Fampridine Extended-Release Tablets (Fampyra) are a potassium channel blocker used to improve walking ability in adult patients with multiple sclerosis (MS).
How to Use Fampridine Extended-Release Tablets (Fampyra)
Confirmation of Medication Indication
Fampridine Extended-Release Tablets are specifically used to improve walking ability in adult patients with multiple sclerosis; clinical studies have proven that they can increase walking speed.
Before use, it is necessary to confirm that the patient meets this indication and has no contraindications to the medication.
Standard Dosing Regimen
The recommended dose of Fampridine Extended-Release Tablets is 10mg (1 tablet), taken orally twice daily (approximately 12 hours apart).
The total daily dose should not exceed 20mg (2 tablets), as higher doses not only provide no additional benefit but also increase the risk of adverse reactions (including seizures).
Specific Administration Requirements
Swallow whole: Tablets must be swallowed whole; they cannot be split, crushed, chewed, or dissolved, to avoid damaging the extended-release properties.
Effect of food: Can be taken with or without food; food has a slight and clinically insignificant effect on drug absorption.
Management of missed doses: If a dose is missed, do not make up the dose or double the next dose. Instead, take the medication at the next scheduled time as planned.
Medication monitoring: Creatinine clearance (CrCl) should be evaluated before starting treatment and at least annually during treatment.
Dosage Adjustment of Fampridine Extended-Release Tablets (Fampyra)
Dosage Adjustment Based on Adverse Reactions
Seizures: Discontinue the medication immediately and permanently.
Grade 3 adverse reactions: Suspend administration until symptoms resolve to ≤ Grade 1, then resume treatment at a reduced dose (first reduction to 100mg once daily).
Hypersensitivity/allergic reactions: Discontinue the medication permanently if allergic symptoms occur.
Management of Drug Interactions
Concurrent use with OCT2 inhibitors (e.g., cimetidine) may increase fampridine blood concentration and the risk of seizures; the necessity of concurrent use should be evaluated.
Concurrent use of other products containing 4-aminopyridine should also be avoided to prevent accumulation of the active ingredient.
Medication for Special Populations of Fampridine Extended-Release Tablets (Fampyra)
Patients with Renal Impairment
Mild renal impairment: Patients with CrCl 51-80 mL/min may have plasma drug concentrations close to the level of 15mg twice daily (higher than the recommended dose); the risk-benefit ratio should be carefully evaluated.
Moderate to severe renal impairment: Contraindicated in patients with CrCl ≤ 50 mL/min, as drug clearance is significantly reduced and there is no suitable low-dose dosage form.
Patients with Hepatic Impairment
Fampridine is mainly excreted through the kidneys; hepatic impairment has a small impact on its pharmacokinetics. Patients with mild to moderate hepatic impairment usually do not require dosage adjustment, but data on patients with severe hepatic impairment is limited.
Elderly Patients
Elderly patients are more likely to experience decreased renal function; CrCl must be evaluated before starting fampridine treatment.
Although age itself is not a factor for dosage adjustment, changes in renal function that occur with increasing age may require dosage adjustment.
Pregnant and Lactating Women
Pregnancy: Animal studies have shown that it may be harmful to the fetus; the benefits and risks should be weighed before use, and the pregnant woman should be informed of potential risks.
Lactation: There is no data on whether fampridine passes into human milk; the necessity of breastfeeding and the potential effects of the drug should be comprehensively considered.
Patients with a History of Epilepsy
Absolutely contraindicated for patients with a history of seizures, as fampridine may lower the seizure threshold.
