your treatment. You should keep using birth control for at least 3 months after you stop taking Zeposia.

Talking with your doctor

If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re using Zeposia.

For more information about taking Zeposia during pregnancy, see the “Zeposia and pregnancy” section above.

It’s not known whether Zeposia is safe to take while breastfeeding. In animal studies, Zeposia did pass into breast milk. But it’s not known what effect this had on the offspring.

If you are breastfeeding or planning to breastfeed, talk with your doctor about the risks and benefits of taking Zeposia.

Here are answers to some frequently asked questions about Zeposia.

Could my MS get worse if I stop using Zeposia?

There’s a chance that your multiple sclerosis (MS) could get worse once you stop using Zeposia. This is known as disease rebound. It’s very rare, but it has been reported. After stopping Zeposia treatment, you should keep an eye out for any severe increase in disability. Your doctor will typically monitor you as well.

If you’ve previously taken drugs that can weaken your immune system, your immune system may stay weakened for a time after you’ve stopped treatment. Zeposia can also weaken your immune system, possibly further increasing your risk for infection. Be sure to talk with your doctor about any medications you have taken or plan to take in the future.

You shouldn’t stop taking Zeposia without first talking with your doctor. If you have any questions about ending your treatment, reach out to them.

Which tests will I need before I start taking Zeposia?

There are several tests that you may need before starting Zeposia treatment. They can include:

  • Complete blood count. A complete blood count can measure the level of lymphocytes (white blood cells that fight infections). If your level is low, it might mean that you have an infection and won’t be able to take Zeposia. (To learn more, see the “Zeposia precautions” section below.)
  • Heart evaluation. The heart check will typically include an electrocardiogram (ECG). Your doctor will see how healthy your heart is and if you have an abnormal heart rhythm. If you do have certain heart conditions, you might not be able to use Zeposia. (For more information, see the “Zeposia precautions” section below.)
  • Liver tests. The liver tests check to see if your liver enzyme levels are in the normal range and whether you have any damage to your liver. Depending on the results, Zeposia may not be right for you. (To learn more, see the “Zeposia precautions” section below.)
  • Eye exam. This exam checks whether the pressure and fluid in your eyes are normal. Zeposia may cause eye swelling, so the drug might not be right for you if you have certain eye problems. (For more information, see the “Zeposia precautions” section below.)
  • Antibody tests. If you don’t know your vaccination history, your doctor may want to check antibody levels in your blood. (Antibodies are immune system proteins that are evidence of having had a certain infection or the vaccine for the infection.) Depending on the results, you may need certain vaccines before starting Zeposia treatment.

If you have any questions about tests you’ll need before you start taking Zeposia, talk with your doctor.

What should I know about getting vaccines during my Zeposia treatment?

You should avoid getting live vaccines at certain times before, during, and after your Zeposia treatment.

Live vaccines have a weakened form of the bacteria or virus they’re meant to help prevent. When your immune system is healthy, live vaccines usually don’t cause infection. But if your immune system isn’t healthy, your body may not be able to fight the weakened bacteria or virus in the live vaccine. This could lead to infection, and the vaccine may be less effective.

Because Zeposia use may weaken your immune system, you shouldn’t get any live vaccines:

  • 1 month before starting Zeposia treatment
  • while taking Zeposia
  • at least 3 months after stopping Zeposia treatment

For more details, see “Zeposia and vaccines” in the “Zeposia interactions” section above.

In certain cases, you may need to receive the chickenpox vaccine before using Zeposia.

If you don’t know whether you’ve had chickenpox or received the chickenpox vaccine in the past, your doctor may test your blood. If you have chickenpox antibodies in your blood, it means that you’re immune to chickenpox and don’t need the vaccine. (Antibodies are immune system proteins that are evidence of having had a certain infection or the vaccine for the infection.) If you don’t have chickenpox antibodies, then you may need the chickenpox vaccine before taking Zeposia.

Before you use Zeposia, check with your doctor to see if your vaccines are up to date.

Are there certain foods I shouldn’t eat while using Zeposia?

Yes. Because of the way Zeposia is broken down and absorbed in the body, the drug may interact with foods that contain tyramine. This interaction can cause a hypertensive crisis (a sudden, dangerous increase in blood pressure). It’s recommended that you avoid foods that contain tyramine while you’re taking Zeposia.

Foods that can contain tyramine include:

  • pickled foods
  • smoked foods
  • aged or fermented cheese

For more examples of foods that contain tyramine, visit the drug manufacturer’s website.

If you have any questions about eating certain foods with Zeposia, talk with your doctor or pharmacist.

Will Zeposia cure my MS?

No, Zeposia won’t cure multiple sclerosis (MS). There’s currently no cure available for the condition. However, in some people, Zeposia can help ease MS symptoms and reduce the rate of relapse (how often symptoms return). For details on the effectiveness of the drug, see the “Zeposia uses” section above.

