Change in vital signs after fingolimod initiation in patients with multiple sclerosis: the possible need for 24 h monitoring.

Abstract

Fingolimod is an oral sphingosine-1-phosphate receptor modulator that reduces relapse frequency and prevents disability progression in relapsing-remitting MS (RRMS). The first dose of fingolimod can cause bradycardia that is mostly transient, does not require treatment and typically resolves spontaneously within 24 h. However, the US Food and Drug Administration (FDA) reported that a patient with MS had died within 24 h of taking the first dose of fingolimod in December 2011, (http://www.fda.gov/Drugs/DrugSafety/ucm284240.htm). Furthermore, how fingolimod effects the cardiovascular system is not fully understood. Heart rate (HR) and blood pressure (BP) reductions often occur at night following circadian rhythm, but the effect of fingolimod on circadian rhythms is not well known.