Multiple sclerosis:

Indications for: TASCENSO ODT

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

Adults and Children:

<10yrs: not established. Dissolve on tongue before swallowing with or without food/water. ≥10yrs (>40kg): 0.5mg once daily; (≤40kg): 0.25mg once daily. First dose monitoring for bradycardia: see Warnings/Precautions. Re-initiation of therapy after discontinuation for >14 days: within first 2 weeks, first dose procedures are recommended after interruption of 1 day or more; during weeks 3 and 4, first dose procedures are recommended after interruption of more than 7 days. Children: observe first dose monitoring when dose increased. Currently on another fingolimod product and underwent first-dose monitoring at initiation: may switch to Tascenso ODT at the same daily dose without repeating first-dose monitoring (unless previous tx was discontinued >14 days prior).

TASCENSO ODT Contraindications:

Recent (within the last 6 months) occurrence of: MI, unstable angina, stroke, TIA, decompensated heart failure requiring hospitalization, Class III/IV heart failure. History or presence of Mobitz Type II 2nd degree or 3rd degree AV block or sick sinus syndrome, unless paced. Baseline QTc interval ≥500ms. Arrhythmias requiring treatment with Class Ia or Class III antiarrhythmic drugs. Concomitant use with other products containing fingolimod.

TASCENSO ODT Warnings/Precautions:

Risk of bradyarrhythmia; observe all patients for bradycardia for at least 6hrs after first dose with hourly pulse and BP measurement. Obtain ECG prior to dosing and at the end of observation period. If heart rate (HR) <45bpm (adults), <55bpm (≥12yrs) or <60bpm (10–11yrs), or new onset 2nd degree or higher AV block; monitor until resolution, those at the lowest post-dose HR should be monitored until HR increases. Symptomatic bradycardia: begin continuous ECG monitoring until resolved; if pharmacological intervention necessary, continue ECG monitoring overnight, and first dose monitoring procedures should be repeated for 2nd dose. Pre-existing cardiac conditions (eg, ischemic heart disease, history of MI, cardiac arrest or symptomatic bradycardia, cerebrovascular disease, CHF, uncontrolled hypertension, recurrent syncope, untreated sleep apnea, AV block, sino-atrial block), QT prolongation risk (eg, hypokalemia, hypomagnesemia, congenital long-QT syndrome): monitor ECG overnight after first dose. Monitor BP during treatment. Increased risk of infections (may be fatal). Obtain recent CBC before starting treatment. Consider suspending therapy if serious infection develops; continue monitoring for 2 months after discontinuation. Active acute or chronic infection: do not start treatment until infection resolved. Test for antibodies to varicella zoster virus; consider immunization before starting fingolimod. Consider HPV immunization prior to initiation. Perform cancer screening (including Pap test). Immunosuppressed. Withhold and evaluate at first sign/symptom of progressive multifocal leukoencephalopathy (PML); discontinue if confirmed and monitor for immune reconstitution inflammatory syndrome (IRIS). Diabetes, history of uveitis: increased risk of macular edema. Monitor visual acuity and for visual disturbances. Do ophthalmic exam at baseline, and at 3–4 months after starting therapy. Renal or severe hepatic impairment. Obtain ALT, AST, total bilirubin prior to initiation (eg, within 6 months); monitor periodically until 2 months after stopping treatment. Monitor for hepatic injury; discontinue if occurs. Interrupt treatment if ALT >3 times the reference range with total bilirubin >2 times the reference range; do not resume if no alternative etiology established. Respiratory dysfunction; obtain spirometry and DLCO when needed. Monitor for severe increase in disability after treatment discontinuation. Malignancies. Consider tumefactive MS if severe MS relapse occurs during (esp initiation) or after discontinuing. Perform periodic skin exam (esp. with risk factors); monitor for suspicious skin lesions and evaluate if observed. Complete all immunizations in children prior to initiation. Elderly. Advise females of reproductive potential to use effective contraception during and for 2 months after discontinuation. Pregnancy: exclude status prior to initiation. Nursing mothers.

TASCENSO ODT Classification:

Sphingosine 1-phosphate receptor modulator.

TASCENSO ODT Interactions:

Concomitant QT prolonging drugs (eg, citalopram, chlorpromazine, haloperidol, methadone, erythromycin): risk of torsades de pointes; monitor. Potentiated by ketoconazole; monitor if receiving systemic therapy. Concomitant β-blockers, digoxin, diltiazem, verapamil may be associated with severe bradycardia or heart block; consider alternatives. Avoid live virus vaccines during treatment and for 2 months after discontinuing fingolimod; may have suboptimal response. Antineoplastic, immunosuppressant or immunomodulating therapies may increase risk of immunosuppression; use caution when switching from long-acting immunotherapies (eg, natalizumab, teriflunomide, mitoxantrone).

Adverse Reactions:

Headache, increased liver transaminases, diarrhea, cough, influenza, sinusitis, back pain, abdominal pain, pain in extremity; bradyarrhythmia, AV blocks, hypertension, increased infection risk, macular edema, decreased pulmonary function, basal cell carcinoma/melanoma, lymphoma, hypersensitivity reactions; PML, IRIS; rare: posterior reversible encephalopathy syndrome (discontinue if suspected).


The biotransformation of fingolimod in humans occurs by 3 main pathways: by reversible stereoselective phosphorylation to the pharmacologically active (S)-enantiomer of fingolimod-phosphate, by oxidative biotransformation catalyzed mainly by the cytochrome P450 4F2 (CYP4F2) and possibly other CYP4F isoenzymes with subsequent fatty acid-like degradation to inactive metabolites, and by formation of pharmacologically inactive non-polar ceramide analogs of fingolimod. Inhibitors or inducers of CYP4F2 and possibly other CYP4F isozymes might alter the exposure of fingolimod or fingolimod-phosphate. In vitro studies in hepatocytes indicated that CYP3A4 may contribute to fingolimod metabolism in the case of strong induction of CYP3A4.

Drug Elimination:

After oral administration, about 81% of the dose is slowly excreted in the urine as inactive metabolites. Fingolimod and fingolimod-phosphate are not excreted intact in urine but are the major components in the feces with amounts of each representing <2.5% of the dose. Blood clearance: 6.3±2.3 L/h. Terminal half-life: 6–9 days.

Generic Drug Availability:


How Supplied:

Blister cards—30