ponesimod (Rx)

Multiple Sclerosis

Indicated for relapsing forms of multiple sclerosis (MS), including clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease

Initiation

• Starter pack must be used for initiating treatment
• 2 mg PO qDay initially; increase dose as per dose titration regimen (14-day titration)

• Dose titration regimen

  • Days 1-2: 2 mg qDay
  • Days 3-4: 3 mg qDay
  • Days 5-6: 4 mg qDay
  • Day 7: 5 mg qDay
  • Day 8: 6 mg qDay
  • Day 9: 7 mg qDay
  • Day 10: 8 mg qDay
  • Day 11: 9 mg qDay
  • Days 12-14: 10 mg qDay

Maintenance

• Day 15 and thereafter: 20 mg qDay

Dosage Modifications

Renal impairment

• Mild-to-severe: No dosage adjustment necessary
• Hemodialysis: No dose adjustment necessary; owing to high plasma protein binding (ie, >99%), dialysis not expected to alter concentration

Hepatic impairment

• Mild (Child-Pugh A): No dosage adjustment necessary
• Moderate-to-severe (Child-Pugh B or C): Not recommended

Dosing Considerations

Monitoring parameters

• Before first dose

  • Recent CBC count, including lymphocyte count (eg, within the last 6 months or after discontinuing previous MS therapy)
  • ECG
  • Review medication history for drugs that may slow HR or AV conduction, antineoplastic agents, immunosuppressives, or immune-modulating therapies
  • Recent (eg, within last 6 months) AST/ALT and bilirubin levels
  • Evaluate fundus, including macula
  • Test for antibodies to varicella zoster virus (VZV); VZV vaccination for antibody-negative patients recommended; if vaccination required, administer at least 1 month before initiating ponesimod

• First dose monitoring

  • Recommended for the following: Patients with sinus bradycardia (HR <55 beats per minute [bpm]), first- or second-degree (Mobitz type I) AV block, or a history of myocardial infarction (MI) or heart failure (HF) occurring >6 months before initiating treatment and in stable condition
  • Administer in setting where bradycardia can be appropriately managed
  • Monitor HR and BP at least hourly for 4 hr after first dose for signs and symptoms of bradycardia
  • Obtain an ECG before dosing and at the end of 4-hr observation period

• After 4-hour monitoring

  • If symptomatic bradycardia, bradyarrhythmia, or conduction-related symptoms, or if new-onset second-degree or higher AV block or QTc ≥500 msec occur, initiate appropriate management, begin continuous ECG monitoring, and continue monitoring until resolution if no pharmacological treatment is required
  • If pharmacological treatment is required, continue monitoring overnight and repeat 4-hr monitoring after second dose

• Possible abnormalities 4 hours post dose

  • If any of these abnormalities are present after 4 hr (even in absence of symptoms), continue monitoring until resolution
  • HR <45 bpm
  • HR is at lowest value post dose, suggesting that maximum pharmacodynamic effect on the heart may not have occurred
  • ECG shows new-onset second-degree or higher AV block

• Consult cardiologist during treatment initiation for patients with the following

  • Preexisting heart and cerebrovascular conditions
  • Prolonged QTc interval before dosing or during 4-hr observation, or at additional risk for QT prolongation
  • Coadministration with drugs that slow HR or AV conduction, or that prolong QT with a known risk of torsades de pointes

Safety and efficacy not established

Contraindicated (0)

Serious - Use Alternative (124)

• adagrasib

  adagrasib, ponesimod. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

• adenosine

  ponesimod, adenosine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• adenovirus types 4 and 7 live, oral

  ponesimod decreases effects of adenovirus types 4 and 7 live, oral by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• alectinib

  ponesimod, alectinib. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• alfuzosin

  alfuzosin and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• amisulpride

  amisulpride and ponesimod both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

• anagrelide

  anagrelide and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• apalutamide

  apalutamide will decrease the level or effect of ponesimod by Other (see comment). Avoid or Use Alternate Drug. Not recommended. Based on limited data, coadministration of strong CYP3A4 and UGT1A1 inducers (eg, rifampin, phenytoin, carbamazepine) may decrease systemic exposure of ponesimod. The clinical relevance is unclear.

• apomorphine

  apomorphine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• aripiprazole

  aripiprazole and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• arsenic trioxide

  ponesimod, arsenic trioxide. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• artemether

  artemether and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• artemether/lumefantrine

  artemether/lumefantrine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• asenapine

  asenapine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• asenapine transdermal

  asenapine transdermal and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• atomoxetine

  atomoxetine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• bedaquiline

  ponesimod, bedaquiline. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).
  
  bedaquiline and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• brigatinib

  ponesimod, brigatinib. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• bupivacaine

  ponesimod, bupivacaine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• buprenorphine

  buprenorphine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine buccal

  buprenorphine buccal and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine subdermal implant

  buprenorphine subdermal implant and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine transdermal

  buprenorphine transdermal and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine, long-acting injection

  buprenorphine, long-acting injection and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• carbamazepine

  carbamazepine will decrease the level or effect of ponesimod by Other (see comment). Avoid or Use Alternate Drug. Not recommended. Based on limited data, coadministration of strong CYP3A4 and UGT1A1 inducers (eg, rifampin, phenytoin, carbamazepine) may decrease systemic exposure of ponesimod. The clinical relevance is unclear.

• ceritinib

  ponesimod, ceritinib. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.
  
  ceritinib and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• chloroquine

  chloroquine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• chlorpromazine

  ponesimod, chlorpromazine. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• cisapride

  ponesimod, cisapride. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• citalopram

  citalopram and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• clarithromycin

  clarithromycin and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• clonidine

  ponesimod, clonidine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• clozapine

  clozapine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• crizotinib

  ponesimod, crizotinib. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.
  
  crizotinib and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• dasatinib

  dasatinib and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• degarelix

  degarelix and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• dengue vaccine

  ponesimod decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• desflurane

  desflurane and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• dexmedetomidine

  ponesimod, dexmedetomidine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• digoxin

  ponesimod, digoxin. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• diltiazem

  ponesimod, diltiazem. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• dobutamine

  ponesimod, dobutamine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• dolasetron

  dolasetron and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• donepezil

  ponesimod, donepezil. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.
  
  donepezil and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• dopamine

  ponesimod, dopamine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• doxepin

  doxepin and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• dronedarone

  ponesimod, dronedarone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• Ebola Zaire vaccine

  ponesimod decreases effects of Ebola Zaire vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• efavirenz

  efavirenz and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• eliglustat

  eliglustat and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• encorafenib

  encorafenib and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• entrectinib

  entrectinib and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• eribulin

  eribulin and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• fentanyl

  ponesimod, fentanyl. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• fexinidazole

  fexinidazole and ponesimod both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.

