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Brand Name :
Vumerity
Synonyms :
diroximel fumarate
Class :
Multiple Sclerosis Treatments, Immunomodulators
Brand Name :
Vumerity
Synonyms :
diroximel fumarate
Class :
Multiple Sclerosis Treatments, Immunomodulators
Dosage Forms & StrengthsÂ
delayed release, capsuleÂ
231mgÂ
Initial dose: 231 mg orally twice a day
Maintenance: may increase to 462 mg (231- of each capsule) After one week, orally twice a day
Not able to tolerate the maintenance dose
If the maintenance dosage is not tolerated, consider reducing the dose temporarily to 231 mg orally twice a day.
Resuming dosage in 4 weeks at 462 mg orally twice a day
If a patient cannot tolerate an increased dose to the maintenance level, consider discontinuing the medication.
Dose Adjustments
Dosage Modifications
Hepatic impairment
Hepatic impairment has not been the subject of any studies.
No dose adjustments are required since it is not expected to affect the exposure of monomethyl fumarate (MMF).
Renal impairment
Mild: dose adjustment is not required
Moderate to severe: usually not recommended
Safety & efficacy were not establishedÂ
Refer to the adult dosing regimenÂ
measles, mumps, rubella, and varicella vaccine, live (Rx)
may diminish the therapeutic effect of vaccines
measles mumps and rubella vaccine, live
may diminish the therapeutic effect of vaccines
may diminish the therapeutic effect of vaccines
vaccinia immune globulin intravenous (Rx)
may diminish the therapeutic effect of vaccines
may diminish the therapeutic effect of vaccines
poliovirus vaccine, live, trivalent
may diminish the therapeutic effect of vaccines
poliovirus vaccine inactivated
may diminish the therapeutic effect of vaccines
measles, mumps, rubella, and varicella vaccine, live (Rx)
may diminish the therapeutic effect of vaccines
measles mumps and rubella vaccine, live
may diminish the therapeutic effect of vaccines
may diminish the therapeutic effect of vaccines
smallpox (vaccinia) vaccine, live
may diminish the therapeutic effect of vaccines
may diminish the therapeutic effect of vaccines
may reduce the therapeutic effect of vaccines
may have a decreased therapeutic effect when combined with covid-19 vaccine
Immunosuppressants may reduce the therapeutic effect of COVID-19 Vaccine
it may enhance the immunosuppressive effect of Immunosuppressants
it may diminish the therapeutic effect of Influenza Virus Vaccines
influenza virus vaccine h n live
it may diminish the therapeutic effect of Influenza Virus Vaccines
influenza virus vaccine (h n ) adjuvanted
it may diminish the therapeutic effect of Influenza Virus Vaccines
it may diminish the therapeutic effect of Influenza Virus Vaccines
poliovirus vaccine, live, trivalent
immunosuppressants may diminish the therapeutic effect of Vaccines
poliovirus vaccine inactivated
immunosuppressants may diminish the therapeutic effect of Vaccines
immunosuppressants may diminish the therapeutic effect of vaccines
vaccinia immune globulin intravenous (Rx)
immunosuppressants may diminish the therapeutic effect of vaccines
immunosuppressants may diminish the therapeutic effect of vaccines
immunosuppressants may diminish the therapeutic effect of vaccines
immunosuppressants may diminish the therapeutic effect of vaccines
may decrease the therapeutic effect of COVID-19 vaccine
may increase the immunosuppressive effect of tacrolimus
may decrease the therapeutic effect when combined with sipuleucel-t
may decrease the therapeutic effect when combined with vaccines
may decrease the diagnostic effect when combined with coccidioides immitis test
belimumab's immunosuppressive properties reduce the efficacy of the live rotavirus oral vaccine, leading to diminished effects
may increase the immunosuppressive effect of immunosuppressants
may increase the immunosuppressive effect of immunosuppressants
may increase the immunosuppressive effect of immunosuppressants
may increase the immunosuppressive effect of immunosuppressants
may increase the immunosuppressive effect of immunosuppressants
may increase the immunosuppressive effect of immunosuppressants
may increase the immunosuppressive effect of immunosuppressants
may increase the immunosuppressive effect of immunosuppressants
may increase the immunosuppressive effect of Immunosuppressants
respiratory syncytial virus vaccine, adjuvanted
may increase the immunosuppressive effect of Immunosuppressants
respiratory syncytial virus (RSV) vaccine
may increase the immunosuppressive effect of Immunosuppressants
meningococcal A C Y and W polysaccharide tetanus toxoid conjugate vaccineÂ
immunosuppressants can decrease the efficacy of the vaccines
may decrease the diagnostic effect of Immunosuppressants
may decrease the diagnostic effect of Immunosuppressants
may decrease the diagnostic effect of Immunosuppressants
may decrease the diagnostic effect of Immunosuppressants
