teriflunomide
Teriflunomide (Aubagio) is a disease-modifying therapy (DMT). It's used to treat relapsing forms of multiple sclerosis in adults. Teriflunomide (Aubagio) is taken by mouth once per day. Some common side effects of this medication includes headache, diarrhea, and hair loss.
What is Teriflunomide (Aubagio)?
What is Teriflunomide (Aubagio) used for?
Relapsing forms of multiple sclerosis (MS)
How Teriflunomide (Aubagio) works
People with multiple sclerosis (MS) have an immune system that attacks their own nervous system by mistake.
Teriflunomide (Aubagio) is a type of disease-modifying treatment (DMT) called a pyrimidine synthesis inhibitor. The exact way it works to treat MS isn't well-understood. But it's thought to calm down the immune system by blocking a specific enzyme (protein).
Drug Facts
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What are the side effects of Teriflunomide (Aubagio)?
Common Side Effects
- Headache (16-18%)
- Abnormal liver tests (13-15%)
- Diarrhea (13-14%)
- Hair loss (10-13%)
- Nausea (8-11%)
Other Side Effects
- Feeling of "pins and needles" in arms and legs
- Joint pain
- High blood pressure
Serious Side Effects
- Liver problems: nausea, vomiting, stomach pain, swelling of your stomach, yellowing of your skin or the whites of your eyes, clay-colored stool, confusion
- Infections: fever, difficulty breathing, diarrhea, weakness, cough, stomach pain, sweating, chills
- Serious allergic and skin reactions: sore throat, fever, fatigue, rash, hives, painful blisters, skin reddening, skin peeling, swollen lymph nodes
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions or angioedema—skin rash, itching or hives, swelling of the face, eyes, lips, tongue, arms, or legs, trouble swallowing or breathing
- Dry cough, shortness of breath or trouble breathing
- Increase in blood pressure
- Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Pain, tingling, or numbness in the hands or feet
- Rash, fever, and swollen lymph nodes
- Redness, blistering, peeling, or loosening of the skin, including inside the mouth
- Unusual bruising or bleeding
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
Pros and cons of Teriflunomide (Aubagio)
Pros
Taken by mouth once per day
Can be taken with or without food
Cons
Stays in your body for a long time (up to 2 years for some people)
Can cause severe liver damage
Can't take during pregnancy
Pharmacist tips for Teriflunomide (Aubagio)
Make sure to mark your appointments on your calendar to see your provider and get any tests done (e.g., liver tests, blood cell count, pregnancy tests, blood pressure). This will help make sure you're properly being monitored for how well the medication works and for side effects.
If you want to stop taking teriflunomide (Aubagio) for any reason, talk with your provider. This medication can stay in your body for a long time (up to 2 years) even after you stop treatment. If you wish to stop teriflunomide (Aubagio), your provider will ask you to go through a procedure to quickly remove this medication from your body.
Take teriflunomide (Aubagio) at the same time every day with or without food. But nausea and diarrhea are possible side effects, so taking it with food can help prevent or ease these from happening.
Teriflunomide (Aubagio) can raise your blood pressure. Your provider might have you monitor your blood pressure at home or when you see your provider to make sure it's within a safe range. If you measure your blood pressure and notice it's going up, let your provider know.
Teriflunomide (Aubagio) can cause numbness and tingling in the hands and feet. Let your provider know if this happens. Depending on how serious your symptoms are, your provider might ask you to stop teriflunomide (Aubagio).
Teriflunomide (Aubagio) can interact with other medications. For examples, it can cause warfarin (Coumadin) (blood thinner) to not work as well and raise your risk of blood clots. Additionally, taking teriflunomide (Aubagio) with medications that affect your immune system could raise your risk for serious infections. Make sure to tell your provider about all the medications you're taking before starting teriflunomide (Aubagio).
Before you get any vaccines, tell your provider or pharmacist that you're taking teriflunomide (Aubagio). Your providers can make sure the vaccines are safe for you to get. It's not known whether the medication affects how your body responds to live vaccines.
Teriflunomide (Aubagio) should be avoided in pregnancy due to severe risk of harm to babies. If you (or your partner) are able to have children, you need to use birth control while taking teriflunomide (Aubagio). Talk to your provider if you're pregnant or thinking of getting pregnant while taking teriflunomide (Aubagio).
It's not recommended to breastfeed while taking teriflunomide (Aubagio) because the medication can potentially cause severe side effects in your baby.
Frequently asked questions about Teriflunomide (Aubagio)
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What are the risks and warnings for Teriflunomide (Aubagio)?
Teriflunomide (Aubagio) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Liver problems
Risk factors: History of liver problems | Taking medications that affect your liver
Liver damage has occurred in some people taking teriflunomide (Aubagio). Some cases have been severe and required a liver transplant. The risk is higher in people who already have liver problems or people who take other medications that harm the liver. You won't be able to take teriflunomide (Aubagio) if you've serious liver problems. Your provider will monitor your liver closely through blood tests while you're taking teriflunomide (Aubagio). They might ask you to stop teriflunomide (Aubagio) if you've symptoms of liver damage, such as feeling more tired, having little to no appetite, having yellowing of the skin or eyes, or dark-colored urine.
Harm to unborn baby
Teriflunomide (Aubagio) can cause severe and life-threatening harm to an unborn baby. Females taking teriflunomide (Aubagio) will need to have a pregnancy test before the start of treatment. If you or your partner is able to become pregnant, you (or your partner) must use effective birth control during teriflunomide (Aubagio) treatment. If you (or your partner) becomes pregnant, let your provider know right away. You'll need to go through a procedure to quickly remove teriflunomide (Aubagio) from the body.
