Fingolimod is a sphingosine-1-phosphate receptor modulator. It achieves immunomodulatory treatment for multiple sclerosis by blocking the migration of lymphocytes from lymph nodes to the periphery.

Precautions for Administration of Fingolimod (Fingolimod)

Cardiovascular System Evaluation

Electrocardiogram (ECG) testing is required to screen for the following contraindications: baseline QTc interval ≥ 500 milliseconds, Mobitz type II second-degree/third-degree atrioventricular block, and sick sinus syndrome (except for patients with a pacemaker implanted).

For patients with ischemic heart disease, a history of heart failure, a history of cardiac arrest, uncontrolled hypertension, or other such conditions, evaluation must be completed by a cardiovascular specialist. If necessary, 24-hour ambulatory ECG monitoring should be performed.

Baseline Laboratory Tests

Complete Blood Count (CBC): To assess the risk of infection and establish a baseline for subsequent changes in lymphocyte counts.

Comprehensive Liver Function Tests: Including alanine transaminase (ALT), aspartate transaminase (AST), and total bilirubin (to be conducted within 6 months before treatment initiation).

Varicella-Zoster Virus Antibody Screening: For patients with negative serum results, treatment should be delayed for 1 month after receiving the varicella-zoster vaccine.

Specialist Examination Requirements

Fundus Examination: Must include a baseline assessment of the macular area. Enhanced screening is required for diabetic patients.

Dermatological Examination: To screen for suspicious skin lesions. Long-term follow-up records should be established for patients at high risk of skin cancer.

Management of High-Risk Patients

For patients at risk of QT interval prolongation or those concurrently using drugs that prolong the QT interval (such as citalopram, chlorpromazine, erythromycin, etc.), overnight continuous ECG monitoring must be implemented.

Patients with symptomatic bradycardia need to start continuous ECG monitoring immediately. If drug intervention is required, the patient should be hospitalized for observation until the next day, and the monitoring process should be repeated during the administration of the second dose.

Medication Monitoring for Fingolimod (Fingolimod)

Monitoring of Infection Indicators

During treatment, lymphocyte counts may decrease to 20%-30% of the baseline value. Caution should be exercised regarding opportunistic infections, including those caused by herpes simplex virus and Cryptococcus.

When infection symptoms such as fever and chills occur, etiological testing must be conducted immediately. For patients with active infections, medication should be suspended.

Regular Evaluation of Organ Function

Liver Function: Transaminase levels should be tested monthly until treatment stabilizes, after which rechecks should be performed every 3-6 months.

Fundus Examination: A recheck including the macular area must be completed 3-4 months after the start of treatment.

Blood Pressure Monitoring: For patients showing a tendency of elevated blood pressure 1 month after treatment initiation, the frequency of monitoring should be increased.

Respiratory Function: When unexplained dyspnea occurs, pulmonary function testing and carbon monoxide diffusion capacity testing should be performed.