{"id":13407,"date":"2021-09-16T07:21:00","date_gmt":"2021-09-16T07:21:00","guid":{"rendered":"https:\/\/zeepedia.com\/?p=13407"},"modified":"2021-11-06T11:34:04","modified_gmt":"2021-11-06T11:34:04","slug":"gilenya","status":"publish","type":"post","link":"https:\/\/zeepedia.com\/medical\/medicines\/gilenya\/","title":{"rendered":"Gilenya &#8211; Fingolimod uses, dose and side effects"},"content":{"rendered":"\n<p>.25 mg and 0.5 mg&nbsp;hard capsules<br>fingolimod<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">1. What Gilenya is and what it is used for<\/h2>\n\n\n\n<p><strong>What Gilenya is<\/strong><\/p>\n\n\n\n<p>Gilenya contains the active substance fingolimod.<\/p>\n\n\n\n<p><strong>What Gilenya is used for<\/strong><\/p>\n\n\n\n<p>Gilenya is used in adults and in children and adolescents (aged 10 years and older) to treat relapsing&nbsp;multiple sclerosis&nbsp;(MS), more specifically in:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Patients who did not respond despite treatment with MS treatment.<\/li><\/ul>\n\n\n\n<p>or<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Patients who have rapid development of severe MS.<\/li><\/ul>\n\n\n\n<p>Gilenya does not cure MS but helps to reduce the number of&nbsp;relapses&nbsp;and to slow down the development of physical disabilities due to MS.<\/p>\n\n\n\n<p><strong>What is&nbsp;multiple sclerosis?<\/strong><\/p>\n\n\n\n<p>MS is a&nbsp;chronic&nbsp;disease that affects the&nbsp;central nervous system&nbsp;(&nbsp;CNS&nbsp;), which consists of the brain and spinal cord.&nbsp;In MS, the protective sheath (called myelin) that surrounds the nerves in the&nbsp;CNS is destroyed&nbsp;due to&nbsp;inflammation, which means that the nerves do not function properly.&nbsp;This is called demyelination.<\/p>\n\n\n\n<p>Relapsing-remitting MS is characterized by repeated attacks (&nbsp;relapses&nbsp;) of symptoms from the nervous system that reflect&nbsp;inflammation&nbsp;in the&nbsp;CNS.&nbsp;The symptoms vary from patient to patient, but the typical symptoms are difficulty walking, numbness, visual disturbances, or balance disorders.&nbsp;When the&nbsp;relapse&nbsp;is over, the symptoms may disappear completely, but some problems may also persist.<\/p>\n\n\n\n<p><strong>How Gilenya works<\/strong><\/p>\n\n\n\n<p>Gilenya helps protect against the immune system&#8217;s attacks on the&nbsp;CNS&nbsp;by reducing the ability of certain white blood cells (lymphocytes) to move freely in the body and by preventing those that cause&nbsp;inflammation&nbsp;from reaching the brain and spinal cord.&nbsp;This limits nerve damage caused by MS.&nbsp;Gilenya also lowers some of the body&#8217;s immune reactions.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">2. What you need to know before taking Gilenya<\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">Do not take Gilenya<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li>if you have&nbsp;<strong>a reduced&nbsp;immune response<\/strong>&nbsp;(due to an immune deficiency syndrome, disease or drugs that inhibit the immune system).<\/li><li>if you have a&nbsp;<strong>severe, active&nbsp;infection&nbsp;or active,&nbsp;chronic&nbsp;infection<\/strong>&nbsp;such as&nbsp;hepatitis&nbsp;or&nbsp;tuberculosis&nbsp;.<\/li><li>if you have an&nbsp;<strong>active cancer<\/strong>&nbsp;.<\/li><li>if you have&nbsp;<strong>severe liver problems<\/strong>&nbsp;.<\/li><li><strong>if you have had a heart attack, angina,&nbsp;stroke&nbsp;or warning of a&nbsp;stroke&nbsp;or certain types of&nbsp;heart failure&nbsp;in the last 6 months.<\/strong><\/li><li>if you have certain types of&nbsp;<strong>irregular or abnormal heartbeat<\/strong>&nbsp;(&nbsp;arrhythmia&nbsp;), including patients in whom the electrocardiogram (&nbsp;ECG&nbsp;) shows a long&nbsp;QT interval&nbsp;before you start using Gilenya.<\/li><li><strong>if you are taking or have recently taken medicines for irregular heartbeats,<\/strong>&nbsp;such as&nbsp;quinidine&nbsp;,&nbsp;disopyramide&nbsp;,&nbsp;amiodarone&nbsp;or sotalol.<\/li><li>if you are&nbsp;<strong>pregnant<\/strong>&nbsp;or&nbsp;<strong>a woman of&nbsp;childbearing potential&nbsp;not using effective contraception<\/strong>&nbsp;.<\/li><li><strong>if you are allergic<\/strong>&nbsp;to fingolimod or any of the other ingredients of this medicine (listed in section 6).<\/li><\/ul>\n\n\n\n<p>If this applies to you or if you are&nbsp;<strong>not sure, talk to your doctor before taking Gilenya.<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Warnings and cautions<\/h2>\n\n\n\n<p>Talk to your doctor before taking Gilenya:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>if you have severe breathing problems during sleep (severe&nbsp;sleep apnea&nbsp;).<\/strong><\/li><li><strong>if you have been told that you have an abnormal&nbsp;ECG&nbsp;.<\/strong><\/li><li><strong>if you have symptoms of a slow heart rate (eg dizziness, nausea or palpitations).<\/strong><\/li><li><strong>if you are taking or have recently taken medicines that lower your heart rate<\/strong>&nbsp;(such as&nbsp;beta-blockers&nbsp;, verapamil,&nbsp;diltiazem&nbsp;or&nbsp;ivabradine&nbsp;,&nbsp;digoxin&nbsp;, cholinesterase inhibitors or pilocarpine).<\/li><li><strong>if you have previously had sudden unconsciousness or fainting (&nbsp;syncope&nbsp;).<\/strong><\/li><li><strong>if you are planning to get vaccinated.<\/strong><\/li><li><strong>if you have never had chickenpox.<\/strong><\/li><li><strong>if you have or have had visual disturbances<\/strong>&nbsp;or other signs of swelling in the central vision area (&nbsp;yellow spot&nbsp;or&nbsp;macula&nbsp;) located at the back of the eye (a condition called macular edema, see below),&nbsp;inflammation&nbsp;or&nbsp;infection&nbsp;in the eye (&nbsp;uveitis&nbsp;)&nbsp;<strong>or if you have&nbsp;diabetes<\/strong>&nbsp;(which can cause eye problems).