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ZEPOSIA is a once-daily pill for adults with relapsing multiple sclerosis (MS).

Take as directed by your doctor if certain liver problems exist.

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ZEPOSIA is a once-daily pill for adults with relapsing multiple sclerosis (MS).

Take as directed by your doctor if certain liver problems exist.

Understanding safety & side effects

When starting any medication, it’s important to learn about its safety and possible side effects.

ZEPOSIA has a well-established safety profile

The safety of ZEPOSIA has been studied:

  • Across 2 conditions—multiple sclerosis and ulcerative colitis
  • In over 1,300 patients

90% of people taking ZEPOSIA remained on treatment throughout the clinical studies

A 6-year clinical study showed that only 3% of patients stopped taking ZEPOSIA due to a side effect they experienced.

Received by ~35,000 patients since approval

Approximately 35,000 patients have received ZEPOSIA across both conditions.*

  • As of April 30, 2023.

Serious and common side effects

These are some of the side effects that people taking ZEPOSIA reported during both of the clinical studies.

  • Infections: ZEPOSIA can increase your risk of serious infections that can be life-threatening and cause death. Symptoms include fever, feeling very tired, flu-like symptoms, cough, painful and frequent urination (signs of a urinary tract infection), rash, or symptoms of meningitis, such as headache with fever, neck stiffness, sensitivity to light, nausea, or confusion
  • Progressive multifocal leukoencephalopathy (PML): ZEPOSIA can increase your risk for PML, which is a rare brain infection that gets worse over days to weeks, and usually leads to death or severe disability
  • ZEPOSIA may cause your heart rate to temporarily slow down (also known as bradyarrhythmia): when you start taking ZEPOSIA—especially during the first 8 days. Symptoms include dizziness, lightheadedness, feeling like your heart is beating slowly or skipping beats, shortness of breath, confusion, chest pain, or tiredness
  • Liver problems: Symptoms include unexplained nausea, vomiting, stomach area (abdominal) pain, tiredness, loss of appetite, yellowing of the whites of your eyes or skin, or dark-colored urine
  • Increased blood pressure: Your healthcare provider should check your blood pressure during treatment with ZEPOSIA. A sudden, severe increase in blood pressure (hypertensive crisis) can happen when you eat certain foods that contain a high level of tyramine
  • Breathing problems: Such as shortness of breath
  • Macular edema (a vision problem): Your risk for macular edema is higher if you have diabetes or have had an inflammation of your eye called uveitis. Symptoms include blurriness, shadows, or a blind spot in the center of your vision, sensitivity to light, or unusually colored vision
  • Swelling and narrowing of blood vessels in your brain. Posterior Reversible Encephalopathy Syndrome (or PRES): A rare condition that has happened with ZEPOSIA and with drugs in the same class. Symptoms include sudden severe headache, sudden confusion, sudden loss of vision or other vision changes, or seizure
  • Severe worsening of multiple sclerosis (MS) after stopping ZEPOSIA: When ZEPOSIA is stopped, MS symptoms may return and become worse compared to before or during treatment. Always talk to your healthcare team before you stop taking ZEPOSIA for any reason

If you feel you are experiencing a side effect while taking ZEPOSIA, reach out to your healthcare professional.

Here are the side effects that occurred in at least 4% of people, along with the percentage of people who experienced each.

Side effect ZEPOSIA
(882 people)		 A leading injectable
medicine, Avonex*
(885 people)
Upper respiratory tract infections 26% 23%
Elevated liver enzymes 10% 5%
Low blood pressure upon standing 4% 3%
Painful and frequent urination 4% 3%
Back pain 4% 3%
High blood pressure 4% 2%
  • Avonex® (interferon beta-1a).

If you experience any side effects while taking ZEPOSIA, be sure to talk to your doctor right away. These are not all the possible side effects of ZEPOSIA. To see full side effects, click here.

Please see the full Prescribing Information and Medication Guide for information on all of the side effects reported by those taking ZEPOSIA.

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Important facts about
ZEPOSIA® (ozanimod)

This is a summary of important information that you need to know about ZEPOSIA. Your healthcare provider can work with you to help answer any questions you may have about this medication. Keep this information in a safe place, so you can refer to it before and during your treatment.

Look out for the following icons as you
read:

  • Talk to your healthcare provider

  • Call a healthcare provider right away

  • Helpful information to remember

 

What is ZEPOSIA?