• fingolimod

  ponesimod, fingolimod. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• flecainide

  ponesimod, flecainide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• galantamine

  ponesimod, galantamine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• gemifloxacin

  gemifloxacin and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• gilteritinib

  gilteritinib and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• granisetron

  granisetron and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• guanfacine

  ponesimod, guanfacine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• hydroxyzine

  hydroxyzine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• ibrutinib

  ponesimod, ibrutinib. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• inamrinone

  ponesimod, inamrinone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• influenza virus vaccine quadrivalent, intranasal

  ponesimod decreases effects of influenza virus vaccine quadrivalent, intranasal by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• isoflurane

  isoflurane and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• itraconazole

  itraconazole and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• ivosidenib

  ponesimod, ivosidenib. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• lanreotide

  ponesimod, lanreotide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• lasmiditan

  ponesimod, lasmiditan. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• lenvatinib

  ponesimod, lenvatinib. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• lithium

  lithium and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• lofexidine

  ponesimod, lofexidine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• lorlatinib

  ponesimod, lorlatinib. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• measles (rubeola) vaccine

  ponesimod decreases effects of measles (rubeola) vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• measles mumps and rubella vaccine, live

  ponesimod decreases effects of measles mumps and rubella vaccine, live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• measles, mumps, rubella and varicella vaccine, live

  ponesimod decreases effects of measles, mumps, rubella and varicella vaccine, live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• methadone

  ponesimod, methadone. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• milrinone

  ponesimod, milrinone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• mirtazapine

  mirtazapine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• mobocertinib

  mobocertinib and ponesimod both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• neostigmine

  ponesimod, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• octreotide

  ponesimod, octreotide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• olanzapine

  olanzapine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• oxaliplatin

  oxaliplatin and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• ozanimod

  ponesimod, ozanimod. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• pasireotide

  ponesimod, pasireotide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• phenytoin

  phenytoin will decrease the level or effect of ponesimod by Other (see comment). Avoid or Use Alternate Drug. Not recommended. Based on limited data, coadministration of strong CYP3A4 and UGT1A1 inducers (eg, rifampin, phenytoin, carbamazepine) may decrease systemic exposure of ponesimod. The clinical relevance is unclear.

• poliovirus vaccine live oral trivalent

  ponesimod decreases effects of poliovirus vaccine live oral trivalent by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• poractant alfa

  ponesimod, poractant alfa. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• primaquine

  primaquine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• propafenone

  ponesimod, propafenone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• propofol

  ponesimod, propofol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• pyridostigmine

  ponesimod, pyridostigmine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• quinidine

  ponesimod, quinidine. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• quinine

  ponesimod, quinine. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• remifentanil

  ponesimod, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• rifampin

  rifampin will decrease the level or effect of ponesimod by Other (see comment). Avoid or Use Alternate Drug. Not recommended. Based on limited data, coadministration of strong CYP3A4 and UGT1A1 inducers (eg, rifampin, phenytoin, carbamazepine) may decrease systemic exposure of ponesimod. The clinical relevance is unclear.

• rivastigmine

  ponesimod, rivastigmine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• rotavirus oral vaccine, live

  ponesimod decreases effects of rotavirus oral vaccine, live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• rubella vaccine

  ponesimod decreases effects of rubella vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• selpercatinib

  ponesimod, selpercatinib. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• sertraline

  sertraline and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• sevoflurane

  sevoflurane and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• siponimod

  ponesimod, siponimod. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• smallpox (vaccinia) and monkeypox vaccine, live, nonreplicating

  ponesimod decreases effects of smallpox (vaccinia) vaccine, attenuated by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• smallpox (vaccinia) vaccine, attenuated

  ponesimod decreases effects of smallpox (vaccinia) vaccine, attenuated by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• smallpox (vaccinia) vaccine, live

  ponesimod decreases effects of smallpox (vaccinia) vaccine, live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• solifenacin

  solifenacin and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• sufentanil

  ponesimod, sufentanil. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• sunitinib

  sunitinib and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• tacrolimus

  tacrolimus and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• terfenadine

  ponesimod, terfenadine. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• thalidomide

  ponesimod, thalidomide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• tizanidine

  ponesimod, tizanidine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• upadacitinib

  ponesimod, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

• vandetanib

  ponesimod, vandetanib. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• varicella virus vaccine live

  ponesimod decreases effects of varicella virus vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• verapamil

  ponesimod, verapamil. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• vorinostat

  vorinostat and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• yellow fever vaccine

  ponesimod decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• ziprasidone

  ponesimod, ziprasidone. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• zoster vaccine live

  ponesimod decreases effects of zoster vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

Monitor Closely (155)

• abatacept

  ponesimod and abatacept both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• acebutolol

  ponesimod and acebutolol both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• ado-trastuzumab emtansine

  ponesimod and ado-trastuzumab emtansine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• albuterol

  albuterol and ponesimod both increase QTc interval. Use Caution/Monitor.

• aldesleukin

  ponesimod and aldesleukin both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• alemtuzumab

  ponesimod and alemtuzumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• amiodarone

  ponesimod, amiodarone. Either increases effects of the other by QTc interval. Use Caution/Monitor. Consult cardiologist if considering treatment. Class III (eg, amiodarone, dofetilide, sotalol) anti-arrhythmic drugs have been associated with cases of torsades de pointes in patients with bradycardia.

• antithymocyte globulin equine

  ponesimod and antithymocyte globulin equine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• antithymocyte globulin rabbit

  ponesimod and antithymocyte globulin rabbit both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• apalutamide

  ponesimod and apalutamide both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• arformoterol

  arformoterol and ponesimod both increase QTc interval. Use Caution/Monitor.

• arsenic trioxide

  ponesimod and arsenic trioxide both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• atenolol

  ponesimod and atenolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• atezolizumab

  ponesimod and atezolizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• avelumab

  ponesimod and avelumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• azathioprine

  ponesimod and azathioprine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• basiliximab

  ponesimod and basiliximab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• BCG intravesical live

  ponesimod and BCG intravesical live both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• BCG vaccine live

  ponesimod decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• belatacept

  ponesimod and belatacept both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• belinostat

  ponesimod and belinostat both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• bendamustine

  ponesimod and bendamustine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• betamethasone

  ponesimod and betamethasone both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• betaxolol

  ponesimod and betaxolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• bevacizumab

  ponesimod and bevacizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• bexarotene

  ponesimod and bexarotene both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• bicalutamide

  ponesimod and bicalutamide both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• binimetinib

  ponesimod and binimetinib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• bisoprolol

  ponesimod and bisoprolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• bortezomib

  ponesimod and bortezomib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• bosutinib

  ponesimod and bosutinib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• bretylium

  ponesimod, bretylium. Either increases effects of the other by QTc interval. Use Caution/Monitor. Consult cardiologist if considering treatment. Class III (eg, amiodarone, dofetilide, sotalol) anti-arrhythmic drugs have been associated with cases of torsades de pointes in patients with bradycardia.