<\/li><li><strong>if you have liver problems<\/strong>&nbsp;.<\/li><li>if you have&nbsp;<strong>high&nbsp;blood pressure&nbsp;that cannot be controlled with medication<\/strong>&nbsp;.<\/li><li>if you have&nbsp;<strong>severe lung problems<\/strong>&nbsp;or whooping cough.<\/li><\/ul>\n\n\n\n<p>If this applies to you or if you are&nbsp;<strong>not sure, talk to your doctor before taking Gilenya.<\/strong><\/p>\n\n\n\n<p>Slow heart rate (&nbsp;bradycardia&nbsp;) and irregular heartbeat<\/p>\n\n\n\n<p>At the beginning of treatment or after taking the first&nbsp;dose&nbsp;of 0.5 mg when you change from a daily&nbsp;dose&nbsp;of 0.25 mg, Gilenya may cause your heart to beat more slowly.&nbsp;This can cause you to feel dizzy or tired or have a clear heartbeat, or your&nbsp;blood pressure&nbsp;to&nbsp;drop.&nbsp;<strong>If these effects are serious, tell your doctor as you may need immediate treatment.&nbsp;<\/strong>Gilenya can also cause irregular heartbeat, especially after the first&nbsp;dose.&nbsp;Irregular heartbeat usually returns to normal in less than a day.&nbsp;Slow heart rate usually returns to normal within a month.&nbsp;During this period, no clinically relevant effects on heart rate are usually expected.<\/p>\n\n\n\n<p>Your doctor will ask you to stay at the doctor&#8217;s or clinic for at least 6 hours, with&nbsp;heart rate&nbsp;and blood pressure measurements every hour, after taking the first&nbsp;dose&nbsp;of Gilenya or after taking the first&nbsp;dose&nbsp;of 0.5 mg. when switching from a daily&nbsp;dose&nbsp;of 0.25 mg, so that appropriate action can be taken in the event of&nbsp;side effects&nbsp;occurring at the beginning of treatment.&nbsp;You should have an&nbsp;ECG&nbsp;measurement performed before the first&nbsp;dose&nbsp;of Gilenya and after the 6-hour monitoring period.&nbsp;Your doctor can monitor your&nbsp;ECGcontinuously during that time.&nbsp;If after this 6-hour period you have a very slow or decreasing heart rate, or if your&nbsp;ECG&nbsp;shows abnormalities, you may need to be monitored for a longer period (for at least 2 more hours and possibly overnight), until these have disappeared.&nbsp;The same can apply if you resume treatment with Gilenya after a break in treatment, depending on both how long the break was and how long you had taken Gilenya before the break.<\/p>\n\n\n\n<p>If you have or are at risk for abnormal or irregular heartbeat, if your&nbsp;ECG&nbsp;is abnormal or if you have heart disease or&nbsp;heart failure, Gilenya may not be suitable for you.<\/p>\n\n\n\n<p>If you have a history of sudden unconsciousness or decreased heart rate, Gilenya may not be suitable for you.&nbsp;You will be evaluated by a cardiologist (cardiologist) who will advise on how to start treatment with Gilenya, including overnight monitoring.<\/p>\n\n\n\n<p>If you are taking medicines that may cause your&nbsp;heart rate&nbsp;to drop, Gilenya may not be suitable for you.&nbsp;You will need to be evaluated by a cardiologist, who will check if you can switch to another medicine that does not reduce your&nbsp;heart rate&nbsp;so that you can start treatment with Gilenya.&nbsp;If such a change is impossible, your cardiologist will advise you on how to start treatment with Gilenya, including overnight monitoring.<\/p>\n\n\n\n<p>If you have never had chickenpox<\/p>\n\n\n\n<p>If you have never had chickenpox, your doctor will check if you are immune to the&nbsp;virus&nbsp;that causes the disease (varicella-zoster virus).&nbsp;If you have no&nbsp;virus&nbsp;protection, you may need to get vaccinated before starting treatment with Gilenya.&nbsp;If this is the case, your doctor will postpone the start of treatment with Gilenya for one month after the end of the full vaccination program.<\/p>\n\n\n\n<p>Infection&nbsp;is<\/p>\n\n\n\n<p>Gilenya reduces the number of&nbsp;white blood cells&nbsp;(especially the lymphocyte count).&nbsp;White blood cells&nbsp;fight&nbsp;infection with&nbsp;you.&nbsp;While you are taking Gilenya (and up to 2 months after you stop taking the medicine) you may find it easier to get an&nbsp;infection.&nbsp;If you already have an&nbsp;infection, it can get worse.&nbsp;Infection&nbsp;can be serious and life-threatening.&nbsp;Contact your doctor immediately, as it can be serious and life-threatening if you think you have an&nbsp;infection, have a fever, feel like you have the&nbsp;flu, have&nbsp;shingles or headache accompanied by a stiff neck, sensitivity to light, nausea, rash, and\/or confusion or convulsions (seizures) (these may be symptoms of&nbsp;meningitis&nbsp;(&nbsp;meningitis&nbsp;), and\/or brain inflammation (&nbsp;encephalitis&nbsp;) caused by a fungal or herpes infection).<\/p>\n\n\n\n<p>If you think your MS is getting worse (eg weakness or vision changes) or if you notice any new symptoms, talk to your doctor immediately, as this may be a symptom of a rare brain disease caused by&nbsp;infection.&nbsp;This rare brain disease is called&nbsp;progressive&nbsp;multifocal&nbsp;leukoencephalopathy (PML).&nbsp;PML is a serious condition that can lead to severe disability or death.&nbsp;Your doctor will consider performing an MRI scan to evaluate this condition and will decide if you need to stop taking Gilenya.<\/p>\n\n\n\n<p>Infection&nbsp;with human papillomavirus (HPV), including&nbsp;papillomas, dysplasia, warts, and HPV-related cancers have been reported in patients treated with Gilenya.&nbsp;Your doctor will consider whether you need to be vaccinated against HPV before starting treatment.&nbsp;If you are a woman, your doctor will also recommend HPV&nbsp;screening.