People (both males and females) who want to conceive a child after the end of teriflunomide (Aubagio) treatment must go through the procedure to removes all traces of teriflunomide (Aubagio) from their body. Without this procedure, the medication can stay in the body for as long as 2 years.
Removing teriflunomide (Aubagio) from the body
Your body gets rid of teriflunomide (Aubagio) very slowly. After you stop taking teriflunomide (Aubagio), it usually takes about 8 months to get rid of most of it. But for some people, it can take up to 2 years. If you're planning on becoming pregnant or are having side effects that are too much to handle, medications like cholestyramine (Prevalite) can be used to speed up the process and get rid of almost all of teriflunomide (Aubagio) from your body after 11 days.
Risk of serious infections
Risk factors: Active, chronic (long-term), or recurrent infection | Other conditions that raise your risk of infection | Taking medications that weaken your immune system
Teriflunomide (Aubagio) can make it more difficult for your body to fight off infections. This raises your risk of serious bacterial, viral, or fungal infections. The risk is higher for people who are taking or have recently taken other medications that weaken the immune system.
Additionally, teriflunomide (Aubagio) might reactivate (wake up) certain viruses that are already in your body, such as tuberculosis (TB). Before you start teriflunomide (Aubagio) will check to see if you've any current infections.
If you develop an infection, your provider will likely ask you to stop taking teriflunomide (Aubagio) until your body fights off the infection. Let your provider know if you experience symptoms of these infections, such as fever, cough, difficulty breathing, or weakness.
Vaccinations
Make sure you're up-to-date on routine vaccinations before you start teriflunomide (Aubagio). It's unclear how teriflunomide (Aubagio) might affect vaccines. But because teriflunomide (Aubagio) interferes with your immune system, there's a chance vaccines won't work as well for you. In addition, you're recommended to avoid live vaccines while receiving teriflunomide (Aubagio) because there's a risk that you can get sick from the live vaccines. Talk with your provider to see if you still need to schedule any vaccines.
Serious skin reactions
There have been cases of severe and possibly fatal skin reactions with teriflunomide (Aubagio) called Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) Seek medical help right away if you notice sores, fluid-filled blisters, or peeling skin that's painful.
Severe allergic reactions
Severe allergic reactions to teriflunomide (Aubagio) are possible, including life-threatening reactions like facial swelling and anaphylaxis (e.g., closing of the throat). Teriflunomide (Aubagio) can also cause drug reaction with eosinophilia and systemic symptoms (DRESS), which is characterized by fever, rash, and swollen lymph nodes. If you experience symptoms of an allergic reaction, get medical help right away.
Nerve-related problems
Some people who took teriflunomide (Aubagio) have developed nerve-related problems (peripheral neuropathy). Sometimes, they continued to experience nerve problems even after stopping this medication. If you notice numbness or a tingling sensation in your hands or feet, let your provider know. They might ask you to stop taking teriflunomide (Aubagio) and undergo the procedure to quickly remove the medication from your body.
Lung problems
Though rare, people who took teriflunomide (Aubagio) have developed interstitial lung diseaffese (ILD), which can be life-threatening. Symptoms of ILD include cough or trouble breathing. If you experience these symptoms, call your provider right away. You might need to go through a procedure to quickly remove teriflunomide (Aubagio) from the body.
Teriflunomide (Aubagio) dosage forms
Typical dosing for Teriflunomide (Aubagio)
Adults: The typical dose is 7 mg or 14 mg by mouth once a day.
More on Teriflunomide (Aubagio) dosage forms
How much does Teriflunomide (Aubagio) cost?
Teriflunomide (Aubagio) contraindications
Severe liver problems
Not using birth control (for females who are able to become pregnant)
Allergy to leflunomide (Arava) or teriflunomide (Aubagio)
Taking leflunomide (Arava) with teriflunomide (Aubagio)
What are alternatives to Teriflunomide (Aubagio)?
Relapsing forms of multiple sclerosis (MS)
Relapsing forms of multiple sclerosis (MS)
Relapsing forms of multiple sclerosis (MS)
What is the latest news about Teriflunomide (Aubagio)?
Teriflunomide (Aubagio) images
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References
Best studies we foundBar-Or, A., et al. (2014). Teriflunomide and its mechanism of action in multiple sclerosis. Drugs.
Buron, M. D., et al. (2019). Comparative effectiveness of teriflunomide and dimethyl fumarate. Neurology.
Genzyme Corporation. (2023). Aubagio- teriflunomide tablet, film coated [package insert]. DailyMed.
Hendin Travis, L., et al. (2018). Real-world observational evaluation of hair thinning in patients with multiple sclerosis receiving teriflunomide: Is it an issue in clinical practice? Neurology and Therapy.
Lunven, C., et al. (2017). Effectiveness and tolerability of colesevelam HCl for accelerated elimination of teriflunomide in healthy participants. Journal of Clinical Pharmacology.
Miller, A. E., et al. (2015). Teriflunomide: A once-daily oral medication for the treatment of relapsing forms of multiple sclerosis. Clinical Therapeutics.
O'Hara, B. A., et al. (2021). Teriflunomide inhibits JCPyV infection and spread in glial cells and choroid plexus epithelial cells. International Journal of Molecular Sciences.
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