• carfilzomib

  ponesimod and carfilzomib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• carvedilol

  ponesimod and carvedilol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• celiprolol

  ponesimod and celiprolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• cemiplimab

  ponesimod and cemiplimab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• certolizumab pegol

  ponesimod and certolizumab pegol both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• cetuximab

  ponesimod and cetuximab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• cholera vaccine

  ponesimod decreases effects of cholera vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• cobimetinib

  ponesimod and cobimetinib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• corticotropin

  ponesimod and corticotropin both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• cortisone

  ponesimod and cortisone both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• COVID-19 vaccine, adjuvanted-Novavax

  ponesimod decreases effects of COVID-19 vaccine, adjuvanted-Novavax by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• COVID-19 vaccine, mRNA-Pfizer

  ponesimod decreases effects of COVID-19 vaccine, mRNA-Pfizer by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• COVID-19 vaccine, viral vector-Janssen

  ponesimod decreases effects of COVID-19 vaccine, viral vector-Janssen by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• cyclosporine

  ponesimod and cyclosporine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• daratumumab

  ponesimod and daratumumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• decitabine

  ponesimod and decitabine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• deflazacort

  ponesimod and deflazacort both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• denosumab

  ponesimod and denosumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• deutetrabenazine

  deutetrabenazine and ponesimod both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

• dexamethasone

  ponesimod and dexamethasone both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• dinutuximab

  ponesimod and dinutuximab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• diroximel fumarate

  ponesimod and diroximel fumarate both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• disopyramide

  ponesimod, disopyramide. Either increases effects of the other by QTc interval. Use Caution/Monitor. Consult cardiologist if considering treatment. Class Ia (eg, quinidine, procainamide) anti-arrhythmic drugs have been associated with cases of torsades de pointes in patients with bradycardia.

• dofetilide

  ponesimod, dofetilide. Either increases effects of the other by QTc interval. Use Caution/Monitor. Consult cardiologist if considering treatment. Class III (eg, amiodarone, dofetilide, sotalol) anti-arrhythmic drugs have been associated with cases of torsades de pointes in patients with bradycardia.

• dronedarone

  ponesimod, dronedarone. Either increases effects of the other by QTc interval. Use Caution/Monitor. Consult cardiologist if considering treatment. Class III (eg, amiodarone, dofetilide, sotalol) anti-arrhythmic drugs have been associated with cases of torsades de pointes in patients with bradycardia.

• durvalumab

  ponesimod and durvalumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• duvelisib

  ponesimod and duvelisib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• elotuzumab

  ponesimod and elotuzumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• emapalumab

  ponesimod and emapalumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• entrectinib

  ponesimod and entrectinib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• eribulin

  ponesimod and eribulin both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• esmolol

  ponesimod and esmolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• etanercept

  ponesimod and etanercept both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• fingolimod

  ponesimod and fingolimod both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• fludrocortisone

  ponesimod and fludrocortisone both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• gemtuzumab

  ponesimod and gemtuzumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• hepatitis A vaccine inactivated

  ponesimod decreases effects of hepatitis A vaccine inactivated by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• hepatitis a/b vaccine

  ponesimod decreases effects of hepatitis a/b vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• hepatitis b vaccine

  ponesimod decreases effects of hepatitis b vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• HIV vaccine

  ponesimod decreases effects of HIV vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• human papillomavirus vaccine, bivalent

  ponesimod decreases effects of human papillomavirus vaccine, bivalent by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• human papillomavirus vaccine, nonavalent

  ponesimod decreases effects of human papillomavirus vaccine, nonavalent by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• human papillomavirus vaccine, quadrivalent

  ponesimod decreases effects of human papillomavirus vaccine, quadrivalent by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• hydrocortisone

  ponesimod and hydrocortisone both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• hydroxychloroquine sulfate

  ponesimod and hydroxychloroquine sulfate both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• ibritumomab tiuxetan

  ponesimod and ibritumomab tiuxetan both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• ibutilide

  ponesimod, ibutilide. Either increases effects of the other by QTc interval. Use Caution/Monitor. Consult cardiologist if considering treatment. Class III (eg, amiodarone, dofetilide, sotalol) anti-arrhythmic drugs have been associated with cases of torsades de pointes in patients with bradycardia.

• infliximab

  ponesimod and infliximab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• influenza A (H5N1) vaccine

  ponesimod decreases effects of influenza A (H5N1) vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• influenza virus vaccine (H5N1), adjuvanted

  ponesimod decreases effects of influenza virus vaccine (H5N1), adjuvanted by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• influenza virus vaccine quadrivalent

  ponesimod decreases effects of influenza virus vaccine quadrivalent by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• influenza virus vaccine quadrivalent, adjuvanted

  ponesimod decreases effects of influenza virus vaccine quadrivalent, adjuvanted by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• influenza virus vaccine quadrivalent, cell-cultured

  ponesimod decreases effects of influenza virus vaccine quadrivalent, cell-cultured by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• influenza virus vaccine quadrivalent, recombinant

  ponesimod decreases effects of influenza virus vaccine quadrivalent, recombinant by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• influenza virus vaccine trivalent

  ponesimod decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• influenza virus vaccine trivalent, adjuvanted

  ponesimod decreases effects of influenza virus vaccine trivalent, adjuvanted by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• influenza virus vaccine trivalent, recombinant

  ponesimod decreases effects of influenza virus vaccine trivalent, recombinant by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• inotuzumab

  ponesimod and inotuzumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• interferon alfa 2b

  ponesimod and interferon alfa 2b both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• interferon gamma 1b

  ponesimod and interferon gamma 1b both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• ipilimumab

  ponesimod and ipilimumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• ixabepilone

  ponesimod and ixabepilone both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• Japanese encephalitis virus vaccine

  ponesimod decreases effects of Japanese encephalitis virus vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• labetalol

  ponesimod and labetalol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• leflunomide

  ponesimod and leflunomide both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• lenalidomide

  ponesimod and lenalidomide both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• methotrexate