may decrease the diagnostic effect of Immunosuppressants
may decrease the diagnostic effect of Immunosuppressants
may decrease the diagnostic effect of Immunosuppressants
may decrease the diagnostic effect of Immunosuppressants
may decrease the diagnostic effect of Immunosuppressants
apixaban: it may enhance the toxic effect of Anti-Inflammatory Agents
enoxaparin: it may enhance the toxic effect of Anti-Inflammatory Agents
heparin: it may enhance the toxic effect of Anti-Inflammatory Agents
abrocitinib: it may enhance the toxic effect of Anti-Inflammatory Agents
Immunosuppressants may enhance the adverse/toxic effect of Vaccines
vaccinia immune globulin intravenous (Rx)
Immunosuppressants may enhance the adverse/toxic effect of Vaccines
Immunosuppressants may enhance the adverse/toxic effect of Vaccines
Immunosuppressants may enhance the adverse/toxic effect of Vaccines
Immunosuppressants may enhance the adverse/toxic effect of Vaccines
poliovirus vaccine, live, trivalent
Immunosuppressants may enhance the adverse/toxic effect of Vaccines
poliovirus vaccine inactivated
Immunosuppressants may enhance the adverse/toxic effect of Vaccines
Immunosuppressants may enhance the adverse/toxic effect of Vaccines
smallpox (vaccinia) vaccine, live
Immunosuppressants may enhance the adverse/toxic effect of Vaccines
Immunosuppressants may enhance the adverse/toxic effect of Vaccines
Immunosuppressants may enhance the adverse/toxic effect of Vaccines
Immunosuppressants may enhance the adverse/toxic effect of Vaccines
It may enhance the immunosuppressive effects when combined with idecabtagene vicleucel
immunosuppressants may enhance the adverse/toxic effect of dengue Vaccine
Immunosuppressants may enhance the adverse/toxic effect of Vaccines
smallpox (vaccinia) vaccine, live
Immunosuppressants may enhance the adverse/toxic effect of Vaccines
Immunosuppressants may enhance the adverse/toxic effect of Vaccines
Immunosuppressants may enhance the adverse/toxic effect of Vaccines
Immunosuppressants may enhance the adverse/toxic effect of Vaccines
may enhance the adverse/toxic effect of BCG products
may increase the immunosuppressive effect of immunosuppressants
may increase the adverse/toxic effect of immunosuppressants
vaccinia immune globulin intravenous (Rx)
may increase the adverse/toxic effect of immunosuppressants
may increase the adverse/toxic effect of immunosuppressants
may increase the adverse/toxic effect of immunosuppressants
may increase the adverse/toxic effect of immunosuppressants
poliovirus vaccine, live, trivalent
may increase the adverse/toxic effect of immunosuppressants
poliovirus vaccine inactivated
may increase the adverse/toxic effect of immunosuppressants
may increase the adverse/toxic effect of immunosuppressants
smallpox (vaccinia) vaccine, live
may increase the adverse/toxic effect of immunosuppressants
may increase the adverse/toxic effect of immunosuppressants
may increase the adverse/toxic effect of immunosuppressants
may increase the adverse/toxic effect of immunosuppressants
measles, mumps, rubella and varicella vaccine, liveÂ
may increase the toxic effects of varicella virus containing vaccine
it increases the toxicity of rubella or varicella-containing live vaccines
measles, mumps, rubella, and varicella vaccine, live (Rx)Â
may enhance the adverse/toxic effect of rubella, and varicella vaccine, live 
immunosuppressants increase the effect of baricitinib
immunosuppressants increase the toxicity of BCG products
immunosuppressants increase the effect of immunosuppression of cladribine
immunosuppressants increase the toxicity of the dengue tetravalent vaccine
immunosuppressants increase the effect of immunosuppression of natalizumab
it increases the effect of immunosuppressants
immunosuppressants increase the toxicity of the poliovirus vaccine
immunosuppressants increase the effect of immunosuppression of ruxolitinib
immunosuppressants increase the effect of immunosuppression of tacrolimus
immunosuppressants increase the toxicity of talimogene laherparepvec
immunosuppressants increase the effect of immunosuppression of tofacitinib
immunosuppressants increase the toxicity of the typhoid vaccine
immunosuppressants increase the effect of immunosuppression of upadacitinib
measles, mumps, rubella, and varicella vaccine, live (Rx)
immunosuppressants increase the toxicity of live vaccines
measles mumps and rubella vaccine, live
immunosuppressants increase the toxicity of live vaccines
immunosuppressants increase the toxicity of the yellow fever vaccine
may increase the toxic effect
may increase the immunosuppressive effect of immunosuppressive agents
may have an increased immunosuppressive effect when combined with immunosuppressants
may increase the immunosuppressive effect of tacrolimus
may have an increased adverse effect when combined with nadofaragene firadenovec
