Mayzent
Mayzent (siponimod) is a disease-modifying treatment option for relapsing multiple sclerosis (MS) in adults. It can lower the chances of worsening MS and lower the number of MS relapses. Mayzent (siponimod) is a tablet that's taken by mouth. Common side effects include headache, high blood pressure, and falls. Mayzent (siponimod) is currently available as a brand-name only.
What is Mayzent (siponimod)?
What is Mayzent (siponimod) used for?
Relapsing forms of multiple sclerosis (MS)
How Mayzent (siponimod) works
Mayzent (siponimod) is a sphingosine 1-phosphate (S1P) receptor modulator. It attaches to the S1P receptor protein found on your white blood cells. This blocks white blood cells from leaving your lymph nodes and releasing into the body.
The exact way Mayzent (siponimod) works to treat MS is unknown. But it's thought to lower the number of white blood cells that reaches your nervous system where they can cause nerve damage.
Drug Facts
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What are the side effects of Mayzent (siponimod)?
Common Side Effects
- Headache (15%)
- High blood pressure (13%)
- Higher liver enzyme levels in the blood (11%)
- Falls (11%)
- Swelling of the arms and legs (edema, 8%)
- Nausea (7%)
- Dizziness (7%)
- Diarrhea (6%)
- Low heart rate (6%)
- Pain in arms or legs (6%)
Serious Side Effects
- Infection: fever, difficulty breathing, diarrhea, weakness, cough, stomach pain, sweating, chills
- Dangerously slow heart rate: dizziness, tiredness, weakness, confusion, feeling faint, trouble breathing, chest pain
- Liver problems: nausea, vomiting, stomach pain, swelling of your stomach, yellowing of your skin or the whites of your eyes, clay-colored stool
- Skin cancer: skin changes, swollen lymph nodes
- Brain problems: severe headaches, visual changes, difficulty staying awake, weakness on one side of the body, dizziness, trouble speaking, seizure
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—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Change in vision
- Dizziness, loss of balance or coordination, confusion or trouble speaking
- Fever, neck pain or stiffness, sensitivity to light, headache, nausea, vomiting, confusion, which may be signs of meningitis
- Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, 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
- Shortness of breath
- Slow heartbeat—dizziness, feeling faint or lightheaded, confusion, trouble breathing, unusual weakness or fatigue
- Sudden and severe headache, confusion, change in vision, seizures, which may be signs of posterior reversible encephalopathy syndrome (PRES)
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Dizziness
- Headache
- Nausea
- Swelling of the ankles, hands, or feet
Pros and cons of Mayzent (siponimod)
Pros
Works well to slow worsening of MS and lower the number of MS relapses
Taken by mouth once per day
Doesn't require frequent visits to the clinic or infusion center to receive your dose
Cons
Requires several tests before starting (e.g., genetic testing, electrocardiogram, blood tests)
Might not be a good option for people with heart or serious liver problems
Not safe during pregnancy
Pharmacist tips for Mayzent (siponimod)
Take Mayzent (siponimod) at the same time every day with or without food. If it's hurting your stomach, try taking it with food. Swallow the tablets whole; don't split, crush, or chew the tablets.
When you first start taking Mayzent (siponimod), you might experience a temporary drop in your heart rate. You might feel dizzy or tired, which will typically go away within 24 hours. Your heart rate will typically go back to usual within 10 days of treatment.
Check your blood pressure at home or at your provider's office regularly. Mayzent (siponimod) can raise your blood pressure. If you notice your blood pressure going up, let your provider know.
If you have certain heart problems, you might need to be observed by a provider for several hours (or even overnight) after your first dose. Mayzent (siponimod) can affect your heart rate and rhythm. So, your provider will check your heart rate and blood pressure often and perform heart rhythm testing (electrocardiogram or EKG) to make sure the medication is safe for you.