  ponesimod and methotrexate both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• methylprednisolone

  ponesimod and methylprednisolone both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• metoprolol

  ponesimod and metoprolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• midostaurin

  ponesimod and midostaurin both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• mogamulizumab

  ponesimod and mogamulizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• mometasone sinus implant

  ponesimod and mometasone sinus implant both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• moxetumomab pasudotox

  ponesimod and moxetumomab pasudotox both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• muromonab CD3

  ponesimod and muromonab CD3 both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• mycophenolate

  ponesimod and mycophenolate both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• nadolol

  ponesimod and nadolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• natalizumab

  ponesimod and natalizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• nebivolol

  ponesimod and nebivolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• nivolumab

  ponesimod and nivolumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• olaratumab

  ponesimod and olaratumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• omacetaxine

  ponesimod and omacetaxine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• oportuzumab monatox

  ponesimod and oportuzumab monatox both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• oxaliplatin

  ponesimod and oxaliplatin both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• ozanimod

  ponesimod and ozanimod both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• panitumumab

  ponesimod and panitumumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• pembrolizumab

  ponesimod and pembrolizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• penbutolol

  ponesimod and penbutolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• pindolol

  ponesimod and pindolol both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• polatuzumab vedotin

  ponesimod and polatuzumab vedotin both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• poliovirus vaccine inactivated

  ponesimod decreases effects of poliovirus vaccine inactivated by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• ponatinib

  ponesimod and ponatinib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• prednisolone

  ponesimod and prednisolone both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• prednisone

  ponesimod and prednisone both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• procainamide

  ponesimod, procainamide. Either increases effects of the other by QTc interval. Use Caution/Monitor. Consult cardiologist if considering treatment. Class Ia (eg, quinidine, procainamide) anti-arrhythmic drugs have been associated with cases of torsades de pointes in patients with bradycardia.

• propranolol

  ponesimod and propranolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• rabies vaccine

  ponesimod decreases effects of rabies vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• rabies vaccine chick embryo cell derived

  ponesimod decreases effects of rabies vaccine chick embryo cell derived by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• rituximab

  ponesimod and rituximab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• rituximab-hyaluronidase

  ponesimod and rituximab-hyaluronidase both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• SARS-CoV-2 vaccine, inactivated

  ponesimod decreases effects of SARS-CoV-2 vaccine, inactivated by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• selumetinib

  ponesimod and selumetinib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• siltuximab

  ponesimod and siltuximab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• sirolimus

  ponesimod and sirolimus both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• sirolimus intravitreal

  ponesimod and sirolimus intravitreal both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• sotalol

  ponesimod and sotalol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.
  
  ponesimod, sotalol. Either increases effects of the other by QTc interval. Use Caution/Monitor. Consult cardiologist if considering treatment. Class III (eg, amiodarone, dofetilide, sotalol) anti-arrhythmic drugs have been associated with cases of torsades de pointes in patients with bradycardia.

• tacrolimus

  ponesimod and tacrolimus both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• temozolomide

  ponesimod and temozolomide both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• tick-borne encephalitis vaccine

  ponesimod decreases effects of tick-borne encephalitis vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• timolol

  ponesimod and timolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• tivozanib

  ponesimod and tivozanib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• tositumomab

  ponesimod and tositumomab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• trametinib

  ponesimod and trametinib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• trastuzumab

  ponesimod and trastuzumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• trastuzumab deruxtecan

  ponesimod and trastuzumab deruxtecan both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• triamcinolone acetonide extended-release injectable suspension

  ponesimod and triamcinolone acetonide extended-release injectable suspension both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• triamcinolone acetonide injectable suspension

  ponesimod and triamcinolone acetonide injectable suspension both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• typhoid polysaccharide vaccine

  ponesimod decreases effects of typhoid polysaccharide vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• typhoid vaccine live

  ponesimod decreases effects of typhoid vaccine live by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• valbenazine

  valbenazine and ponesimod both increase QTc interval. Use Caution/Monitor.

• vedolizumab

  ponesimod and vedolizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• venetoclax

  ponesimod and venetoclax both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• vernakalant

  ponesimod, vernakalant. Either increases effects of the other by QTc interval. Use Caution/Monitor. Consult cardiologist if considering treatment. Class III (eg, amiodarone, dofetilide, sotalol) anti-arrhythmic drugs have been associated with cases of torsades de pointes in patients with bradycardia.

• zoster vaccine recombinant

  ponesimod decreases effects of zoster vaccine recombinant by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

Minor (0)

• abatacept

  Monitor Closely (1)ponesimod and abatacept both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• acebutolol

  Monitor Closely (1)ponesimod and acebutolol both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• adagrasib

  Serious - Use Alternative (1)adagrasib, ponesimod. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

• adenosine

  Serious - Use Alternative (1)ponesimod, adenosine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• adenovirus types 4 and 7 live, oral

  Serious - Use Alternative (1)ponesimod decreases effects of adenovirus types 4 and 7 live, oral by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• ado-trastuzumab emtansine

  Monitor Closely (1)ponesimod and ado-trastuzumab emtansine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• albuterol

  Monitor Closely (1)albuterol and ponesimod both increase QTc interval. Use Caution/Monitor.

• aldesleukin

  Monitor Closely (1)ponesimod and aldesleukin both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• alectinib

  Serious - Use Alternative (1)ponesimod, alectinib. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• alemtuzumab

  Monitor Closely (1)ponesimod and alemtuzumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• alfuzosin

  Serious - Use Alternative (1)alfuzosin and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• amiodarone

  Monitor Closely (1)ponesimod, amiodarone. Either increases effects of the other by QTc interval. Use Caution/Monitor. Consult cardiologist if considering treatment. Class III (eg, amiodarone, dofetilide, sotalol) anti-arrhythmic drugs have been associated with cases of torsades de pointes in patients with bradycardia.

• amisulpride

  Serious - Use Alternative (1)amisulpride and ponesimod both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

• anagrelide

  Serious - Use Alternative (1)anagrelide and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• antithymocyte globulin equine

  Monitor Closely (1)ponesimod and antithymocyte globulin equine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• antithymocyte globulin rabbit

  Monitor Closely (1)ponesimod and antithymocyte globulin rabbit both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• apalutamide

  Monitor Closely (1)ponesimod and apalutamide both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.Serious - Use Alternative (1)apalutamide will decrease the level or effect of ponesimod by Other (see comment). Avoid or Use Alternate Drug. Not recommended. Based on limited data, coadministration of strong CYP3A4 and UGT1A1 inducers (eg, rifampin, phenytoin, carbamazepine) may decrease systemic exposure of ponesimod. The clinical relevance is unclear.

