Select a medication above to begin.
Zeposia
ozanimod
Adult Dosing .
Dosage forms: CAP: 0.92 mg; CAP (7-day starter pack): 0.23 mg x4 and 0.46 mg x3; CAP (28-day starter pack): 0.23 mg x4, 0.46 mg x3, and 0.92 mg x21
multiple sclerosis, relapsing forms
- [0.92 mg PO qd]
- Start: 0.23 mg PO qd x4 days, then 0.46 mg PO qd x3 days, then 0.92 mg PO qd; Info: for patients w/ clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease; restart titration if dose missed w/in first 2wk of tx
ulcerative colitis, moderate-severe
- [0.92 mg PO qd]
- Start: 0.23 mg PO qd x4 days, then 0.46 mg PO qd x3 days, then 0.92 mg PO qd; Info: restart titration if dose missed w/in first 2wk of tx
renal dosing
- [see below]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [see below]
- Child-Pugh Class A or B: 0.23 mg qd x4 days, then 0.46 mg qd x3 days, then 0.92 mg qod; Child-Pugh Class C: avoid use
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- MAO inhibitor use w/in 14 days
- pregnancy
- hepatic impairment, Child-Pugh Class C
- infection, active
- phototherapy, concurrent
- MI w/in 6mo
- unstable angina w/in 6mo
- stroke w/in 6mo
- TIA w/in 6mo
- decompensated heart failure w/ hospitalization w/in 6mo
- NYHA Class III-IV CHF w/in 6mo
- AV block, 2nd-3rd degree (patients w/o pacemaker)
- sick sinus syndrome (patients w/o pacemaker)
- sino-atrial block (patients w/o pacemaker)
- sleep apnea, severe untreated
- caution: hepatic impairment, Child-Pugh Class A-B
- caution: AV block risk
- caution: bradycardia risk
- caution: QT prolongation
- caution: long QT syndrome, congenital
- caution: QT prolongation family history
- caution: torsades de pointes history
- caution: ventricular arrhythmia
- caution: electrolyte abnormalities
- caution: patients of childbearing potential
- caution: infection risk
- caution: diabetes mellitus
- caution: uveitis history
Drug Interactions .
Overview
ozanimod
S1P modulator
- CYP2C8 substrate
- MAO substrate
- bradycardia
- delays atrioventricular conduction
- hypertensive effects
- immunomodulatory effects
- prolongs QT interval (conditional)
Contraindicated
- adenovirus vaccine, live
- BCG live intravesical
- chikungunya vaccine, live
- cholera vaccine, live
- dengue vaccine, live
- influenza nasal vaccine, live
- isocarboxazid
- linezolid
- measles/mumps/rubella vaccine, live
- methylene blue oral
- phenelzine
- pimozide
- rasagiline
- rotavirus vaccine, live
- safinamide
- selegiline
- selegiline transdermal
- smallpox vaccine, live
- talimogene laherparepvec
- thioridazine
- tranylcypromine
- typhoid vaccine, live
- varicella vaccine, live
- viloxazine
- yellow fever vaccine, live
- yohimbe
Avoid/Use Alternative
- acebutolol
- adagrasib
- adenosine
- albuterol
- albuterol inhaled
- alectinib
- alemtuzumab
- alfentanil
- amiodarone
- anagrelide
- apalutamide
- apomorphine
- apraclonidine ophthalmic
- arsenic trioxide
- artemether/lumefantrine
- articaine
- asenapine
- atazanavir
- atenolol
- azithromycin
- bedaquiline
- benzphetamine
- betaxolol
- betaxolol ophthalmic
- bisoprolol
- brigatinib
- bupivacaine
- bupivacaine liposomal
- cabozantinib
- carbamazepine
- carteolol ophthalmic
- carvedilol
- ceritinib
- chloroprocaine
- chloroquine
- cisapride
- citalopram
- cladribine oral
- clarithromycin
- clofazimine
- clonidine
- clozapine
- crizotinib
- degarelix
- desflurane
- desipramine
- dexmedetomidine
- dexmedetomidine injection
- digoxin
- diltiazem
- disopyramide
- dobutamine
- dofetilide
- domperidone
- donepezil
- dordaviprone
- doxapram
- dronedarone
- droperidol
- dulaglutide
- eliglustat
- encorafenib
- ensartinib
- ephedra
- ephedrine oral
- epinephrine
- epinephrine inhaled
- epirubicin
- eribulin
- erythromycin
- esmolol
- etrasimod
- fentanyl
- fexinidazole
- fingolimod
