10 Oral MS Medications: What to Know About Aubagio, Gilenya, and More

Multiple sclerosis (MS) is a chronic autoimmune disorder caused by the immune system mistakenly attacking cells in the brain and spinal cord. Untreated MS can eventually lead to disability. But managing the condition with medication can prevent it from worsening and help keep symptoms under control.

Over the past few decades, the FDA has approved multiple oral medications to treat MS. While these can be easier to take than injectable medications, they have their own sets of instructions and warnings to be aware of.

Here, we’ll review essential information about 10 oral MS medications that help manage relapses (flare-ups).

1. Aubagio

Aubagio (teriflunomide) treats relapsing forms of MS in adults. It works by blocking a protein that makes certain types of white blood cells that are thought to mistakenly attack nerve cells in the brain and spinal cord in people who have MS. The typical Aubagio dosage is one tablet (7 mg or 14 mg) taken by mouth once daily, with or without food. And you can find it as a generic and brand-name product.

In three clinical studies — study 1, study 2, study 3 — people taking Aubagio were less likely to relapse than those taking a placebo pill. What’s more, one long-term study found that Aubagio was a safe and effective treatment for MS for up to 9 years. 

The medication has some potential downsides, however. Some side effects you might experience while taking Aubagio are headaches, diarrhea, and hair loss. Aubagio also leads to a higher risk of infections. And it has a boxed warning (the FDA’s strictest warning) about potential liver damage and risks during pregnancy.

2. Bafiertam

Bafiertam (monomethyl fumarate) also treats relapsing forms of MS in adults. It belongs to a group of medications known as fumarates. It’s available as delayed-release capsules that are taken by mouth twice a day, with or without food.

Fumarates like Bafiertam are thought to have antioxidant properties and protect against MS-related inflammation and damage over time. These medications might also dampen the body’s immune response, which is overactive in people living with MS.

The most common Bafiertam side effects are flushing, stomach pain, and diarrhea. Rare but serious side effects include liver damage and a heightened risk of potentially serious infections.

3. Tecfidera

Another fumarate medication that treats relapsing forms of MS in adults is Tecfidera (dimethyl fumarate). It comes as delayed-release capsules, with the option of a starter kit to help initiate the medication. Tecfidera is taken twice a day and is also available as a lower-cost generic, unlike Bafiertam.

Tecfidera is thought to treat MS by protecting cells from MS-related inflammation and damage. Its potential side effects include flushing, stomach pain, and nausea. The medication has also been linked to liver damage and potentially serious infections, though these side effects are less common.

4. Vumerity

Vumerity (diroximel fumarate) is a fumarate that treats relapsing forms of MS in adults and is only available as a brand-name medication. Like other fumarates, it’s thought to work by defending the body against oxidative stress. Its potential side effects are similar to those of other fumarates and include flushing, stomach pain, and diarrhea. But Vumerity seems to have fewer stomach-related side effects than Tecfidera.

Vumerity comes as delayed-release capsules that are taken by mouth twice a day, with or without food. Taking the medication with food might help lessen flushing. Just make sure the meal isn’t too fatty, since this could affect how well Vumerity works. 

5. Mavenclad

Mavenclad (cladribine) was approved in 2019 as the first “short-course” oral medication to treat relapsing MS in adults. Its use is generally reserved for people who have MS that hasn’t responded well to other treatments. Mavenclad dampens immune response by lowering the amount of certain white blood cells in the body. 

Mavenclad is unique because you don’t need to take it every day. Mavenclad comes as tablets that are taken by mouth for a maximum of 20 days over 2 years — typically for 4 or 5 days at a time. But it’s currently only available as a brand-name medication.

The most common Mavenclad side effects include infections, headaches, and nausea. Though rare, it also has the potential to raise your risk of cancer, blood cell problems, and liver damage. And you shouldn’t take Mavenclad if you are pregnant.