may have an increasingly adverse effect when combined with immunosuppressants
methotrexate can also enhance the immunosuppressive effect of tacrolimus (Topical)
may have an increased immunosuppressive effect when combined with ritlecitinib
cladribine: they may increase the immunosuppressive effect of immunosuppressants
may decrease the therapeutic effect of immunosuppressants
may decrease the therapeutic effect of immunosuppressants
may decrease the therapeutic effect of immunosuppressants
may decrease the therapeutic effect of immunosuppressants
may decrease the therapeutic effect of immunosuppressants
may diminish the serum concentration of each other when combined
may diminish the serum concentration of each other when combined
may diminish the serum concentration of each other when combined
may diminish the serum concentration of each other when combined
may diminish the serum concentration of each other when combined
respiratory syncytial virus vaccine, adjuvanted
may reduce the therapeutic effect of vaccines
respiratory syncytial virus (RSV) vaccine
may reduce the therapeutic effect of vaccines
respiratory syncytial virus vaccine, adjuvanted
may decrease the therapeutic effect when combined with vaccines
respiratory syncytial virus (RSV) vaccine
may decrease the therapeutic effect when combined with vaccines
may increase the risk of adverse effects
may increase the risk of adverse effects
may increase the risk of adverse effects
may increase the risk of adverse effects
may increase the risk of adverse effects
may increase the risk of adverse effects
may increase the risk of adverse effects
may increase the risk of adverse effects
may increase the risk of adverse effects
may increase the risk of adverse effects
when both drugs are combined, there may be an increased risk of serious infections  
when both drugs are combined, there may be an increased risk of serious infections  
it may enhance the immunosuppressive effect of immunosuppressants
immunosuppressants may reduce the therapeutic effect of COVID-19 Vaccine
Immunosuppressants may enhance the immunosuppressive effect of Inebilizumab.
may enhance the immunosuppressive effect of baricitinib
immunosuppressants decrease the efficacy of brincidofovir
may increase the therapeutic effect of immunosuppressants
may have an increased immunosuppressive effect when combined with inebilizumab
may have an increased immunosuppressive effect when combined with ocrelizumab
may have an increased immunosuppressive effect when combined with ofatumumab
may decrease the therapeutic effect when combined with pidotimod
may have an increased immunosuppressive effect when combined with immunosuppressants
may have an increased immunosuppressive effect when combined with immunosuppressants
may have an increased immunosuppressive effect when combined with immunosuppressants
may have an increased immunosuppressive effect when combined with ublituximab
may decrease the therapeutic effect when combined with pneumococcal vaccines
antithymocyte globulin rabbitÂ
may have an increasingly adverse effect when combined with antithymocyte globulin
leniolisib reduces the efficacy of the live rotavirus oral vaccine by exerting immunosuppressive effects
The immunosuppressive effects of obinutuzumab diminish the effectiveness of the live rotavirus oral vaccine
antithymocyte globulin equineÂ
may have an increasingly adverse effect when combined with antithymocyte globulin
respiratory syncytial virus vaccine, adjuvanted
immunosuppressants decrease the efficacy of vaccines
respiratory syncytial virus (RSV) vaccine
immunosuppressants decrease the efficacy of vaccines
may have an increased immunosuppressive effect when combined with immunosuppressants
elevated doses of corticosteroids can inhibit the delayed-type hypersensitivity (DTH) skin test response after a two-week course of treatment
typically, the response reverts to its pre-treatment level within a few weeks after discontinuing steroid therapy
methotrexate: it may enhance the toxic effect of Anti-Inflammatory Agents
pralatrexate: it may enhance the toxic effect of Anti-Inflammatory Agents
rivaroxaban: it may enhance the toxic effect of Anti-Inflammatory Agents
sincalide: it may enhance the toxic effect of Anti-Inflammatory Agents
acemetacin: it may enhance the toxic effect of Anti-Inflammatory Agents
ketorolac: it may enhance the toxic effect of Anti-Inflammatory Agents
macimorelin: it may enhance the toxic effect of Anti-Inflammatory Agents
phenylbutazone: it may enhance the toxic effect of Anti-Inflammatory Agents
urokinase: it may enhance the toxic effect of Anti-Inflammatory Agents
vancomycin: it may enhance the toxic effect of Anti-Inflammatory Agents
acalabrutinib: it may enhance the toxic effect of Anti-Inflammatory Agents
cephalothin: it may enhance the toxic effect of Anti-Inflammatory Agents
dasatinib: it may enhance the toxic effect of Anti-Inflammatory Agents