<\/p>\n\n\n\n<p>Macular edema<\/p>\n\n\n\n<p>If you have or have had visual disturbances or other signs of swelling in the&nbsp;macula&nbsp;(&nbsp;macula&nbsp;) at the back of the eye,&nbsp;inflammation&nbsp;or&nbsp;infection&nbsp;of the eye (&nbsp;uveitis&nbsp;), or&nbsp;diabetes, your doctor may want you to undergo an eye examination before starting Gilenya.<\/p>\n\n\n\n<p>Your doctor may want you to have an eye examination 3 to 4 months after you start treatment with Gilenya.<\/p>\n\n\n\n<p>The macula&nbsp;(&nbsp;macula&nbsp;) is a small area on the retina at the back of the eye that allows you to see shapes, colors, and details clearly and sharply.&nbsp;Gilenya can cause swelling in the&nbsp;macula, a condition called macular edema.&nbsp;The swelling usually occurs within the first 4 months of Gilenya treatment.<\/p>\n\n\n\n<p>The risk of developing macular edema is higher if you have&nbsp;<strong>diabetes<\/strong>&nbsp;or have had an&nbsp;inflammation&nbsp;of the eye called&nbsp;uveitis.&nbsp;In such cases, your doctor will want you to have regular eye examinations to detect macular edema.<\/p>\n\n\n\n<p>If you have had macular edema, talk to your doctor before resuming treatment with Gilenya.<\/p>\n\n\n\n<p>Macular edema can cause the same visual symptoms as an MS&nbsp;relapse&nbsp;(&nbsp;optic&nbsp;neuritis&nbsp;).&nbsp;In the early course, the condition can cause symptoms or be asymptomatic.&nbsp;If your vision changes, be sure to tell your doctor.&nbsp;Your doctor may want you to have an eye exam, especially if:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>the center of the&nbsp;field&nbsp;of&nbsp;view&nbsp;becomes blurred or has shadows;<\/li><li>you develop a blind spot in the middle of the field of vision;<\/li><li>you have difficulty seeing colors or small details.<\/li><\/ul>\n\n\n\n<p>Liver function tests<\/p>\n\n\n\n<p>If you have severe liver problems, do not take Gilenya.&nbsp;Gilenya may affect your liver function.&nbsp;You will probably not notice any symptoms, but if the skin or whites of the eyes turn yellow, if the urine is abnormally dark (brown), pain on the right side of the stomach (abdomen), fatigue, feeling less appetite than usual, or if you feel sick or vomit for no reason,&nbsp;<strong>tell your doctor immediately<\/strong>.<\/p>\n\n\n\n<p>If you experience any of these symptoms after starting Gilenya,&nbsp;<strong>tell your doctor immediately.<\/strong><\/p>\n\n\n\n<p>Before, during, and after treatment, your doctor will want to take blood samples to check your liver function.&nbsp;If the test results show problems with the liver, you may need to stop treatment with Gilenya.<\/p>\n\n\n\n<p>High&nbsp;blood pressure<\/p>\n\n\n\n<p>Because Gilenya causes a slight increase in&nbsp;blood pressure, your doctor may want to check your&nbsp;blood pressure&nbsp;at regular intervals.<\/p>\n\n\n\n<p>Pulmonary problems<\/p>\n\n\n\n<p>Gilenya has a small effect on lung function.&nbsp;Patients with severe lung problems or whooping cough may be at higher risk of developing&nbsp;side effects.<\/p>\n\n\n\n<p>Blood cell count<\/p>\n\n\n\n<p>The effect you want Gilenya to have is to reduce the number of&nbsp;white blood cells&nbsp;in the blood.&nbsp;This usually returns to normal within 2 months of stopping treatment.&nbsp;If you need to take blood samples, tell your doctor that you are taking Gilenya.&nbsp;Otherwise, the results of the test may be difficult to interpret and for some types of blood tests, your doctor may need to take more blood than normal.<\/p>\n\n\n\n<p>Before starting Gilenya, your doctor will confirm if you have enough&nbsp;white blood cells&nbsp;in&nbsp;your&nbsp;blood and may want to repeat a check-up at regular intervals.&nbsp;If you do not have enough&nbsp;white blood cells, you may need to stop taking Gilenya.<\/p>\n\n\n\n<p>Posterior reversible encephalopathy syndrome (PRES)<\/p>\n\n\n\n<p>A condition called posterior reversible encephalopathy syndrome (PRES) has been reported rarely in MS patients treated with Gilenya.&nbsp;The symptoms may be sudden onset of severe headache, confusion, seizures, and changes in vision.&nbsp;Tell your doctor immediately if you experience any of these symptoms during treatment with Gilenya, as it may be serious.<\/p>\n\n\n\n<p>Cancer<\/p>\n\n\n\n<p>Skin cancer has been reported in MS patients treated with Gilenya.&nbsp;Talk to your doctor immediately if you notice any skin nodules (eg shiny, pearlescent nodules), spots, or open wounds that do not heal within a few weeks.&nbsp;Symptoms of skin cancer may include abnormal growth or changes in skin tissue (such as unusual liver spots) with a change in color, shape, or size over time.&nbsp;Before you start taking Gilenya, a skin examination is necessary to check if you have any skin lumps.&nbsp;Your doctor will also perform regular skin examinations during treatment with Gilenya.&nbsp;If you have skin problems, your doctor may refer you to a dermatologist, who may decide after the examination that it is important for you to be examined at regular intervals.<\/p>\n\n\n\n<p>One type of cancer of the&nbsp;lymphatic system&nbsp;(&nbsp;lymphoma&nbsp;) has been reported in MS patients treated with Gilenya.<\/p>\n\n\n\n<p>Exposure to the sun and protection from the sun<\/p>\n\n\n\n<p>Fingolimod weakens your immune system.&nbsp;This increases the risk of developing cancer, especially skin cancer.&nbsp;You should limit your exposure to the sun and UV rays by:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>wear appropriate protective clothing.<\/li><li>regularly apply sunscreen with a high degree of UV protection.<\/li><\/ul>\n\n\n\n<p>Rare disease activity in isolated areas of the brain associated with MS&nbsp;relapses<\/p>\n\n\n\n<p>Rare cases of unusually high disease activity in isolated areas of the brain associated with MS&nbsp;relapses&nbsp;have been reported in patients treated with Gilenya.