Table 2.

Contraindications, warnings, and precautions associated with the approved oral multiple sclerosis drugs^1,3,4

	Dimethyl fumarate	Fingolimod	Teriflunomide
Contraindications
Severe hepatic impairment			X
Pregnancy			X
Current leflunomide treatment			X
Severe cardiovascular event (eg, myocardial infarction, unstable angina, stroke, transient ischemic attack, decompensated heart failure requiring hospitalization, class III/IV heart failure) within the previous 6 months		X
History of or current Mobitz type II second- or third-degree atrioventricular block or sick sinus syndrome, unless patient has a functioning pacemaker		X
Baseline QTc interval ≥ 500 ms		X
Treatment with class Ia or III antiarrhythmic drugs		X
Warnings and precautions
Atrioventricular block		X
Blood pressure increased		X	X
Bone marrow disease; use not recommended			X
Bradyarrhythmia block		X
Hepatoxicity		X	X
Hyperkalemia			X
Interstitial lung disease or worsening of pre-existing interstitial lung disease			X
Lung function decreased		X
Macular edema		X
Method for accelerated elimination of drug			X
Peripheral neuropathy			X
Acute renal failure			X
Concurrent use of immunosuppressive or immunomodulating therapies		X	X
Severe immunodeficiency; use not recommended			X
White blood cell count decrease	X	X	X
Risk of infection		X	X
Infections (severe, uncontrolled); use not recommended			X
Tuberculosis screening			X
Varicella zoster virus antibody testing/vaccination		X
Vaccination (live vaccines); use not recommended			X
Risk of malignancy			X
Skin reactions			X
Use in women of childbearing potential		X	X
Flushing	X
Pregnancy	Category C	Category C	Category X
Breast-feeding	Caution	Not recommended	Not recommended