6. Gilenya

Gilenya (fingolimod) became the first FDA-approved oral MS medication in September 2010. It’s used to treat relapsing forms of MS in people ages 10 years and older. It’s available as a brand-name and generic medication, and the capsules are taken once a day.

Gilenya, a sphingosine 1-phosphate (S1P) receptor modulator, works differently than the above medications. It interferes with the movement of certain white blood cells into the central nervous system. This is thought to reduce nerve cell damage over time.

Some side effects you may experience from Gilenya are headaches, abnormal liver tests, and diarrhea. It can also lower your heart rate, raise your risk for infections, and cause eye problems. Gilenya isn’t the best choice if you’re pregnant, either, because it may cause harm to the fetus.

7. Tascenso ODT

Tascenso ODT (fingolimod) contains the same active ingredient as Gilenya and works the same way to treat relapsing MS. The once-daily, orally disintegrating tablets are also approved for people ages 10 years and older.

If you have trouble swallowing pills, Tascenso ODT might be a good option. To take a dose, you place one of the dissolvable tablets directly on the tongue, which allows you to swallow the medication more easily.

Tascenso ODT’s side effects are similar to Gilenya’s side effects.

8. Mayzent

Like Gilenya and Tascenso ODT, Mayzent (siponimod) is a S1P receptor modulator. It comes as once-daily oral tablets and is approved to treat relapsing forms of MS in adults. Currently, there’s no lower-cost generic available.

Your Mayzent dosage will depend on your genetics. This is because the medication is broken down differently by people with different genes. So, before prescribing you the medication, your healthcare provider will need to run a genetic test to determine how high your dosage should be.

Since Mayzent lowers your white blood cell count, it puts you at a higher risk for infections. It can also lower your heart rate, cause liver damage, and raise your risk for skin cancer, but these side effects are rare. More common side effects are headaches and elevated blood pressure.

9. Ponvory

Another brand-name-only S1P receptor modulator is Ponvory (ponesimod). It works similarly to Gilenya, Tascenso ODT, and Mayzent to treat relapsing forms of MS in adults. 

Ponvory comes as oral tablets, and there’s a 14-day starter pack available, too. Ponvory is taken once a day with or without food. And it can help reduce the number of MS-related relapses you experience.

Common Ponvory side effects include upper respiratory infections, abnormal liver tests, and high blood pressure. It carries warnings that are similar to those of Gilenya, Tascenso ODT, and Mayzent.

10. Zeposia

Zeposia (ozanimod) is another S1P receptor modulator. Interestingly, it’s approved to treat relapsing forms of MS and ulcerative colitis. You typically start off with a lower dosage, which is slowly raised over the course of 1 week, until you reach your target dosage. Zeposia is only available as a brand-name medication. 

Zeposia comes as tablets that are taken by mouth once daily. The medication hasn’t been well studied in children, so it’s only approved for adults. It has similar side effect risks as other medications in its class.

How to decide which oral MS medication is best for you

When thinking about your best treatment option for MS, there are a few things to consider. Oral MS medications often differ in terms of their dosages, effectiveness, and side effects. Keep in mind that there are injectable options for MS treatment, too.

Here are a few specific things to keep in mind:

• Dosage schedule: Some oral MS medications are taken just once a day, while others must be taken twice a day. Mavenclad, however, can be taken in just four short courses over 2 years.

• Dosage form: Most oral MS medications are available as tablets or capsules. But Tascenso ODT comes as dissolvable tablets, which may work better for people who have trouble swallowing pills.

• Side effects: Many oral MS medications work by dampening your immune system, which can lead to more infections. Your provider can help you understand your individual risk for infections with each treatment option.

These are only a few factors to consider. Your healthcare provider can help you find the medication that’s safest and most effective for you, as everyone responds to MS medications differently.

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Written by:

Kristianne Hannemann, PharmD

Kristianne Hannemann, PharmD, is a licensed pharmacist in California. She has been a retail pharmacy manager and staff pharmacist for over 7 years and has contributed drug information content to different health companies.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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