&nbsp;In case of severe&nbsp;relapse, your doctor will consider performing a magnetic resonance imaging (MRI) scan to evaluate this condition and determine if you need to stop taking Gilenya.<\/p>\n\n\n\n<p>Switching from other treatments to Gilenya<\/p>\n\n\n\n<p>Your doctor may change your treatment directly from beta-interferon, glatiramer acetate, or dimethyl fumarate to Gilenya if there are no signs of abnormalities caused by your previous treatment.&nbsp;Your doctor may need to take a blood test to rule out such abnormalities.&nbsp;After stopping treatment with natalizumab, you may need to wait 2-3 months before treatment with Gilenya.&nbsp;To switch from teriflunomide, your doctor may advise you to wait a certain amount of time or to undergo an accelerated elimination procedure.&nbsp;If you have been treated with alemtuzumab, a thorough evaluation and discussion with your doctor are required to determine if Gilenya is suitable for you.<\/p>\n\n\n\n<p>Women of&nbsp;childbearing&nbsp;age<\/p>\n\n\n\n<p>If used during pregnancy, Gilenya may harm the unborn baby.&nbsp;Before starting treatment with Gilenya, your doctor will explain the risk to you and ask you to take a pregnancy test to make sure you are not pregnant.&nbsp;Your doctor will give you a card explaining why you should not get pregnant while taking Gilenya.&nbsp;It also explains what to do to avoid getting pregnant while taking Gilenya.&nbsp;You must use an effective method of contraception during treatment and for 2 months after stopping treatment (see section \u201cPregnancy and breastfeeding\u201d).<\/p>\n\n\n\n<p>Exacerbation of MS after discontinuation of Gilenya<\/p>\n\n\n\n<p>Do not stop taking Gilenya or change the&nbsp;dose&nbsp;without talking to your doctor first.<\/p>\n\n\n\n<p>Tell your doctor immediately if you think your MS is getting worse after stopping treatment with Gilenya.&nbsp;This can be serious (see &#8220;If you stop taking Gilenya&#8221; in section 3 and also section 4, &#8220;Possible side effects&#8221;).<\/p>\n\n\n\n<p><strong>Older<\/strong><\/p>\n\n\n\n<p>Experience with Gilenya in elderly patients (over 65 years of age) is limited.&nbsp;Talk to your doctor if you have any questions.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Children and young people<\/h2>\n\n\n\n<p>Gilenya is not intended for use in children under 10 years of age as it has not been studied in MS patients in this age group.<\/p>\n\n\n\n<p>The warnings and precautions listed above also apply to children and adolescents.&nbsp;The following information is particularly important for children and adolescents and their caregivers:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Before you start taking Gilenya, your doctor will check your vaccination status.&nbsp;If you have not been given any vaccinations, it may be necessary for you to get them before starting treatment with Gilenya.<\/li><li>The first time you take Gilenya, or when you switch from a daily&nbsp;dose&nbsp;of 0.25 mg to a daily&nbsp;dose&nbsp;of 0.5 mg, your doctor will monitor your heart rate and heart rate (see \u201cSlow heart rate (&nbsp;bradycardia&nbsp;) and irregular heartbeat&nbsp;\u201d&nbsp;). \u201dAbove).<\/li><li>If you experience seizures or seizures before or while taking Gilenya, talk to your doctor.<\/li><li>If you suffer from depression or anxiety, or if you become depressed or anxious while taking Gilenya, talk to your doctor.&nbsp;You may need to be monitored more closely.<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Other medicines and Gilenya<\/h2>\n\n\n\n<p>Tell your doctor or pharmacist if you have recently taken or might take any other medicines.&nbsp;Tell your doctor if you are taking any of the following medicines:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Drugs that inhibit or modulate the immune system, including other medicines used to treat MS,<\/strong>&nbsp;such as beta-&nbsp;interferon&nbsp;, glatiramer acetate, natalizumab, mitoxantrone, teriflunomide, dimethylfumarate or alemtuzumab.&nbsp;You must not use Gilenya at the same time as such medicines as this may increase the effect on the immune system (see also \u201cDo not take Gilenya\u201d).<\/li><li><strong>Corticosteroid&nbsp;is<\/strong>&nbsp;, due to a possible additional effect on the immune system.<\/li><li><strong>Vaccines<\/strong>&nbsp;.&nbsp;If you need to be vaccinated, ask your doctor&#8217;s advice first.&nbsp;During and up to 2 months after treatment with Gilenya, you should not receive certain types of vaccines (live attenuated vaccines) as they may trigger the&nbsp;infection&nbsp;that they are intended to prevent.&nbsp;Other vaccines may not be as effective as normal if given during this period.<\/li><li><strong>Drugs that lower the heart rate<\/strong>&nbsp;(eg&nbsp;beta-blockers&nbsp;, such as atenolol).&nbsp;Using Gilenya with such medicines may increase the effect on your heart rate during the first days of treatment with Gilenya.<\/li><li><strong>Drugs for irregular heartbeat<\/strong>&nbsp;, such as&nbsp;quinidine&nbsp;,&nbsp;disopyramide&nbsp;,&nbsp;amiodarone&nbsp;or sotalol.&nbsp;You must not use Gilenya if you are taking such a medicine as it may increase the effect on irregular heartbeat (see also \u201cDo not take Gilenya\u201d).<\/li><li><strong>Other medicines:<\/strong><ul><li>protease inhibitors&nbsp;, anti-&nbsp;infective agents&nbsp;such as&nbsp;ketoconazole&nbsp;, azole antifungals, clarithromycin or telithromycin.<\/li><li>carbamazepine, rifampicin, phenobarbital,&nbsp;phenytoin&nbsp;, efavirenz or&nbsp;St. John&#8217;s wort&nbsp;(possible risk of reduced effect of Gilenya).