ZEPOSIA® (ozanimod) is a prescription medicine used to treat:

Adults with relapsing forms of multiple sclerosis (MS), including:

  • Clinically Isolated Syndrome (CIS)
  • Relapsing-Remitting MS Disease (RRMS), and
  • Active Secondary Progressive MS Disease (SPMS)

Adults with moderately to severely active ulcerative colitis (UC)

It is not known if ZEPOSIA is safe and effective in children under 18 years of age.

  • ZEPOSIA should not be taken if:
    • You have or have had problems with your heart or blood flow such as:
      • A heart attack, chest pain (unstable angina), a stroke or mini-stroke (transient ischemic attack [TIA]), or certain types of heart failure in the last six months
      • A history of certain types of irregular or abnormal heartbeat (arrhythmia) that is not corrected by a pacemaker
    • You have untreated, severe breathing problems during your sleep (sleep apnea)
    • You take certain medicines called monoamine oxidase (MAO) inhibitors, such as selegiline, phenelzine, or linezolid, which may be used to treat infections, Parkinson’s, depression, or anxiety
  • Talk to your healthcare provider before taking ZEPOSIA if you have any of these conditions, or don’t know if you have any of these conditions.
 

What is the most important information I should know about ZEPOSIA?

ZEPOSIA may cause serious side effects. A serious side effect is a side effect that can sometimes become life threatening and can lead to hospitalization or death. The serious side effects of ZEPOSIA may include:

Infections. ZEPOSIA lowers the number of white blood cells (lymphocytes) in your blood. Having fewer white blood cells weakens your immune system, and increases your risk of serious infections. Before starting ZEPOSIA, your healthcare provider may do a blood test to make sure that your white blood cells are not too low. After stopping ZEPOSIA, the number of white blood cells that you have in your blood usually goes back to normal within three months.

  • Call your healthcare provider right away if you have any of the following symptoms of an infection during treatment with ZEPOSIA, and for three months after your last dose of ZEPOSIA:
  • Fever
  • Feeling very tired
  • Flu-like symptoms
  • Cough
  • Painful and frequent urination (signs of a urinary tract infection)
  • Rash
  • Headache with fever, neck stiffness, sensitivity to light, nausea, or confusion (these may be symptoms of meningitis, an infection of the lining around your brain and spine)

Your healthcare provider may delay starting, or may stop your ZEPOSIA treatment if you have an infection.

Progressive multifocal leukoencephalopathy (PML). PML is a rare brain infection that usually leads to death or severe disability. ZEPOSIA can increase your risk for PML. PML usually happens in people with weakened immune systems but has happened in people who do not have weakened immune systems.

  • Call your healthcare provider right away if you have any new or worsening symptoms of PML that have lasted several days. Symptoms get worse over days to weeks. These symptoms include:
  • Weakness on one side of your body
  • Loss of coordination in your arms or legs
  • Decreased strength
  • Balance problems
  • Changes in your vision
  • Changes in thinking or memory
  • Confusion
  • Changes in your personality

Your healthcare provider will stop treatment with ZEPOSIA if you are showing symptoms of PML.

Slow heart rate (also known as bradyarrhythmia) when you start taking ZEPOSIA. ZEPOSIA may cause your heart rate to slow down temporarily, especially during the first eight days that you start taking it. Before starting ZEPOSIA, your healthcare provider will do a test called an electrocardiogram (ECG) to measure the electrical activity of your heart.

  • Call your healthcare provider if you have any of these symptoms:
  • Feeling dizzy
  • Feeling lightheaded
  • Feeling tired
  • Feeling like your heart is beating slowly or skipping beats
  • Shortness of breath
  • Feeling confused
  • Chest pain

Your healthcare provider will increase your dosage slowly to reduce the risk of slow heart rate. It is important that you follow directions from your healthcare provider when starting ZEPOSIA and if you miss a dose. Please see additional information on taking ZEPOSIA below.

Liver problems. ZEPOSIA may cause liver problems. Your healthcare provider will do blood tests to check your liver’s health before you start taking ZEPOSIA.

  • Call your healthcare provider right away if you have any of these symptoms of liver problems:
  • Unexplained nausea
  • Vomiting
  • Dark colored urine
  • Pain in the stomach (abdominal) area
  • Feeling tired
  • Loss of appetite
  • Yellowing of the whites of your eyes or skin

Increased blood pressure. ZEPOSIA can cause your blood pressure to go up. Your healthcare provider should check your blood pressure while you take ZEPOSIA.

