dimethyl fumarate


Also found in: Dictionary, Encyclopedia.

dimethyl fumarate

(dye-meth-il fue-ma-rate ) ,

Tecfidera

(trade name),

DMF

(trade name)

Classification

Therapeutic: anti multiple sclerosis agents
Pregnancy Category: C

Indications

Treatment of relapsing forms of multiple sclerosis

Action

Activates Nuclear factor (Nrf2) pathway involved in cellular response to oxidative stress.

Therapeutic effects

Decreased incidence/severity of relapse with decreased progression of lesions and disability.

Pharmacokinetics

Absorption: Following oral administration rapidly converted to active metabolite monomethyl fumarate (MMF) by enzymes in GI tract, blood, and tissue.
Distribution: Unknown.
Metabolism and Excretion: MMF is metabolized by the tricarboxylic acid (TCA) cycle. 60% eliminated via exhalation of CO2. Minor amounts eliminated by renal (16%) and and fecal (1%) routes, trace amounts in urine.
Half-life: MMF—1 hr

Time/action profile (effects on disability)

ROUTEONSETPEAKDURATION
PO24 wk60 wkUnk

Contraindications/Precautions

Contraindicated in: None noted
Use Cautiously in: Serious infections (treatment may be witheld) Obstetric: Use during pregancy only if potential benefit justifies potential risk to fetus Lactation: Use cautiously if breast feeding Pediatric: Safe and effective use in children has not been established

Adverse Reactions/Side Effects

Gastrointestinal

  • abdominal pain (most frequent)
  • diarrhea (most frequent)
  • nausea (most frequent)
  • dyspepsia
  • ↑ liver enzymes
  • vomiting

Dermatologic

  • flushing (most frequent)
  • erythema
  • prutitus
  • rash

Hematologic

  • lymphopenia

Interactions

Drug-Drug interaction

None noted

Route/Dosage

Oral (Adults) 120 mg twice daily for one week, then 240 mg twice daily

Availability

Extended-release capsules: 120 mg, 240 mg

Nursing implications

Nursing assessment

  • Monitor for signs and symptoms of infections (fever, sore throat). Consider withholding medication until serious infections are resolved.
  • Lab Test Considerations: Monitor CBC within 6 mo of starting therapy, then annually or when clinically indicated.
    • May casue ↓ lymphocyte counts.
    • May cause ↑ hepatic transaminases, mostly during first 6 mo of therapy.
    • May cause transient ↑ mean eosinophil count during first 2 mo of therapy.

Potential Nursing Diagnoses

Deficient knowledge, related to disease process and medication regimen (Patient/Family Teaching)

Implementation

  • Oral: Administer 120 mg twice daily for 7 days then increase to maintenance dose of 240 mg twice daily without regard to food. Swallow capsules whole; do not open, crush, chew, or sprinkle on food. Discard any unused capsules 90 days after opening.

Patient/Family Teaching

  • Instruct patient to take dimethyl fumarate as directed. Advise patient to read Patient Information before starting therapy and with each Rx refill in case of changes.
  • Caution patient not to share medication with others, even if they have the same symptoms; may be dangerous.
  • May cause flushing (warmth, redness, itching, and/or burning sensation). Usually begins after starting and resolves over time. Administration of dimethyl fumarate with food may decrease incidence of flushing.
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
  • Advise female patient to notify health care professional if pregnancy is planned or suspected, or if breast feeding. Patients who become pregnant should be encouraged to join the pregnancy registry by calling 1-800-456-2255.

Evaluation/Desired Outcomes

  • Decreased incidence/severity of relapse of multiple sclerosis.
Mentioned in ?
References in periodicals archive ?
Attenuation of 7-ketocholesterol-induced overproduction of reactive oxygen species, apoptosis, and autophagy by dimethyl fumarate on 158 N murine oligodendrocytes," The Journal of Steroid Biochemistry and Molecular Biology, 2016.
Upon cooling, white crystals of the isomerized product, dimethyl fumarate, were obtained in better yield and purity.
More than 5,000 people have reported eye, skin and chest injuries after using the furniture which, it is claimed, has been produced with Dimethyl Fumarate (DMF).
Cladribine, dimethyl fumarate (BG12, an oral fumarate) and teriflunomide all represent agents which are investigated as DMDs for MS based on their recognized immunomodulatory effects in other diseases.
Dimethyl fumarate is the only currently known investigational compound for the treatment of RRMS that has experimentally demonstrated activation of the Nrf-2 pathway.
Limited Tenders are invited for Local Purchase Of Medicine Tab Dimethyl Fumarate 240mg, Inj Leuprolide 11.
The immunologic agent dimethyl fumarate (Tecfidera) is indicated for the treatment of patients with relapsing forms of multiple sclerosis.
Patients at the city's Royal Victoria Infirmary were offered dimethyl fumarate tablets, under the brand name Tec-fidera, in an attempt to slow the progress of the debilitating disease and prevent flare ups.
In 2010, Argos, along with 13 other retailers, participated in a Group Litigation Order granted by the High Court to compensate customers for personal injury from exposure to dimethyl fumarate from leather sofas.
The first use of dimethyl fumarate as a medicine was a leap of faith.
SAN DIEGO--Full results of the second phase III trial of dimethyl fumarate in relapsing-remitting multiple sclerosis show that the investigational drug reduces annualized relapse rates and MRI lesions over the course of 2 years.
SAN DIEGO -- Full results of the second phase III trial of dimethyl fumarate in patients with relapsing-remitting multiple sclerosis show that the investigational drug significantly reduced annualized relapse rates and MRI lesions over the course of 2 years.