<\/li><\/ul><\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Pregnancy and breastfeeding<\/h2>\n\n\n\n<p>If you are pregnant or breastfeeding, think you may be pregnant, or are planning to have a baby, ask your doctor for advice before using this medicine.<\/p>\n\n\n\n<p>Pregnancy<\/p>\n\n\n\n<p>Do not use Gilenya during pregnancy, if you are trying to conceive or if you are a woman who may become pregnant and you are not using an effective method of contraception.&nbsp;If Gilenya is used during pregnancy, there is a risk of harm to the unborn baby.&nbsp;The incidence of congenital malformations observed in infants exposed to Gilenya during pregnancy is approximately 2 times the frequency observed in the general population (in which the incidence of congenital malformations is approximately 2-3%).&nbsp;The most commonly reported malformations include heart, kidney, and musculoskeletal malformations.<\/p>\n\n\n\n<p>Therefore, if you are a woman of&nbsp;childbearing&nbsp;age:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Before starting treatment with Gilenya, your doctor will inform you about the risk of an unborn baby and ask you to take a pregnancy test to make sure you are not pregnant.<\/li><\/ul>\n\n\n\n<p>and,<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>you must use an effective method of contraception while taking Gilenya and for 2 months after you stop taking it to avoid getting pregnant.&nbsp;Talk to your doctor about reliable contraceptive methods.<\/li><\/ul>\n\n\n\n<p>Your doctor will give you a card explaining why you should not get pregnant while taking Gilenya.<\/p>\n\n\n\n<p><strong>If you become pregnant while taking Gilenya, tell your doctor immediately<\/strong>.&nbsp;Your doctor will decide to stop your treatment (see \u201cIf you stop taking Gilenya\u201d in section 3 and also section 4, \u201cPossible side effects\u201d).&nbsp;Specialized pregnancy tests will be performed.<\/p>\n\n\n\n<p>Breast-feeding<\/p>\n\n\n\n<p><strong>You should not breastfeed while taking Gilenya.&nbsp;<\/strong>Gilenya can pass into breast milk and there is a risk of serious&nbsp;side effects&nbsp;in the baby.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Driving and using machines<\/h2>\n\n\n\n<p>Your doctor will tell you if you can drive, cycle or use machines safely with your illness.&nbsp;Gilenya is not expected to affect your ability to drive or use machines.<\/p>\n\n\n\n<p>However, when starting treatment, you must stay at the doctor&#8217;s office or clinic for 6 hours after taking the first&nbsp;dose&nbsp;of Gilenya.&nbsp;Your driving ability and used machines may deteriorate during and possibly after this time period.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">How to take Gilenya<\/h2>\n\n\n\n<p>Treatment with Gilenya will be supervised by a doctor who has experience in the treatment of&nbsp;multiple sclerosis.<\/p>\n\n\n\n<p>Always take this medicine exactly as your doctor has told you.&nbsp;Consult a doctor if you are unsure.<\/p>\n\n\n\n<p>Recommended dose:<\/p>\n\n\n\n<p><strong>Adults:<\/strong><\/p>\n\n\n\n<p><strong>Dose&nbsp;one is one capsule 0.5 mg a day<\/strong>.<\/p>\n\n\n\n<p><strong>Children and adolescents (aged 10 years and older):<\/strong><\/p>\n\n\n\n<p><strong>Dose&nbsp;one depends on body weight:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><em>Children and adolescents with body weight equal to or less than 40 kg:<\/em>&nbsp;one 0.25 mg capsule per day.<\/li><li><em>Children and adolescents with body weight over 40 kg:<\/em>&nbsp;one 0.5 mg capsule per day.<\/li><\/ul>\n\n\n\n<p>Children and adolescents starting on a 0.25 mg capsule per day and later reaching a stable body weight over 40 kg will be instructed by their doctor to switch to a 0.5 mg capsule per day.&nbsp;In this case, it is recommended to repeat the observation time for the first&nbsp;dose.<\/p>\n\n\n\n<p>Do not take more than the recommended&nbsp;dose.<\/p>\n\n\n\n<p>Gilenya is for&nbsp;oral&nbsp;use.<\/p>\n\n\n\n<p>Take Gilenya once a day with a glass of water.&nbsp;Gilenya capsules should always be swallowed whole, without opening them.&nbsp;Gilenya can be taken with or without food.<\/p>\n\n\n\n<p>Taking Gilenya at the same time each day will make it easier to remember when to take the medicine.<\/p>\n\n\n\n<p>If you have any further questions on the use of Gilenya, ask your doctor or pharmacist.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">If you take more Gilenya than you should<\/h2>\n\n\n\n<p>If you take more Gilenya than you should, contact your doctor immediately.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">If you forget to take Gilenya<\/h2>\n\n\n\n<p>If you have been taking Gilenya for less than 1 month and you forget to take 1&nbsp;dose&nbsp;for a whole day, consult your doctor before taking the next&nbsp;dose.&nbsp;Your doctor may decide to keep you under observation when you take the next&nbsp;dose.<\/p>\n\n\n\n<p>If you have been taking Gilenya for at least 1 month and have forgotten to take your treatment for more than 2 weeks, consult your doctor before taking the next&nbsp;dose.&nbsp;Your doctor may decide to keep you under observation when you take the next&nbsp;dose.&nbsp;However, if you have forgotten to take your treatment for a maximum of 2 weeks, you can take the next&nbsp;dose&nbsp;as planned.<\/p>\n\n\n\n<p>Never take a double&nbsp;dose&nbsp;to make up for a forgotten&nbsp;dose.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">If you stop taking Gilenya<\/h2>\n\n\n\n<p>Do not stop taking Gilenya and do not change&nbsp;your&nbsp;dose&nbsp;without talking to your doctor first.<\/p>\n\n\n\n<p>Gilenya stays in the body for up to 2 months after stopping treatment.&nbsp;The number of&nbsp;white blood cells&nbsp;(lymphocyte count) may also remain low during this time and the&nbsp;side effects&nbsp;described in this leaflet may still occur.