What is Teriflunomide: Uses, Dosage, Side Effects and More

Teriflunomide is a prescription medication primarily used to treat relapsing forms of multiple sclerosis (MS). It belongs to a class of drugs called immunomodulators, which work by adjusting your immune system's activity to help reduce the frequency of MS relapses and slow the progression of disability.

What is Teriflunomide?

Teriflunomide is an oral medication that helps manage multiple sclerosis by modifying how your immune system functions. It's what doctors call a disease-modifying therapy, meaning it doesn't just treat symptoms but actually works to change the course of MS itself.

This medication is taken as a tablet once daily and is designed for long-term use. Unlike some MS treatments that require injections or infusions, teriflunomide offers the convenience of oral administration, making it easier to incorporate into your daily routine.

What is Teriflunomide Used For?

Teriflunomide is specifically approved for treating relapsing forms of multiple sclerosis in adults. This includes relapsing-remitting MS and active secondary progressive MS where patients still experience relapses.

The medication helps reduce the number of MS relapses you might experience each year. It also works to slow down the accumulation of physical disability that can occur with MS over time. Your doctor might recommend teriflunomide if you've been diagnosed with MS and are looking for an oral treatment option that can help manage your condition long-term.

In some cases, doctors may also prescribe teriflunomide off-label for other autoimmune conditions, though this is less common and would be carefully considered based on your specific medical situation.

How Does Teriflunomide Work?

Teriflunomide works by blocking a specific enzyme called dihydroorotate dehydrogenase, which certain immune cells need to multiply rapidly. By limiting this enzyme's activity, the medication reduces the number of activated immune cells that can attack the protective covering around your nerve fibers.

Think of it as gently applying the brakes to your immune system's overactive response. This medication is considered moderately strong in the MS treatment landscape - it's more potent than some basic therapies but not as intensive as high-efficacy treatments that require more frequent monitoring.

The medication takes time to build up in your system and reach its full effectiveness. You might not notice significant changes in your MS symptoms for several months after starting treatment, which is completely normal and expected.

How Should I Take Teriflunomide?

Take teriflunomide exactly as your doctor prescribes, typically once daily at the same time each day. You can take it with or without food, though some people find taking it with a meal helps reduce any stomach upset.

Swallow the tablet whole with water - don't crush, chew, or break it. If you have trouble swallowing pills, talk to your doctor about strategies that might help, but don't alter the tablet itself.

Try to establish a routine by taking your medication at the same time every day. Many people find it helpful to take it with breakfast or dinner, as this creates a natural reminder tied to their daily meals.

There are no specific dietary restrictions while taking teriflunomide, but maintaining a balanced, healthy diet can support your overall well-being and help your body process the medication effectively.

How Long Should I Take Teriflunomide For?

Teriflunomide is designed for long-term use, often for many years or even indefinitely, as long as it continues to be effective and well-tolerated. Multiple sclerosis is a chronic condition that requires ongoing management, and stopping disease-modifying therapy can lead to increased disease activity.

Your doctor will regularly monitor your response to the medication through periodic check-ups, blood tests, and MRI scans. These appointments help determine whether teriflunomide is still the right choice for you or if adjustments to your treatment plan are needed.

If you and your doctor decide to stop teriflunomide, you'll likely need to go through a medication elimination process. This involves taking a different medication called cholestyramine for about 11 days to help clear teriflunomide from your system more quickly, since it can remain in your body for up to two years otherwise.

What Are the Side Effects of Teriflunomide?

Like all medications, teriflunomide can cause side effects, though not everyone experiences them. Most side effects are manageable and tend to improve as your body adjusts to the medication over the first few months.

Here are the most common side effects you might experience:

• Hair thinning or hair loss, which is usually temporary and reversible
• Diarrhea or loose stools, especially during the first few weeks
• Nausea or stomach discomfort
• Headache
• Increased levels of certain liver enzymes
• Numbness or tingling in hands or feet
• Flu-like symptoms

These common side effects often improve with time, and there are strategies your healthcare team can suggest to help manage them if they occur.

Less common but more serious side effects require immediate medical attention. These include signs of liver problems such as yellowing of skin or eyes, dark urine, or persistent nausea and vomiting. Severe infections, unusual bleeding or bruising, or significant breathing difficulties should also prompt immediate medical care.

Very rarely, some people may experience severe skin reactions, significant blood pressure changes, or peripheral neuropathy that worsens over time. Your doctor will monitor for these possibilities through regular check-ups and blood tests.

Who Should Not Take Teriflunomide?

Teriflunomide isn't suitable for everyone, and your doctor will carefully review your medical history before prescribing it. The medication is not recommended if you're pregnant, planning to become pregnant, or breastfeeding, as it can cause serious birth defects.

You should not take teriflunomide if you have severe liver disease or significantly elevated liver enzymes. People with serious infections or severely compromised immune systems may also need to avoid this medication or wait until their condition stabilizes.

Your doctor will also consider whether teriflunomide is appropriate if you have:

• A history of significant blood disorders or bone marrow problems
• Severe kidney disease
• Active tuberculosis or other serious infections
• A history of severe skin reactions to medications
• Significant respiratory problems

If you have any of these conditions, it doesn't necessarily mean you can't take teriflunomide, but your doctor will need to weigh the benefits against the risks and may recommend additional monitoring or alternative treatments.

Teriflunomide Brand Names

Teriflunomide is available under the brand name Aubagio in most countries, including the United States. This is the most commonly prescribed formulation of the medication.

The generic version of teriflunomide has become available in some regions, which may offer a more affordable option while providing the same active ingredient and effectiveness. Your pharmacy can help you understand which version is available and covered by your insurance.

Whether you receive brand-name Aubagio or generic teriflunomide, the medication works the same way and should provide similar benefits for managing your MS.

Teriflunomide Alternatives

Several alternative medications are available for treating relapsing forms of multiple sclerosis, each with different mechanisms of action, side effect profiles, and administration methods. Your doctor can help you explore these options if teriflunomide isn't the right fit for you.

Other oral MS medications include dimethyl fumarate, fingolimod, and siponimod. These work through different pathways but offer similar convenience of oral administration. Injectable options like interferon beta medications and glatiramer acetate have been used successfully for many years.

For people who need more intensive treatment, high-efficacy therapies like natalizumab, ocrelizumab, or alemtuzumab might be considered. These typically require infusion at a medical facility but can be very effective for aggressive forms of MS.

The choice between these alternatives depends on factors like your specific type of MS, previous treatment responses, side effect tolerance, and personal preferences about administration methods.

Is Teriflunomide Better Than Interferon Beta?

Teriflunomide and interferon beta medications are both effective first-line treatments for relapsing MS, but they work differently and have distinct advantages. Clinical studies suggest that teriflunomide may be slightly more effective at reducing relapses compared to some interferon beta formulations.

The main advantage of teriflunomide is its oral administration, which many people find more convenient than the regular injections required for interferon beta. This can lead to better adherence to treatment, which is crucial for long-term MS management.

However, interferon beta has a longer track record of use and may be better tolerated by some people, particularly those who experience significant side effects from teriflunomide. The choice between these medications often comes down to individual factors like lifestyle preferences, side effect tolerance, and how well each medication works for your specific situation.

Your doctor will consider your medical history, current MS activity, and personal preferences when recommending between these options.