  • Eating certain foods that are high (over 150 mg) in tyramine (such as aged, fermented, cured, smoked, and pickled foods) can cause your blood pressure to go up suddenly and severely (hypertensive crisis). It is important to avoid these foods while you are taking ZEPOSIA.

Breathing problems. Some people who take ZEPOSIA feel as though they cannot catch their breath (shortness of breath).

  • Call your healthcare provider right away if you have new or worsening breathing problems.

A problem with your vision called macular edema. ZEPOSIA may cause swelling in the back of the eye (macula). Your chance of developing macular edema is higher if you have diabetes, or have had uveitis (a type of inflammation of your eye). Your healthcare provider should check your vision before you start ZEPOSIA, especially if you’re at a higher risk for macular edema or if you notice vision changes while taking ZEPOSIA.

  • Call your healthcare provider right away if you have any of these symptoms:
  • A blind spot, blurriness, or shadows in the
    center of your vision
  • Sensitivity to light
  • Unusually colored vision

Swelling and narrowing of blood vessels in your brain. A condition called Posterior Reversible Encephalopathy Syndrome (PRES) is a rare condition of ZEPOSIA and other drugs like it. If left untreated, it may lead to a stroke. The symptoms of PRES usually get better once you stop taking ZEPOSIA.

  • Call your healthcare provider right away if you have any of these symptoms:
  • Sudden severe headache
  • Sudden confusion
  • Sudden changes or loss of vision
  • Seizure

Your healthcare provider will test to see if you have any symptoms of PRES.

If you take or have previously taken ZEPOSIA for multiple sclerosis (MS): You may have severe worsening of MS symptoms after stopping ZEPOSIA. Your symptoms of MS may return and become worse compared to before or during treatment.

  • Talk to your healthcare provider before you stop taking ZEPOSIA for any reason. Tell your healthcare provider if you have worsening symptoms of MS after stopping ZEPOSIA.
 

What are the most common side effects of ZEPOSIA?

The most common side effects of ZEPOSIA can include:

  • Colds or infections that affect the nose, throat, and sinuses (upper respiratory tract infection)
  • Elevated liver enzymes
  • Sudden drops in blood pressure when you stand up (orthostatic hypotension), which can feel like dizziness or lightheadedness
  • Painful and frequent urination (signs of urinary tract infection)
  • Back pain
  • High blood pressure
  • Headache

These are not all of the possible side effects of ZEPOSIA.

  • Talk to your healthcare provider for more information or advice about side effects. You are encouraged to report side effects of prescription drugs to the FDA by visiting www.fda.gov/medwatch or calling 1-800-FDA-1088.
 

What should I discuss with my healthcare provider before receiving ZEPOSIA?

  • Talk to your healthcare provider about all of your medical conditions, including if you have:
  • A recent fever or infection
  • A disease that makes you unable to fight infections
  • Problems with your heart, which may include:
    • A slow heart rate
    • An irregular or abnormal heartbeat (arrhythmia)
    • Heart attack, or chest pain
  • High blood pressure
  • A history of stroke
  • Liver problems
  • Breathing problems, while awake or sleeping
  • Eye problems, especially eye inflammation (called uveitis)
  • Diabetes
  • Talk to your healthcare provider if you have had chickenpox, or have received the vaccine for chickenpox.

Your healthcare provider may do a blood test for the chickenpox virus. You may need to get the full course of the chickenpox (Varicella Zoster Virus) vaccine, and then wait one month before you start taking ZEPOSIA.

  • Talk to your healthcare provider about all the medicines you are taking or have recently taken, including:
  • Prescription medicines
  • Over-the-counter medicines
  • Vitamins
  • Herbal supplements

It is especially important to tell your healthcare provider if you take, or have taken any medicines that:

  • Affect or lower your immune system (such as alemtuzumab)
  • Control your heart rhythm (such as antiarrhythmics) or heartbeat
  • Promote or inhibit CYP2C8 activity (such as rifampin or gemfibrozil)
  • Are opioids
  • Treat depression
  • Treat Parkinson’s disease
  • Control your heart rate and blood pressure (such as beta blocker and calcium channel blocker medicines)
  • Talk to your healthcare provider if you are not sure if you take any of these medications. Using ZEPOSIA with other medicines can cause serious side effects. Keep a list of the medicines you take to show your healthcare provider and pharmacist.
  • Talk to your healthcare provider if you have received a vaccine in the past 30 days, or are scheduled to receive a vaccine (immunization). ZEPOSIA may cause vaccines to be less effective.