deferasirox: it may enhance the toxic effect of Anti-Inflammatory Agents
may decrease the therapeutic effect when combined with covid-19 vaccine
immunosuppressants decrease the efficacy of the COVID-19 vaccine
it increases the effect of immunosuppressive agents
immunosuppressants decrease the efficacy of the influenza virus vaccine
immunosuppressants increase the effect of immunosuppression of leflunomide
immunosuppressants decrease the efficacy of the rabies vaccine
measles, mumps, rubella, and varicella vaccine, live (Rx)
immunosuppressants decrease the efficacy of vaccines
measles mumps and rubella vaccine, live
immunosuppressants decrease the efficacy of vaccines
Frequency definedÂ
1-10%Â
Pruritus (8%)Â
presence of Albumin urine (6%)Â
Dyspepsia (5%)Â
Lymphopenia (2%)Â
Vomiting (9%)Â
Rash (8%)Â
Erythema (5%)Â
increased AST (4%)Â Â
Frequency not definedÂ
Transient increase in the mean eosinophil count Â
Post marketing ReportsÂ
RhinorrheaÂ
Acute pancreatitisÂ
Liver function abnormalitiesÂ
Herpes zoster infectionÂ
AlopeciaÂ
opportunistic infectionsÂ
Black Box Warning:Â
there is no black box warning associated with diroximel fumarate.Â
Contraindication/Caution:Â
Contraindication:Â
diroximel fumarate is contraindicated in individuals with a known hypersensitivity to diroximel fumarate or any of its components. It is contraindicated in severe renal impairment. Additionally, diroximel fumarate should not be used concomitantly with dimethyl fumarate, as they are similar drugs. Â
Caution:Â
Comorbidities:Â
Pregnancy consideration: N/AÂ
Lactation: Not excreted into the human milk as a parent drug, but excretes as an active metabolite i.e., monomethyl fumarate. Â
Pregnancy category:Â
Pharmacology:Â
diroximel fumarate is prodrug of monomethyl fumarate (MMF). Once ingested, diroximel fumarate is rapidly converted to MMF in the gastrointestinal tract. The exact mechanism of action of diroximel fumarate and MMF in multiple sclerosis is not fully understood. However, it is believed that MMF exerts its therapeutic effects through its immunomodulatory properties.
It can activate the nuclear factor (erythroid-derived 2)-like 2 (Nrf2) pathways, leading to the upregulation of antioxidant and cytoprotective genes. This helps to reduce oxidative stress and inflammation, that play a role in pathogenesis of multiple sclerosis. Â
Pharmacodynamics:Â
The pharmacodynamics of diroximel fumarate are attributed to its active metabolite, monomethyl fumarate (MMF). MMF is known to exhibit immunomodulatory and antioxidant effects, which play a role in its therapeutic actions.Â
Pharmacokinetics:Â
AbsorptionÂ
diroximel fumarate is rapidly and efficiently absorbed after oral administration. It is a prodrug that rapidly converts to its active metabolite, monomethyl fumarate (MMF), in the gastrointestinal tract. MMF is then absorbed into the systemic circulation.Â
DistributionÂ
MMF is extensively distributed throughout the body. It has higher affinity for plasma proteins, primarily albumin. MMF can cross the blood-brain barrier and distribute into the central nervous system.Â
MetabolismÂ
Once in the body, MMF undergoes further metabolism via several pathways, including hydrolysis and oxidation. The major metabolite of MMF is fumaric acid, a naturally occurring substance in the body. MMF is also involved in the tricarboxylic acid cycle and is metabolized to carbon dioxide.Â
Elimination and excretionÂ
The elimination of diroximel fumarate and its metabolites primarily occurs via renal excretion. After metabolism, the resulting fumaric acid and other metabolites are excreted in the urine. A minor portion of diroximel fumarate is excreted in the feces.Â
Administration:Â
diroximel fumarate is typically administered orally in the form of capsules. The recommended dosage and administration instructions may vary based on the conditions treated and the prescribed dosing instructions.Â
diroximel fumarate can be taken with or without food. It is important to follow dosing instructions. Swallow the capsule whole with water, without chewing or crushing it.Â
If there is a difficulty swallowing capsules, you may consult your healthcare provider or pharmacist for alternative methods of administration, such as opening the capsule and sprinkling the contents onto soft food or mixing it with applesauce.Â
Patient information leafletÂ
Generic Name: diroximel fumarateÂ
Pronounced: (dye-rox-i-mel few-ma-rate)Â Â
Why do we use diroximel fumarate?Â
diroximel fumarate is used to treat multiple sclerosis. It is a disease-modifying therapy that helps to decrease the frequency of relapses and slow down the progression of disability associated with Multiple sclerosis. diroximel fumarate is indicated for adults and can be an option for patients who prefer an alternative to other oral medications for Multiple sclerosis.Â
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