- flecainide
- fluorouracil
- fosphenytoin
- galantamine
- gemfibrozil
- gilteritinib
- glasdegib
- goserelin
- guanfacine
- haloperidol
- hydroxychloroquine
- hydroxyzine
- ibutilide
- inotuzumab ozogamicin
- isoflurane
- isoniazid
- ivabradine
- ivosidenib
- labetalol
- lacosamide
- lamotrigine
- landiolol
- lanreotide
- lasmiditan
- lefamulin
- leuprolide
- levalbuterol inhaled
- levobunolol ophthalmic
- levofloxacin
- levoketoconazole
- lidocaine
- lofexidine
- lonafarnib
- lopinavir/ritonavir
- lorlatinib
- macimorelin
- mefloquine
- mepivacaine
- methadone
- metoprolol
- midodrine
- mobocertinib
- moxifloxacin
- nadolol
- natalizumab
- nebivolol
- neostigmine
- nilotinib
- norepinephrine
- octreotide
- oliceridine
- ondansetron
- osimertinib
- pacritinib
- paliperidone
- palonosetron
- paltusotine
- panobinostat
- pasireotide
- pentamidine
- phenylephrine
- phenytoin
- pimecrolimus topical
- pindolol
- ponesimod
- praziquantel
- procainamide
- procarbazine
- propafenone
- propofol
- propranolol
- pseudoephedrine
- pyridostigmine
- quinidine (antiarrhythmic)
- quinidine (CYP2D6 inhibitor)
- quinine
- quizartinib
- rabies vaccine
- regadenoson
- remifentanil
- remimazolam
- revumenib
- ribociclib
- rifampin
- ritonavir
- rivastigmine
- romidepsin
- ropivacaine
- rucaparib
- selpercatinib
- sevoflurane
- siponimod
- sotalol
- succinylcholine
- sufentanil
- sugammadex
- taletrectinib
- telavancin
- tetrabenazine
- thalidomide
- ticagrelor
- timolol
- timolol ophthalmic
- toremifene
- tramadol
- triclabendazole
- trifluridine
- triptorelin
- vandetanib
- vemurafenib
- verapamil
- ziprasidone
Monitor/Modify Tx
- abiraterone acetate
- aliskiren
- almotriptan
- amiloride
- amlodipine
- amphetamine
- angiotensin II
- anthrax vaccine
- aprocitentan
- arformoterol inhaled
- armodafinil
- asciminib
- atogepant
- atomoxetine
- atropine ophthalmic
- axitinib
- azilsartan medoxomil
- benazepril
- betamethasone
- bevacizumab
- bismuth subsalicylate
- budesonide
- bumetanide
- bupropion
- caffeine
- caffeine citrate
- candesartan cilexetil
- cannabis
- captopril
- carfilzomib
- celecoxib
- chikungunya vaccine
- chlorothiazide
- chlorthalidone
- clevidipine
- clopidogrel
- cocaine
- copanlisib
- corticotropin
- cortisone
- COVID-19 vaccine
- cyclosporine
- danazol
- darbepoetin alfa
- deferasirox
- deflazacort
- desmopressin
- desvenlafaxine
- dexamethasone
- dexmethylphenidate
- dextroamphetamine
- diclofenac
- diclofenac topical
- diethylpropion
- diflunisal
- dihydroergotamine
- diphtheria/tetanus vaccine
- diphtheria/tetanus/pertussis vaccine
- dopamine
- doxazosin
- dronabinol
- droxidopa
- ebola vaccine, live
- eletriptan
- enalapril
- enalaprilat
- enzalutamide
- ephedrine injection
- eplerenone
- epoetin alfa
- eptinezumab
- erenumab
- ergotamine
- esketamine
- estetrol (contraceptive)
- estradiol (contraceptive)
- ethacrynic acid
- ethinyl estradiol (contraceptive)
- etodolac
- everolimus
- felodipine
- fenfluramine
- fenoldopam
- fenoprofen
- fludrocortisone
- flurbiprofen
- formoterol inhaled
- fosinopril
- fostamatinib
- fremanezumab
- frovatriptan
- fruquintinib
- furosemide
- galcanezumab
- Haemophilus b vaccine
- hepatitis A vaccine
- hepatitis B vaccine
- histrelin
- hoodia
- human papillomavirus vaccine
- hydralazine
- hydrochlorothiazide
- hydrocortisone
- hydroxocobalamin IV
- ibrutinib
- ibuprofen
- indapamide
- indomethacin
- influenza H5N1 vaccine
- influenza vaccine
- irbesartan
- isradipine
- Japanese encephalitis vaccine
- ketamine
- ketoprofen
- ketorolac
- leflunomide
- lenvatinib
- levomilnacipran
- licorice
- lisdexamfetamine
- lisinopril
- losartan
- lumacaftor/ivacaftor
- luspatercept
- magnesium salicylate
- meclofenamate
- mefenamic acid
- meloxicam
- meningococcal vaccine
- methamphetamine