You should not receive live vaccines during treatment with ZEPOSIA, for at least one month before taking ZEPOSIA, and for three months after you stop taking ZEPOSIA. Live vaccines are vaccines that use a small amount of the weakened virus. Some common live vaccines (among others) include:

  • Measles, mumps, and rubella (MMR)
  • Intranasal flu vaccine
  • Rotavirus
  • Smallpox
  • Chickenpox
  • Yellow fever
 

What should I discuss with my healthcare provider about pregnancy, birth control, and breastfeeding?

  • Talk to your healthcare provider if:
  • You are pregnant or plan to become pregnant — ZEPOSIA may harm your unborn baby.
    If you are able to become pregnant, you should use effective birth control during your treatment with ZEPOSIA and for three months after you stop taking ZEPOSIA.
  • Talk to your healthcare provider about birth control methods you can use with ZEPOSIA.
  • You are breastfeeding or plan to breastfeed — It is not known if ZEPOSIA passes into your breast milk.
    • Talk to your healthcare provider about the best way to feed your baby if you take ZEPOSIA.
  • Call your healthcare provider right away if you become pregnant or think you are pregnant while taking ZEPOSIA, or within three months after you stop taking it.

    If you are taking ZEPOSIA for multiple sclerosis: Talk to your healthcare provider about registering for the ZEPOSIA Pregnancy registry. This registry is for people with multiple sclerosis who become pregnant during treatment with ZEPOSIA. Its purpose is to collect information about you and your baby’s health. Either you or your healthcare provider can enroll you in this registry by calling 1-877-301-9314 or visiting www.zeposiapregnancyregistry.com.

 

How will I take ZEPOSIA?

Take ZEPOSIA exactly as your healthcare provider tells you. Your healthcare provider may change your dose schedule (frequency) if certain liver problems exist.

ZEPOSIA is an opaque capsule filled with a white to off-white powder. It comes in three dosage strengths (0.23 mg, 0.46 mg, and 0.92 mg) that are different colors. The capsules all have “OZA” and their dosage strength in mg printed in black ink.

Inactive ingredients: colloidal silicon dioxide, croscarmellose sodium, magnesium stearate, and microcrystalline cellulose

Capsule shell inactive ingredients: black iron oxide, gelatin, red iron oxide, titanium oxide, and yellow iron oxide

  • Do swallow ZEPOSIA capsules whole
  • Do take ZEPOSIA with or without food
  • Do take ZEPOSIA exactly as your healthcare provider tells you
  • Avoid certain foods that are high (over 150 mg) in tyramine, such as aged, fermented, cured, smoked, and pickled foods
  • Do not skip a dose of ZEPOSIA
  • Do not stop taking ZEPOSIA without talking with your healthcare provider first

Starting ZEPOSIA (days 1 to 7): Your treatment with ZEPOSIA begins with a 7-day Starter Pack. This pack includes all of the pills that you need for the first 7 days of treatment, and helps to gradually increase your dosage of ZEPOSIA. Be sure to follow the instructions written on the pack and take the pills in the correct order.

Days 1 – 4

One 0.23 mg capsule one time per day
This capsule is light grey

Days 5 – 7

One 0.46 mg capsule one time per day
This capsule is half-light grey and half-orange

Continuing ZEPOSIA (day 8 onwards): After finishing your first week of treatment, you will take your regular dose of ZEPOSIA.

Day 8
onwards

One 0.92 mg capsule one time per day, or as directed by your healthcare provider
This capsule is orange

 

What if I miss a dose of ZEPOSIA?

Do not take an extra dose.

During days 1– 14 (first two weeks) of starting treatment: If you miss one or more doses, let your healthcare provider know. You will need to restart your ZEPOSIA treatment and get a new 7-day Starter Pack.

After the first 14 days of treatment: If you miss one dose of ZEPOSIA, take one capsule at your next usual time. You can continue your treatment as planned.

 

How should I store ZEPOSIA?

ZEPOSIA capsules should be stored at room temperature between 68°F to 77°F (20°C to 25°C).
Keep ZEPOSIA and all medicines out of reach of children.

 

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