• apomorphine

  Serious - Use Alternative (1)apomorphine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• arformoterol

  Monitor Closely (1)arformoterol and ponesimod both increase QTc interval. Use Caution/Monitor.

• aripiprazole

  Serious - Use Alternative (1)aripiprazole and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• arsenic trioxide

  Monitor Closely (1)ponesimod and arsenic trioxide both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.Serious - Use Alternative (1)ponesimod, arsenic trioxide. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• artemether

  Serious - Use Alternative (1)artemether and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• artemether/lumefantrine

  Serious - Use Alternative (1)artemether/lumefantrine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• asenapine

  Serious - Use Alternative (1)asenapine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• asenapine transdermal

  Serious - Use Alternative (1)asenapine transdermal and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• atenolol

  Monitor Closely (1)ponesimod and atenolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• atezolizumab

  Monitor Closely (1)ponesimod and atezolizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• atomoxetine

  Serious - Use Alternative (1)atomoxetine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• avelumab

  Monitor Closely (1)ponesimod and avelumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• azathioprine

  Monitor Closely (1)ponesimod and azathioprine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• basiliximab

  Monitor Closely (1)ponesimod and basiliximab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• BCG intravesical live

  Monitor Closely (1)ponesimod and BCG intravesical live both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• BCG vaccine live

  Monitor Closely (1)ponesimod decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• bedaquiline

  Serious - Use Alternative (2)ponesimod, bedaquiline. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).
  
  bedaquiline and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• belatacept

  Monitor Closely (1)ponesimod and belatacept both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• belinostat

  Monitor Closely (1)ponesimod and belinostat both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• bendamustine

  Monitor Closely (1)ponesimod and bendamustine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• betamethasone

  Monitor Closely (1)ponesimod and betamethasone both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• betaxolol

  Monitor Closely (1)ponesimod and betaxolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• bevacizumab

  Monitor Closely (1)ponesimod and bevacizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• bexarotene

  Monitor Closely (1)ponesimod and bexarotene both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• bicalutamide

  Monitor Closely (1)ponesimod and bicalutamide both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• binimetinib

  Monitor Closely (1)ponesimod and binimetinib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• bisoprolol

  Monitor Closely (1)ponesimod and bisoprolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• bortezomib

  Monitor Closely (1)ponesimod and bortezomib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• bosutinib

  Monitor Closely (1)ponesimod and bosutinib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• bretylium

  Monitor Closely (1)ponesimod, bretylium. Either increases effects of the other by QTc interval. Use Caution/Monitor. Consult cardiologist if considering treatment. Class III (eg, amiodarone, dofetilide, sotalol) anti-arrhythmic drugs have been associated with cases of torsades de pointes in patients with bradycardia.

• brigatinib

  Serious - Use Alternative (1)ponesimod, brigatinib. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• bupivacaine

  Serious - Use Alternative (1)ponesimod, bupivacaine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• buprenorphine

  Serious - Use Alternative (1)buprenorphine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine buccal

  Serious - Use Alternative (1)buprenorphine buccal and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine subdermal implant

  Serious - Use Alternative (1)buprenorphine subdermal implant and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine transdermal

  Serious - Use Alternative (1)buprenorphine transdermal and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine, long-acting injection

  Serious - Use Alternative (1)buprenorphine, long-acting injection and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• carbamazepine

  Serious - Use Alternative (1)carbamazepine will decrease the level or effect of ponesimod by Other (see comment). Avoid or Use Alternate Drug. Not recommended. Based on limited data, coadministration of strong CYP3A4 and UGT1A1 inducers (eg, rifampin, phenytoin, carbamazepine) may decrease systemic exposure of ponesimod. The clinical relevance is unclear.

• carfilzomib

  Monitor Closely (1)ponesimod and carfilzomib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• carvedilol

  Monitor Closely (1)ponesimod and carvedilol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• celiprolol

  Monitor Closely (1)ponesimod and celiprolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• cemiplimab

  Monitor Closely (1)ponesimod and cemiplimab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• ceritinib

  Serious - Use Alternative (2)ponesimod, ceritinib. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.
  
  ceritinib and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• certolizumab pegol

  Monitor Closely (1)ponesimod and certolizumab pegol both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• cetuximab

  Monitor Closely (1)ponesimod and cetuximab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• chloroquine

  Serious - Use Alternative (1)chloroquine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• chlorpromazine

  Serious - Use Alternative (1)ponesimod, chlorpromazine. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• cholera vaccine

  Monitor Closely (1)ponesimod decreases effects of cholera vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• cisapride

  Serious - Use Alternative (1)ponesimod, cisapride. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• citalopram

  Serious - Use Alternative (1)citalopram and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• clarithromycin

  Serious - Use Alternative (1)clarithromycin and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• clonidine

  Serious - Use Alternative (1)ponesimod, clonidine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• clozapine

  Serious - Use Alternative (1)clozapine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• cobimetinib

  Monitor Closely (1)ponesimod and cobimetinib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• corticotropin

  Monitor Closely (1)ponesimod and corticotropin both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• cortisone

  Monitor Closely (1)ponesimod and cortisone both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• COVID-19 vaccine, adjuvanted-Novavax

  Monitor Closely (1)ponesimod decreases effects of COVID-19 vaccine, adjuvanted-Novavax by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• COVID-19 vaccine, mRNA-Pfizer

  Monitor Closely (1)ponesimod decreases effects of COVID-19 vaccine, mRNA-Pfizer by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• COVID-19 vaccine, viral vector-Janssen

  Monitor Closely (1)ponesimod decreases effects of COVID-19 vaccine, viral vector-Janssen by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• crizotinib

  Serious - Use Alternative (2)ponesimod, crizotinib. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.
  
  crizotinib and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• cyclosporine

  Monitor Closely (1)ponesimod and cyclosporine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• daratumumab

  Monitor Closely (1)ponesimod and daratumumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• dasatinib

  Serious - Use Alternative (1)dasatinib and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• decitabine

  Monitor Closely (1)ponesimod and decitabine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• deflazacort

  Monitor Closely (1)ponesimod and deflazacort both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• degarelix

  Serious - Use Alternative (1)degarelix and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• dengue vaccine

  Serious - Use Alternative (1)ponesimod decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• denosumab

  Monitor Closely (1)ponesimod and denosumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• desflurane

  Serious - Use Alternative (1)desflurane and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• deutetrabenazine

  Monitor Closely (1)deutetrabenazine and ponesimod both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

• dexamethasone

  Monitor Closely (1)ponesimod and dexamethasone both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• dexmedetomidine

  Serious - Use Alternative (1)ponesimod, dexmedetomidine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• digoxin

  Serious - Use Alternative (1)ponesimod, digoxin. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• diltiazem

  Serious - Use Alternative (1)ponesimod, diltiazem. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• dinutuximab

  Monitor Closely (1)ponesimod and dinutuximab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• diroximel fumarate

  Monitor Closely (1)ponesimod and diroximel fumarate both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• disopyramide

  Monitor Closely (1)ponesimod, disopyramide. Either increases effects of the other by QTc interval. Use Caution/Monitor. Consult cardiologist if considering treatment. Class Ia (eg, quinidine, procainamide) anti-arrhythmic drugs have been associated with cases of torsades de pointes in patients with bradycardia.