- methoxy polyethylene glycol-epoetin beta
- methyldopa
- methylene blue injection
- methylergonovine
- methylphenidate
- methylprednisolone
- methyltestosterone
- metoclopramide
- metolazone
- milnacipran
- minoxidil
- mirabegron
- mitomycin
- modafinil
- moexipril
- nabumetone
- naphazoline ophthalmic
- naproxen
- naratriptan
- naxitamab
- nicardipine
- nifedipine
- nimodipine
- niraparib
- nisoldipine
- obinutuzumab
- olmesartan medoxomil
- olodaterol inhaled
- osilodrostat
- oxaprozin
- oxymetazoline nasal
- oxymetazoline ophthalmic
- oxymetazoline topical
- oxytocin
- pazopanib
- perindopril
- pexidartinib
- phendimetrazine
- phenoxybenzamine
- phentermine
- phentolamine
- phenylephrine injection
- phenylephrine nasal
- phenylephrine ophthalmic
- phenylephrine rectal
- piroxicam
- pirtobrutinib
- pneumococcal vaccine
- poliovirus vaccine
- ponatinib
- pralsetinib
- prazosin
- prednisolone
- prednisone
- quetiapine
- quinapril
- ramipril
- ramucirumab
- regorafenib
- respiratory syncytial virus vaccine
- rimegepant
- ripretinib
- rizatriptan
- ropinirole
- rotigotine transdermal
- salmeterol inhaled
- salsalate
- sipuleucel-T
- smallpox/mpox vaccine, live
- solriamfetol
- sorafenib
- spironolactone
- sulindac
- sumatriptan
- sunitinib
- tacrolimus
- tagraxofusp
- telmisartan
- temsirolimus
- terazosin
- terbutaline
- teriflunomide
- testosterone
- tetrahydrozoline ophthalmic
- tick-borne encephalitis vaccine
- tivozanib
- tolmetin
- torsemide
- trametinib
- trandolapril
- triamcinolone
- triamterene
- typhoid vaccine
- ubrogepant
- vadadustat
- valsartan
- vamorolone
- vasopressin
- venlafaxine
- vilanterol inhaled
- voclosporin
- zavegepant
- ziv-aflibercept
- zolmitriptan
Caution Advised
- abatacept
- abemaciclib
- abrocitinib
- acalabrutinib
- adalimumab
- afamitresgene autoleucel
- aldesleukin
- anakinra
- anifrolumab
- anti-thymocyte globulin
- atidarsagene autotemcel
- avacopan
- axicabtagene ciloleucel
- azacitidine
- azathioprine
- baricitinib
- basiliximab
- beclomethasone inhaled
- beclomethasone nasal
- belatacept
- belimumab
- belinostat
- bendamustine
- bimekizumab
- blinatumomab
- bortezomib
- brentuximab vedotin
- brexucabtagene autoleucel
- brodalumab
- budesonide inhaled
- budesonide nasal
- budesonide rectal
- busulfan
- cabazitaxel
- canakinumab
- carboplatin
- carmustine
- certolizumab pegol
- chlorambucil
- ciltacabtagene autoleucel
- cisplatin
- cladribine injection
- clobetasol ophthalmic
- clofarabine
- coccidioides immitis skin test antigen
- crovalimab
- cyclophosphamide
- cytarabine
- dactinomycin
- danicopan
- daratumumab
- daunorubicin
- decitabine
- delgocitinib topical
- deucravacitinib
- deuruxolitinib
- dexamethasone ophthalmic
- difluprednate ophthalmic
- dimethyl fumarate
- dinutuximab
- diroximel fumarate
- docetaxel
- doxorubicin
- dupilumab
- duvelisib
- eculizumab
- efgartigimod alfa
- elivaldogene autotemcel
- elotuzumab
- elranatamab
- emapalumab
- epcoritamab
- etanercept
- etoposide
- floxuridine
- fludarabine
- flunisolide nasal
- fluocinolone intravitreal
- fluorometholone ophthalmic
- fluticasone furoate
- fluticasone propionate
- gemtuzumab ozogamicin
- glofitamab
- golimumab
- guselkumab
- hydrocortisone ophthalmic
- hydroxyurea
- ibritumomab tiuxetan
- idarubicin
- idecabtagene vicleucel
- idelalisib
- ifosfamide
- inebilizumab
- infliximab
- iptacopan
- irinotecan
- isatuximab
- ixabepilone
- ixekizumab
- lebrikizumab
- lenalidomide
- lifileucel
- linvoseltamab
- lisocabtagene maraleucel
- lomustine
- loncastuximab tesirine
- loteprednol ophthalmic
- lymphocyte immune globulin, anti-thymocyte globulin
- melphalan
- mercaptopurine
- methotrexate
- mirikizumab
- mitoxantrone
- mogamulizumab
- momelotinib
- mometasone implant
- mometasone inhaled