&nbsp;After you stop taking Gilenya, you may have to wait 6-8 weeks before starting a new MS treatment.<\/p>\n\n\n\n<p>If you need to resume medication with Gilenya more than 2 weeks after you stopped taking it, the effect on your heart rate that is normally seen at the start of treatment may reappear and you will need to be monitored at a doctor&#8217;s office or clinic to resume treatment.&nbsp;You should not start treatment with Gilenya, if it was stopped more than 2 weeks ago, without seeking advice from your doctor.<\/p>\n\n\n\n<p>Your doctor will decide if and how you need to be monitored after you stop taking Gilenya.<\/p>\n\n\n\n<p>Tell your doctor immediately if you think your MS has worsened after stopping treatment with Gilenya.&nbsp;It can be serious.<\/p>\n\n\n\n<p>If you have any further questions on the use of this product, ask your doctor or pharmacist.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">4. Possible side effects<\/h2>\n\n\n\n<p>Like all medicines, this medicine can cause&nbsp;side effects, although not everybody gets them.<\/p>\n\n\n\n<p>Some&nbsp;side effects&nbsp;may be or maybe serious<\/p>\n\n\n\n<p><strong>Common<\/strong>&nbsp;(may affect up to 1 in 10 people)<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Cough with mucus, chest discomfort, fever (signs of lung disease)<\/li><li>Herpes virus infection (&nbsp;shingles&nbsp;or&nbsp;herpes&nbsp;zoster) with symptoms such as blisters, burning,&nbsp;itching&nbsp;or pain in the skin, usually on the upper body or face.&nbsp;Other symptoms may include fever and weakness in the early stages of the infection, followed by numbness,&nbsp;itching&nbsp;or red spots with severe pain<\/li><li>Slow heartbeat (&nbsp;bradycardia&nbsp;), irregular heartbeat<\/li><li>A type of skin cancer called basal cell carcinoma (BCC) that often appears as a pearlescent nodule, but it can also take other forms.<\/li><li>Depression and anxiety have occurred with increasing frequency in the MS population and have also been reported in&nbsp;pediatric patients&nbsp;treated with Gilenya<\/li><li>Weight loss<\/li><\/ul>\n\n\n\n<p><strong>Uncommon<\/strong>&nbsp;(may affect up to 1 in 100 people)<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Pneumonia&nbsp;with symptoms such as fever, cough, difficulty breathing<\/li><li>Macular edema (swelling of the&nbsp;yellow spot&nbsp;on the retina at the back of the eye) with symptoms such as shadows or a blind spot in the middle of the&nbsp;visual field&nbsp;, blurred vision, difficulty seeing colors or details<\/li><li>Reduction in the number of&nbsp;platelets&nbsp;, which increases the risk of bleeding or bruising<\/li><li>Malignant&nbsp;melanoma&nbsp;(a type of skin cancer that usually develops from an unusual liver spot).&nbsp;Possible signs of&nbsp;melanoma&nbsp;include liver spots that can change size, shape, height or color over time or new liver spots.&nbsp;Liver spots may itch, bleed or become sore<\/li><li>Seizures, seizures (more common in children and adolescents than in adults)<\/li><\/ul>\n\n\n\n<p><strong>Rare<\/strong>&nbsp;(may affect up to 1 in 1,000 people)<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>A condition called posterior reversible encephalopathy syndrome (PRES).&nbsp;Symptoms may include sudden onset of severe headache, confusion, seizures and \/ or visual disturbances<\/li><li>Lymphoma&nbsp;(a type of cancer that affects the&nbsp;lymphatic system&nbsp;)<\/li><li>Squamous cell carcinoma: a type of skin cancer that can be shaped like a firm, small, red lump, a wound with a crust or a new wound on an existing scar<\/li><\/ul>\n\n\n\n<p><strong>Very rare<\/strong>&nbsp;(may affect up to 1 in 10,000 people)<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Abnormal&nbsp;ECG&nbsp;(T-wave inversion)<\/li><li>The tumor&nbsp;associated with&nbsp;infection&nbsp;by the human herpesvirus 8 (&nbsp;Kaposi&#8217;s sarcoma&nbsp;)<\/li><\/ul>\n\n\n\n<p><strong>No known frequency<\/strong>&nbsp;(can not be calculated from the available data)<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Allergic reactions, including symptoms of skin rash or itchy&nbsp;hives&nbsp;, swelling of the lips, tongue or face, which are more likely to occur on the day you start treatment with Gilenya.<\/li><li>Signs of liver disease (including liver failure), such as yellowing of the skin or whites of the eyes (jaundice), nausea or vomiting, pain on the right side of the abdomen (abdomen), dark urine (brown), feeling less appetite than usual, fatigue and abnormal liver function values.&nbsp;In a very small number of cases, liver failure can lead to liver transplantation.<\/li><li>Risk of a rare brain infection, called&nbsp;progressive&nbsp;multifocal&nbsp;leukoencephalopathy (PML).&nbsp;The symptoms of PML may be similar to an MS&nbsp;relapse&nbsp;.&nbsp;Symptoms may also occur that you may not be aware of yourself, such as changes in mood or behavior, memory problems, speech and communication difficulties, which your doctor may need to investigate further to rule out PML.&nbsp;Therefore, if you think that your MS is getting worse or if you or your relatives notice any new or unusual symptoms, it is very important that you talk to your doctor as soon as possible.<\/li><li>Cryptococcal infections (a type of fungal infection), including&nbsp;meningitis&nbsp;(&nbsp;cryptococcal meningitis&nbsp;) with symptoms such as headache accompanied by stiff neck, photosensitivity, nausea and \/ or confusion.<\/li><li>Merkel cell carcinoma (a type of skin cancer).&nbsp;Possible signs of Merkel cell carcinoma include flesh-colored or bluish-red, painless lump, often on the face, head or neck.&nbsp;Merkel cell carcinoma can also be designed as a firm, painless lump or mass.