• dobutamine

  Serious - Use Alternative (1)ponesimod, dobutamine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• dofetilide

  Monitor Closely (1)ponesimod, dofetilide. Either increases effects of the other by QTc interval. Use Caution/Monitor. Consult cardiologist if considering treatment. Class III (eg, amiodarone, dofetilide, sotalol) anti-arrhythmic drugs have been associated with cases of torsades de pointes in patients with bradycardia.

• dolasetron

  Serious - Use Alternative (1)dolasetron and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• donepezil

  Serious - Use Alternative (2)ponesimod, donepezil. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.
  
  donepezil and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• dopamine

  Serious - Use Alternative (1)ponesimod, dopamine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• doxepin

  Serious - Use Alternative (1)doxepin and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• dronedarone

  Monitor Closely (1)ponesimod, dronedarone. Either increases effects of the other by QTc interval. Use Caution/Monitor. Consult cardiologist if considering treatment. Class III (eg, amiodarone, dofetilide, sotalol) anti-arrhythmic drugs have been associated with cases of torsades de pointes in patients with bradycardia.Serious - Use Alternative (1)ponesimod, dronedarone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• durvalumab

  Monitor Closely (1)ponesimod and durvalumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• duvelisib

  Monitor Closely (1)ponesimod and duvelisib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• Ebola Zaire vaccine

  Serious - Use Alternative (1)ponesimod decreases effects of Ebola Zaire vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• efavirenz

  Serious - Use Alternative (1)efavirenz and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• eliglustat

  Serious - Use Alternative (1)eliglustat and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• elotuzumab

  Monitor Closely (1)ponesimod and elotuzumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• emapalumab

  Monitor Closely (1)ponesimod and emapalumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• encorafenib

  Serious - Use Alternative (1)encorafenib and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• entrectinib

  Monitor Closely (1)ponesimod and entrectinib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.Serious - Use Alternative (1)entrectinib and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• eribulin

  Monitor Closely (1)ponesimod and eribulin both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.Serious - Use Alternative (1)eribulin and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• esmolol

  Monitor Closely (1)ponesimod and esmolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• etanercept

  Monitor Closely (1)ponesimod and etanercept both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• fentanyl

  Serious - Use Alternative (1)ponesimod, fentanyl. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• fexinidazole

  Serious - Use Alternative (1)fexinidazole and ponesimod both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.

• fingolimod

  Monitor Closely (1)ponesimod and fingolimod both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.Serious - Use Alternative (1)ponesimod, fingolimod. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• flecainide

  Serious - Use Alternative (1)ponesimod, flecainide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• fludrocortisone

  Monitor Closely (1)ponesimod and fludrocortisone both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• galantamine

  Serious - Use Alternative (1)ponesimod, galantamine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• gemifloxacin

  Serious - Use Alternative (1)gemifloxacin and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• gemtuzumab

  Monitor Closely (1)ponesimod and gemtuzumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• gilteritinib

  Serious - Use Alternative (1)gilteritinib and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• granisetron

  Serious - Use Alternative (1)granisetron and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• guanfacine

  Serious - Use Alternative (1)ponesimod, guanfacine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• hepatitis A vaccine inactivated

  Monitor Closely (1)ponesimod decreases effects of hepatitis A vaccine inactivated by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• hepatitis a/b vaccine

  Monitor Closely (1)ponesimod decreases effects of hepatitis a/b vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• hepatitis b vaccine

  Monitor Closely (1)ponesimod decreases effects of hepatitis b vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• HIV vaccine

  Monitor Closely (1)ponesimod decreases effects of HIV vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• human papillomavirus vaccine, bivalent

  Monitor Closely (1)ponesimod decreases effects of human papillomavirus vaccine, bivalent by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• human papillomavirus vaccine, nonavalent

  Monitor Closely (1)ponesimod decreases effects of human papillomavirus vaccine, nonavalent by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• human papillomavirus vaccine, quadrivalent

  Monitor Closely (1)ponesimod decreases effects of human papillomavirus vaccine, quadrivalent by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• hydrocortisone

  Monitor Closely (1)ponesimod and hydrocortisone both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• hydroxychloroquine sulfate

  Monitor Closely (1)ponesimod and hydroxychloroquine sulfate both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• hydroxyzine

  Serious - Use Alternative (1)hydroxyzine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• ibritumomab tiuxetan

  Monitor Closely (1)ponesimod and ibritumomab tiuxetan both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• ibrutinib

  Serious - Use Alternative (1)ponesimod, ibrutinib. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• ibutilide

  Monitor Closely (1)ponesimod, ibutilide. Either increases effects of the other by QTc interval. Use Caution/Monitor. Consult cardiologist if considering treatment. Class III (eg, amiodarone, dofetilide, sotalol) anti-arrhythmic drugs have been associated with cases of torsades de pointes in patients with bradycardia.