You can also talk with your doctor to see if Zeposia is right for you.

This drug comes with several precautions. Before taking Zeposia, talk with your doctor about your health history. Zeposia may not be right for you if you have certain medical conditions or other factors affecting your health. These include the ones listed below.

Note: For more information about the potential negative effects of Zeposia, see the “Zeposia side effects” section above.

Certain heart conditions

You shouldn’t use Zeposia if you currently have or have had certain types of arrhythmia that aren’t being treated with a pacemaker.

You also shouldn’t take the drug if you’ve had any of the following in the past 6 months:

Zeposia can cause changes in blood pressure and heart rate, so the drug can make the heart conditions worse. (For more information, see the “Zeposia side effects” section above.) Talk with your doctor about other treatments that may be better choices for you.

Liver disease

Zeposia can increase the levels of liver enzymes, which can be a sign of liver damage. If you already have liver disease, Zeposia may make it worse and should be used very carefully. (To learn more, see the “Zeposia side effects” section above.) Talk with your doctor to see whether Zeposia or a different treatment is right for you.

Infections

It’s important to make sure that you don’t have any serious infections, such as shingles, before starting treatment with Zeposia. The drug may prevent your body from being able to fight off infection and can make it hard to treat the infection. If you think you might have an infection, talk with your doctor. They’ll likely treat it before you start using Zeposia, or they may recommend a different medication.

Sleep apnea

You shouldn’t take Zeposia if you have severe sleep apnea that isn’t being treated. Sleep apnea affects your breathing, and Zeposia can cause side effects such as shortness of breath. Because of this, it isn’t safe to take Zeposia if you have untreated sleep apnea.

Talk with your doctor about other treatments for your multiple sclerosis. And for information about side effects, see the “Zeposia side effects” section above.

Certain eye problems

Before you take Zeposia, tell your doctor if you have certain eye problems, including uveitis. The drug can cause eye swelling, which could make eye problems worse. Your doctor can help determine whether Zeposia or a different treatment is right for you.

Diabetes

Before you take Zeposia, tell your doctor if you have diabetes. Your doctor can help determine whether Zeposia or a different treatment is right for you.

Allergic reaction

If you’ve had an allergic reaction to Zeposia or any of its ingredients, you shouldn’t take Zeposia. Ask your doctor what other medications are better options for you.

Pregnancy

It’s not known whether Zeposia is safe to use during pregnancy. For more information, see the “Zeposia and pregnancy” section above.

Breastfeeding

It’s not known whether Zeposia is safe to take while breastfeeding. For more information, see the “Zeposia and breastfeeding” section above.

Using more than the recommended dosage of Zeposia can lead to serious side effects.

Do not use more Zeposia than your doctor recommends.

What to do in case you take too much Zeposia

If you think you’ve taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or your local emergency number, or go to the nearest emergency room right away.

When you get Zeposia from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee that the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk to your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good can depend on many factors, including how and where you store the medication.

You should store Zeposia capsules at room temperature (68°F to 77°F/20°C to 25°C) in a tightly sealed container away from light. Avoid storing this medication in areas where it could get damp or wet, such as bathrooms.

Disposal

If you no longer need to take Zeposia and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

This article provides several useful tips on medication disposal. You can also ask your pharmacist for information on how to dispose of your medication.

The following information is provided for clinicians and other healthcare professionals.

Indications

Zeposia is indicated for the treatment of certain forms of multiple sclerosis (MS) that have relapsed in adults. The drug is approved to treat:

Administration

Zeposia should be swallowed whole, by mouth, once daily. It can be taken without regard to meals.

Mechanism of action

It is not known exactly how Zeposia works for the treatment of relapsing MS. However, the drug binds to the sphingosine 1-phosphate (S1P) receptor. This inhibits lymphocytes from moving out of lymph nodes into the central nervous system. By preventing this migration, Zeposia may work to prevent lymphocytes from attacking the nervous system.

Pharmacokinetics and metabolism

Zeposia takes 6 to 8 hours to reach its maximum concentration in the body. Its half-life is around 21 hours, and the half-life of its metabolite is around 11 days. Zeposia and its metabolites are highly protein-bound (98.2% to 99.8%).

Zeposia is metabolized by multiple enzymes including ALDH/ADH, NAT-2, CYP2C8, and others to its active metabolites. It is excreted 26% in the urine and 37% in the feces.

Contraindications

Zeposia is contraindicated in people who:

Zeposia is also contraindicated in people who have had any of the following in the past 6 months:

Storage

Zeposia should be stored at room temperature (68°F to 77°F/20°C to 25°C). Deviations are allowed between 59°F and 86°F (15°C and 30°C).

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.