Make sure to tell your provider about all the medications you're taking before starting Mayzent (siponimod). Mayzent (siponimod) can interact with other medications, which can lead to potentially serious problems. For example, taking Mayzent (siponimod) with beta-blockers can lower your heart rate too much. In addition, taking Mayzent (siponimod) with medications that affect your immune system could raise your risk for serious infections.
Before getting any vaccines, it's important to let your provider or pharmacist know that you're taking Mayzent (siponimod). Most types of vaccines, including the flu shot, are generally safe to get while you're taking Mayzent (siponimod). But, you should avoid live vaccines because we don't know whether they're safe or work well with Mayzent (siponimod) treatment. If you need to get a live vaccine, speak with your provider beforehand about what you should do.
Don't stop taking Mayzent (siponimod) without talking to your provider first. Stopping the medication can cause your MS symptoms to come back. Sometimes, the symptoms can be worse than they were before you started the medication. Tell your provider if you have worsening symptoms of MS if you stop Mayzent (siponimod) so they can help you manage your symptoms.
Frequently asked questions about Mayzent (siponimod)
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What are the risks and warnings for Mayzent (siponimod)?
Mayzent (siponimod) 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.
Infections
Risk factors: Active, chronic (long term), or recurrent infection | Having other conditions that raise your risk of infection | Taking medications that weaken your immune system
Mayzent (siponimod) lowers your white blood cell count, which affects your body's ability to fight off infections. This can raise your risk of bacterial, viral, and fungal infections that can sometimes be serious. Make sure you're up-to-date on all of your vaccinations before starting Mayzent (siponimod). If you develop an infection during treatment, your provider will probably ask you to stop taking Mayzent (siponimod) so your body can fight the infection first. Let your provider know if you develop symptoms of an infection, such as fever, cough, difficulty breathing, diarrhea, or chills.
Be aware that you might still be at risk for infections for a few weeks after stopping Mayzent (siponimod). This is because it takes some time for your white blood cell counts to go back to normal after stopping the medication. Continue to look out for symptoms of infection and avoid or limit your time around others who are sick for at least 1 month about stopping Mayzent (siponimod).
Eye problems
Risk factors: Diabetes | History of eye inflammation (uveitis)
Some people developed an eye condition called macular edema while they were taking Mayzent (siponimod). In studies, this eye problem happened within the first 4 months of treatment. Your provider will examine your eyes before and during treatment. Make sure you let them know if you start to have blurry or worsening vision at any time while you're taking Mayzent (siponimod).
Slow heart rate
Risk factors: Taking other medications that affect heart rate | History of heart problems | Starting or restarting Mayzent (siponimod)
Mayzent (siponimod) can temporarily cause your heart rate to slow down when you first start treatment. This can happen within 24 hours after each dose of Mayzent (siponimod) during the initial ramp-up period. In studies, heart rate went back up after the sixth day of treatment. You'll typically go back to your usual heart rate within 10 days of starting Mayzent (siponimod). Let your provider know if you have any heart-related conditions or if you're taking medications that also affect heart rate. In certain situations, your provider will monitor your heart for at least 6 hours after your first dose of Mayzent (siponimod). Get medical help if you have symptoms of low heart rate, such as dizziness, tiredness, weakness, feeling faint, trouble breathing, and chest pain, while you're taking Mayzent (siponimod),
Breathing problems
Mayzent (siponimod) can cause breathing problems. This can sometimes happen as early as 3 months after you start the medication. Let your provider know if you have trouble breathing while you're taking Mayzent (siponimod). You might need to do routine breathing tests to check how well your lungs are working.
Liver damage
Mayzent (siponimod) can sometimes cause liver injury. This can happen to anyone, but be sure to tell your provider if you have liver problems before starting treatment. You'll need to do blood work to check your liver health before you start and during Mayzent (siponimod) treatment. If your liver lab results are outside of the normal range, your provider might ask you to stop taking this medication. Typically, your liver health should return to normal after you stop Mayzent (siponimod). Get medical attention right away if you notice symptoms of liver damage, such as loss of appetite, dark urine, stomach pain, or yellowing of the eyes or skin.