• inamrinone

  Serious - Use Alternative (1)ponesimod, inamrinone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• infliximab

  Monitor Closely (1)ponesimod and infliximab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• influenza A (H5N1) vaccine

  Monitor Closely (1)ponesimod decreases effects of influenza A (H5N1) vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• influenza virus vaccine (H5N1), adjuvanted

  Monitor Closely (1)ponesimod decreases effects of influenza virus vaccine (H5N1), adjuvanted by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• influenza virus vaccine quadrivalent

  Monitor Closely (1)ponesimod decreases effects of influenza virus vaccine quadrivalent by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• influenza virus vaccine quadrivalent, adjuvanted

  Monitor Closely (1)ponesimod decreases effects of influenza virus vaccine quadrivalent, adjuvanted by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• influenza virus vaccine quadrivalent, cell-cultured

  Monitor Closely (1)ponesimod decreases effects of influenza virus vaccine quadrivalent, cell-cultured by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• influenza virus vaccine quadrivalent, intranasal

  Serious - Use Alternative (1)ponesimod decreases effects of influenza virus vaccine quadrivalent, intranasal by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• influenza virus vaccine quadrivalent, recombinant

  Monitor Closely (1)ponesimod decreases effects of influenza virus vaccine quadrivalent, recombinant by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• influenza virus vaccine trivalent

  Monitor Closely (1)ponesimod decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• influenza virus vaccine trivalent, adjuvanted

  Monitor Closely (1)ponesimod decreases effects of influenza virus vaccine trivalent, adjuvanted by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• influenza virus vaccine trivalent, recombinant

  Monitor Closely (1)ponesimod decreases effects of influenza virus vaccine trivalent, recombinant by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• inotuzumab

  Monitor Closely (1)ponesimod and inotuzumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• interferon alfa 2b

  Monitor Closely (1)ponesimod and interferon alfa 2b both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• interferon gamma 1b

  Monitor Closely (1)ponesimod and interferon gamma 1b both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• ipilimumab

  Monitor Closely (1)ponesimod and ipilimumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• isoflurane

  Serious - Use Alternative (1)isoflurane and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• itraconazole

  Serious - Use Alternative (1)itraconazole and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• ivosidenib

  Serious - Use Alternative (1)ponesimod, ivosidenib. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• ixabepilone

  Monitor Closely (1)ponesimod and ixabepilone both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• Japanese encephalitis virus vaccine

  Monitor Closely (1)ponesimod decreases effects of Japanese encephalitis virus vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• labetalol

  Monitor Closely (1)ponesimod and labetalol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• lanreotide

  Serious - Use Alternative (1)ponesimod, lanreotide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• lasmiditan

  Serious - Use Alternative (1)ponesimod, lasmiditan. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• leflunomide

  Monitor Closely (1)ponesimod and leflunomide both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• lenalidomide

  Monitor Closely (1)ponesimod and lenalidomide both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• lenvatinib

  Serious - Use Alternative (1)ponesimod, lenvatinib. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• lithium

  Serious - Use Alternative (1)lithium and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• lofexidine

  Serious - Use Alternative (1)ponesimod, lofexidine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• lorlatinib

  Serious - Use Alternative (1)ponesimod, lorlatinib. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• measles (rubeola) vaccine

  Serious - Use Alternative (1)ponesimod decreases effects of measles (rubeola) vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• measles mumps and rubella vaccine, live

  Serious - Use Alternative (1)ponesimod decreases effects of measles mumps and rubella vaccine, live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• measles, mumps, rubella and varicella vaccine, live

  Serious - Use Alternative (1)ponesimod decreases effects of measles, mumps, rubella and varicella vaccine, live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• methadone

  Serious - Use Alternative (1)ponesimod, methadone. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• methotrexate

  Monitor Closely (1)ponesimod and methotrexate both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• methylprednisolone

  Monitor Closely (1)ponesimod and methylprednisolone both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• metoprolol

  Monitor Closely (1)ponesimod and metoprolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• midostaurin

  Monitor Closely (1)ponesimod and midostaurin both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• milrinone

  Serious - Use Alternative (1)ponesimod, milrinone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• mirtazapine

  Serious - Use Alternative (1)mirtazapine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• mobocertinib

  Serious - Use Alternative (1)mobocertinib and ponesimod both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• mogamulizumab

  Monitor Closely (1)ponesimod and mogamulizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• mometasone sinus implant

  Monitor Closely (1)ponesimod and mometasone sinus implant both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• moxetumomab pasudotox

  Monitor Closely (1)ponesimod and moxetumomab pasudotox both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• muromonab CD3

  Monitor Closely (1)ponesimod and muromonab CD3 both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• mycophenolate

  Monitor Closely (1)ponesimod and mycophenolate both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• nadolol

  Monitor Closely (1)ponesimod and nadolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• natalizumab

  Monitor Closely (1)ponesimod and natalizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• nebivolol

  Monitor Closely (1)ponesimod and nebivolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• neostigmine

  Serious - Use Alternative (1)ponesimod, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• nivolumab

  Monitor Closely (1)ponesimod and nivolumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• octreotide

  Serious - Use Alternative (1)ponesimod, octreotide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• olanzapine

  Serious - Use Alternative (1)olanzapine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• olaratumab

  Monitor Closely (1)ponesimod and olaratumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• omacetaxine

  Monitor Closely (1)ponesimod and omacetaxine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• oportuzumab monatox

  Monitor Closely (1)ponesimod and oportuzumab monatox both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• oxaliplatin

  Monitor Closely (1)ponesimod and oxaliplatin both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.Serious - Use Alternative (1)oxaliplatin and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• ozanimod

  Monitor Closely (1)ponesimod and ozanimod both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.Serious - Use Alternative (1)ponesimod, ozanimod. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• panitumumab

  Monitor Closely (1)ponesimod and panitumumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• pasireotide

  Serious - Use Alternative (1)ponesimod, pasireotide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• pembrolizumab

  Monitor Closely (1)ponesimod and pembrolizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• penbutolol

  Monitor Closely (1)ponesimod and penbutolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• phenytoin

  Serious - Use Alternative (1)phenytoin will decrease the level or effect of ponesimod by Other (see comment). Avoid or Use Alternate Drug. Not recommended. Based on limited data, coadministration of strong CYP3A4 and UGT1A1 inducers (eg, rifampin, phenytoin, carbamazepine) may decrease systemic exposure of ponesimod. The clinical relevance is unclear.

• pindolol

  Monitor Closely (1)ponesimod and pindolol both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• polatuzumab vedotin

  Monitor Closely (1)ponesimod and polatuzumab vedotin both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• poliovirus vaccine inactivated

  Monitor Closely (1)ponesimod decreases effects of poliovirus vaccine inactivated by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• poliovirus vaccine live oral trivalent

  Serious - Use Alternative (1)ponesimod decreases effects of poliovirus vaccine live oral trivalent by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• ponatinib

  Monitor Closely (1)ponesimod and ponatinib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• poractant alfa

  Serious - Use Alternative (1)ponesimod, poractant alfa. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• prednisolone

  Monitor Closely (1)ponesimod and prednisolone both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• prednisone

  Monitor Closely (1)ponesimod and prednisone both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• primaquine

  Serious - Use Alternative (1)primaquine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• procainamide

  Monitor Closely (1)ponesimod, procainamide. Either increases effects of the other by QTc interval. Use Caution/Monitor. Consult cardiologist if considering treatment. Class Ia (eg, quinidine, procainamide) anti-arrhythmic drugs have been associated with cases of torsades de pointes in patients with bradycardia.