- mometasone nasal
- monomethyl fumarate
- mosunetuzumab
- mycophenolate mofetil
- mycophenolic acid
- nadofaragene firadenovec intravesical
- nelarabine
- nipocalimab
- obecabtagene autoleucel
- ocrelizumab
- ofatumumab
- oxaliplatin
- paclitaxel
- pegcetacoplan
- pentostatin
- polatuzumab vedotin
- pomalidomide
- pozelimab
- prednisolone ophthalmic
- ravulizumab
- rilonacept
- rilzabrutinib
- risankizumab
- ritlecitinib
- rituximab
- ropeginterferon alfa-2b
- rozanolixizumab
- ruxolitinib
- ruxolitinib topical
- sarilumab
- satralizumab
- secukinumab
- selinexor
- siltuximab
- sirolimus
- sirolimus albumin-bound
- spesolimab
- sulfasalazine
- sutimlimab
- tafasitamab
- talquetamab
- tarlatamab
- teclistamab
- temozolomide
- teplizumab
- thioguanine
- thiotepa
- tildrakizumab
- tisagenlecleucel
- tocilizumab
- tofacitinib
- topotecan
- tralokinumab
- tuberculin purified protein derivative
- ublituximab
- upadacitinib
- ustekinumab
- vedolizumab
- venetoclax
- vilobelimab
- vinblastine
- vincristine
- vinorelbine
- zanubrutinib
- zilucoplan
Adverse Reactions .
Serious Reactions
- bradyarrhythmia
- AV block
- infection, serious
- PML
- PML-associated immune reconstitution syndrome after D/C
- posterior reversible encephalopathy syndrome
- macular edema
- hepatic injury
- hypertensive crisis
- malignancy
- disability incr. after D/C, severe (MS use)
- skin CA
Common Reactions
- infection
- LFTs elevated
- headache
- hypotension, orthostatic
- back pain
- HTN
- lymphopenia
- fever
- nausea
- arthralgia
- peripheral edema
- upper abdominal pain
- pulmonary function decr.
Safety/Monitoring .
Monitoring Parameters
CBC w/ diff at baseline if none w/in 6mo of tx start; LFTs at baseline if none w/in 6mo of tx start, then periodically until 2mo after D/C; ECG at baseline; ophthalmic exam at baseline, then periodically or if change in vision; dermatologic exam at baseline, then periodically, esp if incr. skin CA risk; BP; signs/symptoms of infection during tx and x3mo after D/C; VZV antibody testing at baseline if no varicella or vaccination history; consider MRI for signs/symptoms of PML
Pregnancy/Lactation .
Pregnancy
Clinical Summary
avoid use during pregnancy; inadequate human data available; risk of teratogenicity and embryo-fetal death based on animal data at >2x MRHD
Pregnancy Registry
enroll or encourage patients w/ multiple sclerosis to enroll in Zeposia Pregnancy Registry at 1-877-301-9314 or www.zeposiapregnancyregistry.com
Individuals of Reproductive Potential
avoid pregnancy by using effective contraception during tx and x3mo after D/C in patients of childbearing potential
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no human data available to assess risk of infant harm or effects on milk production
Pharmacology .
Metabolism: liver; CYP450: 2C8 (primary), 3A4 substrate; Info: active metabolites
Excretion: feces 37%, urine 26%; Half-life: 21h (parent drug), 11 days (active metabolites)
Subclass: Inflammatory Bowel Disease (IBD) ; Multiple Sclerosis
Mechanism of Action
exact mechanism of action unknown; binds to sphingosine 1-phosphate receptors 1 and 5; reduces lymphocyte egress from lymph nodes and migration into CNS and intestine
Formulary .
No Formulary Selected
Join Now to View Patient Handouts!
Create a FREE epocrates Online account to access patient medication instructions. Your patients and caregivers will appreciate you printing these friendly handouts, available in English and Spanish. Each handout addresses common concerns such as how to take the medication, and possible side effects.
Current Members: Sign In.
Pill Pictures
Join Now to View Pill Pictures!
Create a FREE epocrates Online account to access full-color images of medications within the drug monograph.
Current Members: Sign In.