Do not take Gilenya
- if you have a lowered immune response (due to an immunodeficiency syndrome, a disease or to medicines that suppress the immune system).
- if you have a severe active infection or active chronic infection such as hepatitis or tuberculosis.
- if you have an active cancer (unless it is a type of skin cancer called basal cell carcinoma).
- if you have severe liver problems.
- if you are allergic (hypersensitive) to fingolimod or any of the other ingredients of Gilenya. If this applies to you , tell your doctor without taking Gilenya.
Take special care with Gilenya
Talk to your doctor before taking Gilenya:
- if you are taking medicine for irregular heartbeat such as quinidine, disopyramide, amiodarone or sotalol.
- if you have a slow resting heart rate (less than 55 beats per minute), if you are taking medicines (for example beta blockers) that slow your heart rate, if you have irregular or abnormal heart beat or a history of sudden loss of consciousness.
- if you have any heart problems.
- if you plan to get vaccinated.
- if you have never had chickenpox.
- if you have or have had visual disturbances or other signs of swelling in the central vision area (macula) at the back of the eye (a condition known as macular oedema, see below), inflammation or infection of the eye (uveitis), or if you have diabetes (which can cause eye problems).
- if you have liver problems.
- if you have high blood pressure that cannot be controlled by medicines.
- if you have severe lung problems or smoker-s cough. If any of these applies to you, tell your doctor before taking Gilenya.
Slow heart rate (bradycardia) and irregular heartbeat: At the beginning of treatment, Gilenya causes the heart rate to slow down. As a result, you may feel dizzy or tired, or be consciously aware of your heartbeat, or your blood pressure may drop. If these effects are pronounced, tell your doctor, because you may need treatment right away. Gilenya can also cause an irregular heartbeat, especially after the first dose. Irregular heartbeat usually returns to normal in less than one day. Slow heart rate usually returns to normal within one month.
Your doctor will ask you to stay at the surgery or clinic for 6 hours after taking the first dose of Gilenya so that appropriate measures can be taken in the event of side effects that occur at the start of treatment. The same applies if you are resuming treatment after a break of more than two weeks.
If you have an irregular or abnormal heartbeat or a history of sudden loss of consciousness, your condition may worsen temporarily with Gilenya. If any of this applies to you, your doctor may check your heart before you start treatment with Gilenya.
The same applies if you have a slow heart rate (less than 55 beats per minute), or if you are taking medicines called beta blockers (which slow the heartbeat).
If you have never had chickenpox: If you have never had chickenpox, your doctor may want to check your immunity against the virus that causes it (varicella zoster virus). If you are not protected against the virus, you may need a vaccination before you start treatment with Gilenya. If this is the case, your doctor will delay the start of treatment with Gilenya by one month.
Infections: Gilenya lowers the white blood cell count (particularly the lymphocyte count). White blood cells fight infection. While you are taking Gilenya (and for up to 2 months after you stop taking it), you may get infections more easily. Any infection that you already have may get worse. Infections could be serious and life-threatening. If you think you have an infection, have fever, or feel like you have the flu, call your doctor right away.
Macular oedema: Before you start Gilenya, if you have or have had visual disturbances or other signs of swelling in the central vision area (macula) at the back of the eye, inflammation or infection of the eye (uveitis) or diabetes, your doctor may want you to undergo an eye examination.
Your doctor may want you to undergo an eye examination 3 to 4 months after starting Gilenya treatment.
The macula is a small area of the retina at the back of the eye which enables you to see shapes, colours, and details clearly and sharply. Gilenya may cause swelling in the macula, a condition that is known as macular oedema. The swelling usually happens in the first 4 months of Gilenya treatment.
Your chance of developing macular oedema is higher if you have diabetes or have had an inflammation of the eye called uveitis. In these cases your doctor will want you to undergo regular eye examinations in order to detect macular oedema.
If you have had macular oedema, talk to your doctor before you resume treatment with Gilenya.
