Immunization status of VZV must be confirmed with serology levels prior to starting therapy. If negative then vaccination must be completed at least 4 to 6 weeks prior to starting the treatment.
Immunization should be brought to date and vaccination for pneumococcus and haemophilus influenza type B done.
Resting blood pressure.
Patients with diabetes mellitus or a history of uveitis are at increased risk of macular edema and should undergo an ophthalmic evaluation prior to initiating therapy.
No washout period is necessary when switching from interferons or glatiramer acetate.
The washout period should be less than 2 months when switching from natalizumab.
Cholestyramine should be used to fully eliminate teriflunomide when switching from it to Zeposia.
Negative pregnancy test and counseling with regards to contraception
First Dose :
CBC,ALT, LD, total bilirubin Q1 months X6 then Q4 months
Regular blood pressure monitoring
All patients should undergo an ophthalmological examination at month 3 or 4 for possible macular edema
Diabetic patients should undergo regular ophthalmological examinations while on therapy
Annual influenza vaccination of patient and his/her family members
Ophthalmological examination if there is visual symptoms
Spirometric evaluation if there is respiratory symptoms (can occur within 1 month of initiation)
Discontinue Therapy :
There is evidence of a serious infection such as disseminated VZV or herpetic infection or cryptococcal meningitis
PML is suspected
There is a sustained 5X ULN increase in the transaminases level
