An oral MS disease-modifying medicine
Teriflunomide
A once-daily tablet for relapsing multiple sclerosis that needs liver monitoring and strict pregnancy precautions because it can harm an unborn baby.
What is Teriflunomide?
Teriflunomide is a once-daily tablet taken to reduce relapses in relapsing multiple sclerosis. It works by calming the immune cells that drive the disease and is taken long term rather than for a single relapse. It needs regular liver-function blood tests, can thin the hair and can raise blood pressure. Its most important caution is that it can seriously harm an unborn baby, so reliable contraception is essential for both women and men; because it stays in the body for a very long time, a special accelerated-elimination washout procedure may be needed to clear it quickly if a pregnancy is planned or happens.
Education and reference only. This is a plain-language guide to Teriflunomide — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Teriflunomide is an oral disease-modifying therapy for relapsing multiple sclerosis, a condition where the immune system attacks the protective coating of nerves. It is taken as a single tablet once a day over the long term to reduce how often relapses occur and to slow disability. It is not a cure and does not undo existing damage. A notable feature is that it lingers in the body for many months after the last dose, which is important when planning a pregnancy or switching treatments.
How it works
Teriflunomide blocks an enzyme that immune cells need in order to multiply rapidly, which reduces the number of activated immune cells available to attack the nerves. This lowers inflammation and cuts the frequency of relapses and new areas of damage on scans. Because it interferes with cell multiplication, it can also affect a developing baby, which is the basis of its strict pregnancy warning. The medicine is removed from the body very slowly, so its effects and risks persist for a long time after stopping unless a washout is used.
Company & origin
Originated / developed by: Sanofi.
An oral once-daily disease-modifying treatment used in the UK for relapsing multiple sclerosis.
Practical use
How to take Teriflunomide
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take one tablet by mouth once a day, with or without food, at roughly the same time each day.
- Use reliable contraception throughout treatment; this applies to both women and men because of the risk to an unborn baby.
- Tell your MS team straight away if you think you might be pregnant or are planning a pregnancy, so a washout can be arranged.
- Attend regular blood tests, especially for liver function and blood counts.
- Have your blood pressure checked as advised, as the medicine can raise it.
- Report yellowing of the skin or eyes, dark urine, severe tummy pain or signs of infection promptly.
Weighing it up
Advantages & disadvantages of Teriflunomide
Advantages
- A simple once-daily tablet that reduces relapses in relapsing multiple sclerosis.
- Avoids the need for injections or infusions.
- A well-established treatment with a long track record in MS care.
Disadvantages
- Can seriously harm an unborn baby, so strict contraception is essential for women and men.
- Stays in the body for many months, often needing a washout procedure when stopping or planning pregnancy.
- Requires regular liver monitoring and can cause hair thinning and raised blood pressure.
Practical use
Good to know
The single most important thing to understand about teriflunomide is that it is teratogenic, meaning it can cause serious harm to an unborn baby. Because of this, women who could become pregnant must use reliable contraception throughout treatment, and men are also advised to use contraception, as the medicine can be present in semen. It stays in the body for a very long time after the last dose, so if a pregnancy is planned or happens, a special accelerated-elimination (washout) procedure using certain other medicines is used to clear it quickly and confirm low levels with blood tests. Beyond this, it needs regular liver-function monitoring, can cause hair thinning that usually recovers, can raise blood pressure, and may cause diarrhoea or nausea early on. Tell your team about any yellowing of the skin or eyes, dark urine or severe tummy pain.
Who should not take it / use with caution
- Women who are pregnant, breastfeeding or could become pregnant without reliable contraception must not take it.
- People with significant liver disease should not use it.
- It is avoided in those with severe immune problems or a serious active infection until reviewed.
Monitoring
- Liver-function blood tests before starting and regularly afterwards.
- Blood counts and blood pressure checks during treatment.
- Pregnancy planning, contraception review and washout blood levels when stopping if pregnancy is intended.
Side effects
- Diarrhoea, nausea and hair thinning, which often eases over time.
- Raised blood pressure and changes in liver-function blood tests.
- A lowering of blood counts and an increased risk of infections.
Key interactions
- Combining it with other immune-suppressing medicines can raise the risk of infection and needs specialist guidance.
- It can affect the levels of some other medicines, including certain blood thinners, so prescribers should be told what you take.
- Live vaccines are generally avoided during treatment because of the effect on the immune system.
Available as: Tablets taken by mouth.
Answers
Teriflunomide: frequently asked questions
Why is contraception so important with this medicine?
Teriflunomide can seriously harm an unborn baby, so reliable contraception is essential for both women and men throughout treatment.
What is the washout procedure?
Because the medicine stays in the body for a very long time, a course of certain other medicines can be used to clear it quickly, with blood tests to confirm low levels, if you plan or have a pregnancy.
Will my hair fall out permanently?
Some people notice hair thinning, especially early on; it is usually temporary and tends to recover.
Why do I need liver blood tests?
The medicine can affect the liver, so regular liver-function tests help catch any problems early.
Does it cure multiple sclerosis?
No. It is a disease-modifying treatment that reduces relapses and slows damage, but it does not cure MS or reverse existing damage.
Authoritative sources
- BNF
- NICE CKS
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