Macular oedema can cause some of the same vision symptoms as an MS attack (optic neuritis). Early on, there may not be any symptoms. Be sure to tell your doctor about any changes in your vision. Your doctor may want you to undergo an eye examination, especially if:
- the centre of your vision gets blurry or has shadows;
- you develop a blind spot in the centre of your vision;
- you have problems seeing colours or fine detail.
Liver function tests: If you have severe liver problems, you should not take Gilenya.Gilenya may cause abnormal results of liver function tests. You will probably not notice any symptoms but if you notice yellowing of your skin or the whites of your eyes, abnormal darkening of the urine or unexplained nausea and vomiting, tell your doctor straight away.
If you get any of these symptoms after starting Gilenya, tell your doctor straight away.
During the first six months of treatment your doctor will request blood tests to monitor your liver function. If your test results indicate a problem with your liver you may have to interrupt treatment with Gilenya.
High blood pressure
As Gilenya causes a slight elevation of blood pressure, your doctor may want to check your blood pressure regularly.
Lung problems
Gilenya has a slight effect on the lung function. Patients with severe lung problems or with smoker-s cough may have a higher chance of developing side effects.
Blood count
The desired effect of Gilenya treatment is to reduce the amount of white blood cells in your blood. This will usually go back to normal within 2 months of stopping treatment. If you need to have any blood tests, tell the doctor that you are taking Gilenya. Otherwise, it may not be possible for the doctor to understand the results of the test, and for certain types of blood test your doctor may need to take more blood than usual.
Before you start Gilenya, your doctor will confirm whether you have enough white blood cells in your blood and may want to repeat a check regularly. In case you do not have enough white blood cells, you may have to interrupt treatment with Gilenya.
Elderly
Experience with Gilenya in elderly patients (over 65 years) is limited. Talk to your doctor if you have any concerns.
Use in children
Gilenya is not intended to be used in children and adolescents below 18 years old as it has not been studied in MS patients below 18 years old.
Taking other medicines
Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription. Tell your doctor if you are taking any of the following medicines:
- Medicines that suppress or modulate the immune system, including other medicines used to treat MS, such as beta interferon, glatiramer acetate, natalizumab or mitoxantrone. You must not use Gilenya together with such medicines as this could intensify the effect on the immune system (see also ?Do not take Gilenya-).
- Vaccines. During and for up to 2 months after treatment with Gilenya, you should not be given certain types of vaccine (live attenuated vaccines) as they could trigger the infection that they were supposed to prevent. Other vaccines may not work as well as usual if given during this period.
- Medicines that slow the heartbeat (for example beta blockers, such as atenolol). Use of Gilenya together with such medicines could intensify the effect on heartbeat in the first days after starting Gilenya.
- Medicines for irregular heartbeat, such as quinidine, disopyramide, amiodarone or sotalol. Your doctor may decide not to prescribe Gilenya if you are taking such a medicine because it could intensify the effect on irregular heartbeat.
- Other medicines: protease inhibitors, anti-infectives such as ketoconazole, azole antifungals, clarithromycin or telithromycin.
Pregnancy and breast-feeding
Before you start treatment with Gilenya your doctor may ask you to do a pregnancy test in order to ensure that you are not pregnant. You should avoid becoming pregnant while taking Gilenya or in the two months after you stop taking it because there is a risk of harm to the baby. Talk with your doctor about reliable methods of birth control that you should use during treatment and for 2 months after you stop treatment.
If you do become pregnant while taking Gilenya, stop taking the medicine and tell your doctor straight away. You and your doctor will decide what is best for you and your baby.
You should not breast-feed while you are taking Gilenya. Gilenya can pass into breast milk and there is a risk of serious side effects for the baby.
Ask your doctor or pharmacist for advice before taking any medicine.
Driving and using machines
Your doctor will tell you whether your illness allows you to drive vehicles and use machines safely. Gilenya is not expected to have an influence on your ability to drive and use machines.
However, at initiation of treatment you will have to stay at the doctor-s surgery or clinic for 6 hours after taking the first dose of Gilenya. Your ability to drive and use machines may be impaired during and potentially after this time period.
