By, Lisa Laing, RN, BSN & Carrie Sammarco, DNP, FNP-C, MSCN



Starting Tecfidera as treatment for relapsing forms of multiple sclerosis (MS) can be difficult. Dr. Carrie Sammarco and RN Lisa Laing, who both work at the Multiple Sclerosis Comprehensive Care Center of New York University (NYU) Langone Medical Center in Manhattan, share their best timing and diet tips to avoid side effects.

Tecfidera (Dimethyl fumarate) is an oral medication approved for the treatment of relapsing forms of MS. The most common side effects are flushing (a temporary redness of the skin) and gastrointestinal (GI) symptoms such as diarrhea, nausea, and stomach pain. For most patients, these side effects are mild or moderate in severity and lessen after the first month of treatment. Some people experience more intense and longer-lasting symptoms, which can make tolerating the medication a challenge. Ultimately, no medication is going to be effective if someone is unable to take it as prescribed. We came up with tips and suggestions to help our patients tolerate Tecfidera better.

When starting Tecfidera, one receives two bottles in the mail. The smaller bottle is the starter pack containing 14 green and white capsules of 120 milligrams each and a larger bottle containing 46 green capsules of 240 mg each. The directions tell you to take a 120 milligram-capsule twice a day for seven days, then start the maintenance dose of 240 milligrams twice a day. We found that some patients have less side effects if they slow down the titration, so we suggest that patients follow this schedule.

In addition, we suggest a minimum of eight hours between doses. Most importantly, we stress the benefit of taking the medication with food that contains healthy fats. Below are some suggestions.

Healthy Fats
The following is a guide to incorporating healthy fats into your diet.

Good fats to choose are monounsaturated fat and polyunsaturated fat. These healthy fats may reduce your risk for some types of heart disease and improve insulin levels and blood sugar control. Below are some examples of foods containing these fats.



A good rule of thumb is that good fats (monounsaturated and polyunsaturated fats) tend to be liquid at room temperature.

Unhealthy fats are saturated fats and trans fats. You should avoid saturated fats and trans fats because they increase your risk of disease and elevate cholesterol. Unlike healthy fats, these fats tend to be solid at room temperature. Below are examples of foods which contain bad fats.

Of course, prior to making changes to your medication regimen or diet, you should have a conversation with your doctor or nurse. Ideally, before you start any medication, it is helpful to know what to expect in term of side effects and tips for best managing those side effects. Your nurse is an ideal person to discuss this with you.

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Carrie Lyn Sammarco, DrNP, FNP-C, MSCN is a nurse practitioner at the Multiple Sclerosis Comprehensive Care Center of New York University (NYU) Langone Medical Center in Manhattan. She serves as principal investigator for several nursing-generated research projects at the NYU MS Center. Dr. Sammarco is co–author of Multiple Sclerosis: The Nurse Practitioner’s Handbook (2013 edition), which was sponsored by the National MS Society and is available in print and online. Published in peer review journals as an author and co-author, Dr. Sammarco has been an invited speaker at university programs and the American Academy of Nurse Practitioners. She has been a speaker and member of the planning committee for the annual Janet Pearce MS Nurse Education Program sponsored by the National MS Society and Advances in MS Research & Practice at the NY Academy of Science in NYC. In addition, she has served as annual co-host for The Nurse Practitioner Show: MS – Comprehensive Care & Management on Sirius XM.

Carrie Sammarco serves as a consultant and speaker for Biogen, the manufacturer of Tecfidera® (dimethyl fumarate). However, the information provided on this page is Carrie’s independent work – Biogen has not contributed to, has not studied, and does not endorse this research.

Lisa Laing, RN, BSN, MSCN is a Senior Nurse Clinician at the Multiple Sclerosis Comprehensive Care Center of New York University (NYU) Langone Medical Center in Manhattan. In 19 years at this position, she has assisted patients with MS with side effect management, education, case management, and the development of and participation in research projects. She has been published in peer review journals and has been a member of the planning committee and a speaker for the Janet Pearce MS Nurse Education Program sponsored by the National MS Society. She has lectured at the College of Staten Island, The National MS Society, the NYU Nurse Practitioner Research Symposium, and been a guest on the The Nurse Practitioner Show: MS – Comprehensive Care & Management on Sirius XM.