• propafenone

  Serious - Use Alternative (1)ponesimod, propafenone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• propofol

  Serious - Use Alternative (1)ponesimod, propofol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• propranolol

  Monitor Closely (1)ponesimod and propranolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• pyridostigmine

  Serious - Use Alternative (1)ponesimod, pyridostigmine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• quinidine

  Serious - Use Alternative (1)ponesimod, quinidine. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• quinine

  Serious - Use Alternative (1)ponesimod, quinine. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• rabies vaccine

  Monitor Closely (1)ponesimod decreases effects of rabies vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• rabies vaccine chick embryo cell derived

  Monitor Closely (1)ponesimod decreases effects of rabies vaccine chick embryo cell derived by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• remifentanil

  Serious - Use Alternative (1)ponesimod, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• rifampin

  Serious - Use Alternative (1)rifampin will decrease the level or effect of ponesimod by Other (see comment). Avoid or Use Alternate Drug. Not recommended. Based on limited data, coadministration of strong CYP3A4 and UGT1A1 inducers (eg, rifampin, phenytoin, carbamazepine) may decrease systemic exposure of ponesimod. The clinical relevance is unclear.

• rituximab

  Monitor Closely (1)ponesimod and rituximab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• rituximab-hyaluronidase

  Monitor Closely (1)ponesimod and rituximab-hyaluronidase both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• rivastigmine

  Serious - Use Alternative (1)ponesimod, rivastigmine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• rotavirus oral vaccine, live

  Serious - Use Alternative (1)ponesimod decreases effects of rotavirus oral vaccine, live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• rubella vaccine

  Serious - Use Alternative (1)ponesimod decreases effects of rubella vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• SARS-CoV-2 vaccine, inactivated

  Monitor Closely (1)ponesimod decreases effects of SARS-CoV-2 vaccine, inactivated by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• selpercatinib

  Serious - Use Alternative (1)ponesimod, selpercatinib. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• selumetinib

  Monitor Closely (1)ponesimod and selumetinib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• sertraline

  Serious - Use Alternative (1)sertraline and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• sevoflurane

  Serious - Use Alternative (1)sevoflurane and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• siltuximab

  Monitor Closely (1)ponesimod and siltuximab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• siponimod

  Serious - Use Alternative (1)ponesimod, siponimod. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• sirolimus

  Monitor Closely (1)ponesimod and sirolimus both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• sirolimus intravitreal

  Monitor Closely (1)ponesimod and sirolimus intravitreal both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• smallpox (vaccinia) and monkeypox vaccine, live, nonreplicating

  Serious - Use Alternative (2)ponesimod decreases effects of smallpox (vaccinia) vaccine, attenuated by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.
  
  ponesimod decreases effects of smallpox (vaccinia) vaccine, attenuated by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• smallpox (vaccinia) vaccine, live

  Serious - Use Alternative (1)ponesimod decreases effects of smallpox (vaccinia) vaccine, live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• solifenacin

  Serious - Use Alternative (1)solifenacin and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• sotalol

  Monitor Closely (2)ponesimod and sotalol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.
  
  ponesimod, sotalol. Either increases effects of the other by QTc interval. Use Caution/Monitor. Consult cardiologist if considering treatment. Class III (eg, amiodarone, dofetilide, sotalol) anti-arrhythmic drugs have been associated with cases of torsades de pointes in patients with bradycardia.

• sufentanil

  Serious - Use Alternative (1)ponesimod, sufentanil. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• sunitinib

  Serious - Use Alternative (1)sunitinib and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• tacrolimus

  Monitor Closely (1)ponesimod and tacrolimus both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.Serious - Use Alternative (1)tacrolimus and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• temozolomide

  Monitor Closely (1)ponesimod and temozolomide both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• terfenadine

  Serious - Use Alternative (1)ponesimod, terfenadine. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• thalidomide

  Serious - Use Alternative (1)ponesimod, thalidomide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• tick-borne encephalitis vaccine

  Monitor Closely (1)ponesimod decreases effects of tick-borne encephalitis vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• timolol

  Monitor Closely (1)ponesimod and timolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• tivozanib

  Monitor Closely (1)ponesimod and tivozanib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• tizanidine

  Serious - Use Alternative (1)ponesimod, tizanidine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• tositumomab

  Monitor Closely (1)ponesimod and tositumomab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• trametinib

  Monitor Closely (1)ponesimod and trametinib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• trastuzumab

  Monitor Closely (1)ponesimod and trastuzumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• trastuzumab deruxtecan

  Monitor Closely (1)ponesimod and trastuzumab deruxtecan both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• triamcinolone acetonide extended-release injectable suspension

  Monitor Closely (1)ponesimod and triamcinolone acetonide extended-release injectable suspension both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• triamcinolone acetonide injectable suspension

  Monitor Closely (1)ponesimod and triamcinolone acetonide injectable suspension both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• typhoid polysaccharide vaccine

  Monitor Closely (1)ponesimod decreases effects of typhoid polysaccharide vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• typhoid vaccine live

  Monitor Closely (1)ponesimod decreases effects of typhoid vaccine live by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

• upadacitinib

  Serious - Use Alternative (1)ponesimod, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

• valbenazine

  Monitor Closely (1)valbenazine and ponesimod both increase QTc interval. Use Caution/Monitor.

• vandetanib

  Serious - Use Alternative (1)ponesimod, vandetanib. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• varicella virus vaccine live

  Serious - Use Alternative (1)ponesimod decreases effects of varicella virus vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• vedolizumab

  Monitor Closely (1)ponesimod and vedolizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• venetoclax

  Monitor Closely (1)ponesimod and venetoclax both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• verapamil

  Serious - Use Alternative (1)ponesimod, verapamil. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• vernakalant

  Monitor Closely (1)ponesimod, vernakalant. Either increases effects of the other by QTc interval. Use Caution/Monitor. Consult cardiologist if considering treatment. Class III (eg, amiodarone, dofetilide, sotalol) anti-arrhythmic drugs have been associated with cases of torsades de pointes in patients with bradycardia.

• vorinostat

  Serious - Use Alternative (1)vorinostat and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• yellow fever vaccine

  Serious - Use Alternative (1)ponesimod decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• ziprasidone

  Serious - Use Alternative (1)ponesimod, ziprasidone. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• zoster vaccine live

  Serious - Use Alternative (1)ponesimod decreases effects of zoster vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.

• zoster vaccine recombinant

  Monitor Closely (1)ponesimod decreases effects of zoster vaccine recombinant by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.