Siponimod is used to prevent episodes of symptoms and slow the worsening of disability in adults with relapsing-remitting forms (course of disease where symptoms flare up from time to time) of multiple sclerosis (MS; a disease in which the nerves do not function properly and people may experience weakness, numbness, loss of muscle coordination, and problems with vision, speech, and bladder control). Siponimod is in a class of medications called sphingosine l-phosphate receptor modulators. It works by decreasing the action of immune cells that may cause nerve damage.

Side Effects Of Siponimod

Siponimod may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • weakness
  • pain in the arms, legs, hands, or feet
  • diarrhea
  • headache

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:

  • slow heartbeat
  • sore throat, body aches, fever, chills, cough, and other signs of infection and during treatment and for up to 1 month after your treatment
  • headache, neck stiffness, fever, sensitivity to light, nausea, or confusion during treatment and for up to 1 month after your treatment
  • sudden severe headache, confusion, changes in vision, or seizures
  • blurriness, shadows, or a blind spot in the center of your vision; sensitivity to light; unusual color to your vision or other vision problems
  • weakness on one side of the body or clumsiness of the arms or legs that worsens over time; changes in your thinking, memory, or balance; confusion or personality changes; or loss of strength
  • new or worsening shortness of breath
  • nausea, vomiting, loss of appetite, abdominal pain, yellowing of skin or eyes, or dark urine
  • Siponimod may increase the risk of developing skin cancer. Talk to your doctor about the risks of taking this medication.
  • A sudden increase episodes of MS symptoms and worsening of disability may occur after you stop taking siponimod. Tell your doctor if your MS symptoms worsen after stopping siponimod.

Siponimod may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

Warnings & Precautions

Before taking siponimod:

  • tell your doctor and pharmacist if you are allergic to siponimod any other medications, or any of the ingredients in siponimod tablets. Ask your pharmacist or check the Medication Guide for a list of the ingredients.
  • tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: alemtuzumab (Campath, Lemtrada); amiodarone (Nexterone, Pacerone); beta-blockers such as atenolol (Tenormin, in Tenoretic), carteolol, labetalol (Trandate), metoprolol (Lopressor, Toprol-XL, in Dutoprol, in Lopressor HCT), nadolol (Corgard, in Corzide), nebivolol (Bystolic, in Byvalson), propranolol (Inderal LA, Innopran XL), and timolol; carbamazepine (Carbatrol, Equetro, Tegretol, others); digoxin (Lanoxin); diltiazem (Cardizem, Cartia, Tiazac, others); efavirenz (Sustiva, in Atripla, in Symfi); fluconazole (Diflucan); ivabradine (Corlanor); modafinil (Provigil); procainamide; quinidine (in Nuedexta); rifampin (Rifadin, Rimactane, in Rifamate, others); sotalol (Betapace, Sorine, Sotylize); and verapamil (Calan, Verelan, in Tarka). Also, tell your doctor if you are taking any of the following medications, or if you have taken them in the past: corticosteroids such as dexamethasone, methylprednisolone (Medrol), and prednisone (Rayos); medications for cancer; and medications to weaken or control the immune system such as glatiramer acetate (Copaxone, Glatopa) and interferon beta (Betaseron, Extavia, Plegridy). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with siponimod, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
  • tell your doctor if you have or have had any of these conditions in the last six months: heart attack, angina (chest pain), stroke or mini-stroke, or heart failure. Also, tell your doctor if you have an irregular heart rhythm. Your doctor may tell you not to take siponimod.
  • tell your doctor if you have ever fainted, had a heart attack, stroke, or mini-stroke; if you currently have a fever or other signs of infection or if you have an infection that comes and goes or that does not go away; and if you have or have ever had diabetes; sleep apnea (a condition in which you briefly stop breathing many times during the night) or other breathing problems; high blood pressure; uveitis (inflammation of the eye) or other eye problems; a slow heartbeat; skin cancer, or heart or liver disease. Also, tell your doctor if you have recently received a vaccine.
  • tell your doctor if you are pregnant or plan to become pregnant, or are breastfeeding. You should use birth control to prevent pregnancy during your treatment and for at least 10 days after your final dose. If you become pregnant while taking siponimod or within 10 days after your final dose, call your doctor.
  • do not have any vaccinations for 1 week before you begin your treatment with siponimod, during your treatment, or for 1 month after your final dose without talking to your doctor. Talk to your doctor about vaccinations that you may need to receive before beginning your treatment with siponimod.
  • tell your doctor if you have never had chicken pox and have not received the chickenpox vaccine. Your doctor may order a blood test to see if you have been exposed to chickenpox. You may need to receive the chicken pox vaccine and then wait 1 month before beginning your treatment with siponimod.

Dosage Of Siponimod

Siponimod comes as a tablet to take by mouth. It is usually taken once a day with or without food. Take siponimod at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take siponimod exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor will probably start you on a low dose of siponimod and gradually increase your dose for the first 4 or 5 days,

Siponimod may cause the heartbeat to slow, especially during the first 6 hours after you take your first dose. You will receive an electrocardiogram (ECG; test that records the electrical activity of the heart) before you take your first dose and again 6 hours after you take the dose. You will take your first dose of siponimod in your doctor’s office or another medical facility. You will need to stay at the medical facility for at least 6 hours after you take the medication so that you can be monitored. You may need to stay at the medical facility for longer than 6 hours or overnight if you have certain conditions or take certain medications that increase the risk that your heartbeat will slow or if your heartbeat slows more than expected or continues to slow after the first 6 hours. You may also need to stay at a medical facility for at least 6 hours after you take your second dose if your heartbeat slows too much when you take your first dose. Tell your doctor if you experience dizziness, tiredness, chest pain, or slow or irregular heartbeat at any time during your treatment.

Siponimod may help control multiple sclerosis but will not cure it. Do not stop taking siponimod without talking to your doctor. If you do not take siponimod for 1 day or longer during the first 4 or 5 days of treatment or for 4 days or longer after the first week of treatment, talk to your doctor before you start taking it again. You may experience slowed heartbeat when you start taking siponimod again, so you will need to restart the medication at a lower dose in your doctor’s office and gradually increase the dose over 4 or 5 days.


Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests, eye exams, and will monitor your blood pressure before and during your treatment to be sure that it is safe for you to begin taking or continue to take siponimod.

Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking siponimod.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.


All information has been provided courtesy of MedLinePlus from the National Library of Medicine and from the FDA.