Risk of skin cancer
Although rare, Mayzent (siponimod) can raise your risk of getting certain types of skin cancer. You'll probably need regular skin exams while you take Mayzent (siponimod). This helps your provider check for your cancer risk. Make sure to wear protective clothing and sunscreen when you're outside, even on cloudy days. Watch out for new moles or skin damage, and report them to your provider if any appear.
Harm to unborn babies
Based on animal studies, it's possible that Mayzent (siponimod) can harm a unborn baby when it's taken during pregnancy. Women who can have a child should use birth control to avoid pregnancy during treatment and for at least 10 days after the last dose of Mayzent (siponimod). Let your provider know right away if you become pregnant or think you might be pregnant while you're taking Mayzent (siponimod).
Brain problem called posterior reversible encephalopathy syndrome (PRES)
Although rare, there have been reports of a brain problem called posterior reversible encephalopathy syndrome (PRES) in people taking medications like Mayzent (siponimod). So far, there haven’t been reports of PRES in people taking Mayzent (siponimod). But, it's important to be aware of this risk because it can lead to serious complications, such as stroke. Contact your provider right away if you notice a sudden headache, seizures, loss of consciousness, or changes in vision.
Mayzent (siponimod) dosage forms
Typical dosing for Mayzent (siponimod)
Your dose will depend on your genetic makeup, which can affect how well your body can break down the medication. For this reason, you'll need to do genetic testing before starting Mayzent (siponimod) so your provider can choose the appropriate dose for you.
In general, the typical starting dose is 0.25 mg by mouth once daily. Then, your provider will slowly raise your dose over 4 or 5 days to reach the target maintenance dose of 1 mg or 2 mg once daily.
How much does Mayzent (siponimod) cost?
Mayzent (siponimod) contraindications
Genetic makeup that prevents Mayzent (siponimod) from being broken down in the body
Recent heart attack, chest pain, stroke, "mini-stroke", or heart failure within the last 6 months
Certain heart rate or rhythm problems (e.g., AV block, sick sinus syndrome), unless you have a functioning pacemaker
What are alternatives to Mayzent (siponimod)?
Relapsing forms of multiple sclerosis (MS)
Relapsing forms of multiple sclerosis (MS)
Treatment of mutiple sclerosis (MS) relapses, including clinically isolated syndrome, relapsing-remiting disease, and active secondary progressive disease
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References
Best studies we foundAmerican Heart Association. (2022). Unstable angina.
Arnold, D.L., et al. (2022). Effect of siponimod on magnetic resonance imaging measures of neurodegeneration and myelination in secondary progressive multiple sclerosis: Gray matter atrophy and magnetization transfer ratio analyses from the EXPAND phase 3 trial. Multiple sclerosis: Clinical and Laboratory Research.
Hobson, E. V., et al. (2012). Posterior reversible encephalopathy syndrome: A truly treatable neurologic illness. Peritoneal Dialysis International.
MedlinePlus. (2022). Sick sinus syndrome.
National Eye Institute. (2023). Macular edema.
National Multiple Sclerosis Society. (n.d.). Medications.
Novartis Pharmaceuticals Corporation. (2023). Mayzent- siponimod tablet, film coated [package insert]. DailyMed.
ScienceDirect. (n.d.). Siponimod.
Scott, L.J. (2020). Siponimod: A review in secondary progressive multiple sclerosis. CNS Drugs.
Singer, B.A. (2013). Initiating oral fingolimod treatment in patients with multiple sclerosis. Therapeutic Advances in Neurological Disorders.
Tisdale, J. E., et al. (2020). Drug-induced arrhythmias: A scientific statement from the American Heart Association. Circulation.
Yao, L., et al. (2021). Siponimod for multiple sclerosis. The Cochrane Database of Systematic Reviews.
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