Tascenso Odt

Risk of bradyarrhythmia; observe all patients for bradycardia for at least 6hrs after first dose with hourly pulse and BP measurement. Obtain ECG prior to dosing and at the end of observation period. If heart rate (HR) <45bpm (adults), <55bpm (≥12yrs) or <60bpm (10–11yrs), or new onset 2^nd degree or higher AV block; monitor until resolution, those at the lowest post-dose HR should be monitored until HR increases. Symptomatic bradycardia: begin continuous ECG monitoring until resolved; if pharmacological intervention necessary, continue ECG monitoring overnight, and first dose monitoring procedures should be repeated for 2^nd dose. Pre-existing cardiac conditions (eg, ischemic heart disease, history of MI, cardiac arrest or symptomatic bradycardia, cerebrovascular disease, CHF, uncontrolled hypertension, recurrent syncope, untreated sleep apnea, AV block, sino-atrial block), QT prolongation risk (eg, hypokalemia, hypomagnesemia, congenital long-QT syndrome): monitor ECG overnight after first dose. Monitor BP during treatment. Increased risk of infections (may be fatal). Obtain recent CBC before starting treatment. Consider suspending therapy if serious infection develops; continue monitoring for 2 months after discontinuation. Active acute or chronic infection: do not start treatment until infection resolved. Test for antibodies to varicella zoster virus; consider immunization before starting fingolimod. Consider HPV immunization prior to initiation. Perform cancer screening (including Pap test). Immunosuppressed. Withhold and evaluate at first sign/symptom of progressive multifocal leukoencephalopathy (PML); discontinue if confirmed and monitor for immune reconstitution inflammatory syndrome (IRIS). Diabetes, history of uveitis: increased risk of macular edema. Monitor visual acuity and for visual disturbances. Do ophthalmic exam at baseline, and at 3–4 months after starting therapy. Renal or severe hepatic impairment. Obtain ALT, AST, total bilirubin prior to initiation (eg, within 6 months); monitor periodically until 2 months after stopping treatment. Monitor for hepatic injury; discontinue if occurs. Interrupt treatment if ALT >3 times the reference range with total bilirubin >2 times the reference range; do not resume if no alternative etiology established. Respiratory dysfunction; obtain spirometry and DLCO when needed. Monitor for severe increase in disability after treatment discontinuation. Malignancies. Consider tumefactive MS if severe MS relapse occurs during (esp initiation) or after discontinuing. Perform periodic skin exam (esp. with risk factors); monitor for suspicious skin lesions and evaluate if observed. Complete all immunizations in children prior to initiation. Elderly. Advise females of reproductive potential to use effective contraception during and for 2 months after discontinuation. Pregnancy: exclude status prior to initiation. Nursing mothers.