&nbsp;Prolonged exposure to the sun and a weak immune system can affect the risk of developing Merkel cell carcinoma.<\/li><li>After discontinuation of treatment with Gilenya, symptoms of MS may return and become worse than before or during treatment.<\/li><li>Autoimmune&nbsp;form of&nbsp;anemia&nbsp;(decreased amount of&nbsp;red blood cells&nbsp;) where&nbsp;red blood cells&nbsp;are destroyed (&nbsp;autoimmune&nbsp;hemolytic anemia&nbsp;).<\/li><\/ul>\n\n\n\n<p>If you experience any of these symptoms,&nbsp;<strong>tell your doctor immediately<\/strong>.<\/p>\n\n\n\n<p>Other&nbsp;side effects&nbsp;are<\/p>\n\n\n\n<p><strong>Very common<\/strong>&nbsp;(may affect more than 1 in 10 people)<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Infection&nbsp;caused by influenza virus with symptoms such as fatigue, chills, sore throat, joint or muscle aches, fever<\/li><li>Feeling of pressure or pain in the cheeks and forehead (sinusitis)<\/li><li>Headache<\/li><li>Diarrhea<\/li><li>Back pain<\/li><li>Blood tests show higher levels of liver enzymes<\/li><li>Cough<\/li><\/ul>\n\n\n\n<p><strong>Common<\/strong>&nbsp;(may affect up to 1 in 10 people)<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Ringworm&nbsp;, a fungal infection of the skin (&nbsp;tinea&nbsp;versicolor)<\/li><li>Dizziness<\/li><li>Severe headache often accompanied by nausea, vomiting and photosensitivity (&nbsp;migraine&nbsp;)<\/li><li>Low&nbsp;white blood cell count&nbsp;(&nbsp;lymphocytes&nbsp;,&nbsp;leukocytes&nbsp;)<\/li><li>Impotence<\/li><li>Itchy, red, itchy rash (&nbsp;eczema&nbsp;)<\/li><li>Itching<\/li><li>Increase in blood fat level (&nbsp;triglycerides&nbsp;)<\/li><li>Hair loss<\/li><li>Shortness of breath<\/li><li>Depression<\/li><li>Blurred vision (see also the section on macular edema under &#8220;Some&nbsp;side effects&nbsp;may be or may be serious&#8221;)<\/li><li>Hypertension&nbsp;(Gilenya may cause a slight increase in&nbsp;blood pressure&nbsp;)<\/li><li>Muscle aches<\/li><li>Joint pain<\/li><\/ul>\n\n\n\n<p><strong>Uncommon<\/strong>&nbsp;a (may affect up to 1 in 100 people)<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Low levels of certain&nbsp;white blood cells&nbsp;(&nbsp;neutrophils&nbsp;)<\/li><li>Depression<\/li><li>Nausea<\/li><\/ul>\n\n\n\n<p><strong>Rare<\/strong>&nbsp;(may affect up to 1 in 1,000 people)<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Cancer of the&nbsp;lymphatic system&nbsp;(&nbsp;lymphoma&nbsp;)<\/li><\/ul>\n\n\n\n<p><strong>No known frequency<\/strong>&nbsp;(can not be calculated from the available data)<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Peripheral&nbsp;swelling<\/li><\/ul>\n\n\n\n<p>If any of these&nbsp;side effects&nbsp;gets serious,&nbsp;<strong>or if you notice<\/strong>&nbsp;any&nbsp;side effects&nbsp;not listed in&nbsp;this&nbsp;leaflet,&nbsp;<strong>please tell your doctor.<\/strong><\/p>\n\n\n\n<p><em>Reporting of side effects<\/em><\/p>\n\n\n\n<p>If you get any side effects, talk to your doctor, pharmacist, or nurse.&nbsp;This also applies to any side effects not mentioned in this information.&nbsp;You can also report side effects directly to the Medical Products Agency.&nbsp;By reporting side effects, you can help increase drug safety information.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">5. How to store Gilenya<\/h2>\n\n\n\n<p>Keep this medicine out of the sight and reach of children.<\/p>\n\n\n\n<p>Do not use this medicine after the expiry date which is stated on the carton and blister after \u201cEXP\u201d.&nbsp;The expiration date is the last day of the specified month.<\/p>\n\n\n\n<p>Do not store above 25 \u00b0 C.<\/p>\n\n\n\n<p>Store in the original package.&nbsp;Moisture sensitive.<\/p>\n\n\n\n<p>Do not use this medicine if you notice that the packaging is damaged or shows signs of tampering.<\/p>\n\n\n\n<p>Medicines should not be disposed of via wastewater or household waste.&nbsp;Ask your pharmacist how to dispose of medicines no longer required.&nbsp;These measures will help to protect the environment.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">6. Contents of the packaging and other information<\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">Content declaration<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li>The active substance is fingolimod.<\/li><\/ul>\n\n\n\n<p>Gilenya 0.25 mg hard capsules<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Each capsule contains 0.25 mg of fingolimod (as hydrochloride).<\/li><li>Other ingredients are:<em>Capsule contents:<\/em>&nbsp;&nbsp;mannitol;&nbsp;hydroxypropylcellulose;&nbsp;hydroxypropyl betadex;&nbsp;magnesium stearate.<em>Capsule shell:<\/em>&nbsp;gelatin;&nbsp;titanium dioxide (E171);&nbsp;yellow iron oxide (E172).<em>Printing ink:<\/em>&nbsp;shellac (E904);&nbsp;black iron oxide (E172);&nbsp;propylene glycol (E1520);&nbsp;ammonia solution, concentrated (E527).<\/li><\/ul>\n\n\n\n<p>Gilenya 0.5 mg hard capsules<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Each capsule contains 0.5 mg of fingolimod (as hydrochloride).<\/li><li>Other ingredients are:<em>Capsule contents:<\/em>&nbsp;mannitol;&nbsp;magnesium stearate.<em>Capsule shell:<\/em>&nbsp;gelatin;&nbsp;titanium dioxide (E171);&nbsp;yellow iron oxide (E172).<em>Printing ink:<\/em>&nbsp;&nbsp;shellac (E904);&nbsp;ethanol&nbsp;, anhydrous;&nbsp;isopropyl alcohol;&nbsp;butyl alcohol;&nbsp;propylene glycol (E1520);&nbsp;purified water;&nbsp;ammonia solution, concentrated (E527);&nbsp;potassium hydroxide;&nbsp;black iron oxide (E172);&nbsp;yellow iron oxide (E172);&nbsp;titanium dioxide (E171);&nbsp;dimethicone.<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">What the medicine looks like and contents of the pack<\/h2>\n\n\n\n<p>Gilenya 0.25 mg hard capsules have an ivory-colored, opaque top and bottom.&nbsp;&#8220;FTY0.25 mg&#8221; is printed on the upper part with black color and a stripe is printed on the lower part with black color.<\/p>\n\n\n\n<p>Gilenya 0.5 mg hard capsules have a white opaque base and a clear yellow opaque top.&nbsp;&#8220;FTY0.5 mg&#8221; is printed on the upper part with black color and two stripes are printed on the lower part with yellow color.<\/p>\n\n\n\n<p>Gilenya 0.25 mg capsules are supplied in packs containing 7 or 28 capsules.&nbsp;Not all pack sizes may be marketed in your country.<\/p>\n\n\n\n<p>Gilenya 0.5 mg capsules are supplied in packs containing 7, 28 or 98 capsules or in multipacks containing 84 capsules (3 packs of 28 capsules).&nbsp;Not all pack sizes may be marketed in your country.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Marketing Authorization Holder and Manufacturer<\/h2>\n\n\n\n<p>Novartis Europharm Limited<\/p>\n\n\n\n<p>Vista Building<\/p>\n\n\n\n<p>Elm Park, Merrion Road<\/p>\n\n\n\n<p>Dublin 4<\/p>\n\n\n\n<p>Ireland<\/p>\n\n\n\n<p><strong>Manufacturer<\/strong><\/p>\n\n\n\n<p>Novartis Pharma GmbH<\/p>\n\n\n\n<p>Roonstrasse 25<\/p>\n\n\n\n<p>90429 Nuremberg<\/p>\n\n\n\n<p>Germany<\/p>\n\n\n\n<p>Contact the representative of the marketing authorization holder to find out more about this medicine:<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Belgium \/ Belgique \/ Belgien<\/strong>Novartis Pharma NVTel: +32 2 246 16 11<\/td><td><strong>Lithuania<\/strong>SIA Novartis Baltics Lithuanian branchesTel: +370 5 269 16 50<\/td><\/tr><tr><td><strong>Bulgaria<\/strong>Novartis Bulgaria EOODTel .: +359 2 489 98 28<\/td><td><strong>Luxembourg \/ Luxemburg<\/strong>Novartis Pharma NVTel: +32 2 246 16 11<\/td><\/tr><tr><td><strong>Czech Republic<\/strong>Novartis sroTel: +420 225 775 111<\/td><td><strong>Hungary<\/strong>Novartis Hungary Kft.Tel .: +36 1 457 65 00<\/td><\/tr><tr><td><strong>Denmark<\/strong>Novartis Healthcare A \/ STel: +45 39 16 84 00<\/td><td><strong>Malta<\/strong>Novartis Pharma Services Inc.Tel: +356 2122 2872<\/td><\/tr><tr><td><strong>Germany<\/strong>Novartis Pharma GmbHTel: +49 911 273 0<\/td><td><strong>The Netherlands<\/strong>Novartis Pharma BVTel: +31 88 04 52 111<\/td><\/tr><tr><td><strong>Eesti<\/strong>SIA Novartis Baltics Eesti subsidiaryTel: +372 66 30 810<\/td><td><strong>Norway<\/strong>Novartis Norge ASTel: +47 23 05 20 00<\/td><\/tr><tr><td><strong>Greece<\/strong>Novartis (Hellas) AEBE:\u0397\u03bb: +30 210 281 17 12<\/td><td><strong>Austria<\/strong>Novartis Pharma GmbHTel: +43 1 86 6570<\/td><\/tr><tr><td><strong>Spain<\/strong>Novartis Pharmac\u00e9utica, SATel: +34 93 306 42 00<\/td><td><strong>Poland<\/strong>Novartis Poland Sp.&nbsp;z ooTel .: +48 22 375 4888<\/td><\/tr><tr><td><strong>France<\/strong>Novartis Pharma SASTel: +33 1 55 47 66 00<\/td><td><strong>Portugal<\/strong>Novartis Pharma-Pharmaceutical Products, SATel: +351 21 000 8600<\/td><\/tr><tr><td><strong>Croatia<\/strong>Novartis Hrvatska dooTel.&nbsp;+385 1 6274220<\/td><td><strong>Romania<\/strong>Novartis Pharma Services Romania SRLTel: +40 21 31299 01<\/td><\/tr><tr><td><strong>Ireland<\/strong>Novartis Ireland LimitedTel: +353 1 260 12 55<\/td><td><strong>Slovenia<\/strong>Novartis Pharma Services Inc.Tel: +386 1 300 75 50<\/td><\/tr><tr><td><strong>Iceland<\/strong>Vistor hf.Phone: +354 535 7000<\/td><td><strong>Slovak Republic<\/strong>Novartis Slovakia sroTel: +421 2 5542 5439<\/td><\/tr><tr><td><strong>Italy<\/strong>Novartis Farma SpATel: +39 02 96 54 1<\/td><td><strong>Finland \/ Finland<\/strong>Novartis Finland OyPuh \/ Tel: +358 (0) 10 6133 200<\/td><\/tr><tr><td><strong>\u039a\u03cd\u03c0\u03c1\u03bf\u03c2<\/strong>Novartis Pharma Services Inc.:\u0397\u03bb: +357 22 690 690<\/td><td><strong>Sweden<\/strong>Novartis Sverige ABTel: +46 8 732 32 00<\/td><\/tr><tr><td><strong>Latvia<\/strong>SIA Novartis BalticsTel: +371 67 887 070<\/td><td><strong>United Kingdom (Northern Ireland)<\/strong>Novartis Ireland LimitedTel: +44 1276 698370<\/td><\/tr><\/tbody><\/table><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>Gilenya contains the active substance fingolimod.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"cybocfi_hide_featured_image":"","footnotes":""},"categories":[2200,2207],"tags":[14470,14475,14467,14471,14472,14476,14469,14474,14468,14473],"class_list":["post-13407","post","type-post","status-publish","format-standard","hentry","category-medicines","category-g","tag-benefits-of-fingolimod","tag-benefits-of-gilenya","tag-fingolimod","tag-fingolimod-side-effects","tag-gilenya","tag-gilenya-side-effects","tag-what-fingolimod-is-used-for","tag-what-gilenya-is-used-for","tag-what-is-fingolimod","tag-what-is-gilenya"],"_links":{"self":[{"href":"https:\/\/zeepedia.com\/medical\/wp-json\/wp\/v2\/posts\/13407","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/zeepedia.com\/medical\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/zeepedia.com\/medical\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/zeepedia.com\/medical\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/zeepedia.com\/medical\/wp-json\/wp\/v2\/comments?post=13407"}],"version-history":[{"count":5,"href":"https:\/\/zeepedia.com\/medical\/wp-json\/wp\/v2\/posts\/13407\/revisions"}],"predecessor-version":[{"id":15516,"href":"https:\/\/zeepedia.com\/medical\/wp-json\/wp\/v2\/posts\/13407\/revisions\/15516"}],"wp:attachment":[{"href":"https:\/\/zeepedia.com\/medical\/wp-json\/wp\/v2\/media?parent=13407"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/zeepedia.com\/medical\/wp-json\/wp\/v2\/categories?post=13407"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/zeepedia.com\/medical\/wp-json\/wp\/v2\/tags?post=13407"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}