Zeposia (Ozanimod) for Multiple Sclerosis

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Zeposia (ozanimod) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) to treat adults with relapsing forms of multiple sclerosis (MS).

What Members Say

MHT logo These insights are based on 467 comments about Zeposia from MyMSTeam members. These are the experiences of a small number of people and are not meant to be medical advice.

Benefits:

Once-daily capsules feel easier than injections or infusions.
Some notice small improvements in walking, balance, or energy.
Some describe fewer relapses or more stable symptoms over time.

Considerations:

Liver enzyme increases can happen and need blood test monitoring.
Low lymphocyte or white blood cell counts can require closer monitoring.
Heart rate slowing can happen when treatment starts.

How Zeposia Works and How It’s Taken

Zeposia is a type of medication called a sphingosine 1-phosphate receptor modulator. It works by trapping certain white blood cells, called lymphocytes, in the lymph nodes. This lowers the number of these cells in the blood.

This may help reduce how many immune cells reach the brain and spinal cord.

Doctors prescribe Zeposia for adults with relapsing forms of multiple sclerosis. This includes clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease. By targeting this pathway, the medication may help manage symptoms and slow disease activity.

Zeposia comes as a capsule that you take by mouth. Treatment starts with a seven-day starter schedule. After that, it is taken once a day.

Typical Dosing for Multiple Sclerosis

The recommended starting dose of Zeposia for multiple sclerosis:

Days 1 to 4 — Take 0.23 milligrams once daily.
Days 5 to 7 — Take 0.46 milligrams once daily.
Day 8 and after — Take 0.92 milligrams once daily.

For people with mild or moderate liver problems:

Use the same seven-day starter schedule.
Then take 0.92 milligrams every other day starting on day 8.

This information is based on prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Top Advice From Members on Zeposia

These insights are based on 467 comments about Zeposia from MyMSTeam members.

Members who use Zeposia often say it helps to stay in close contact with their neurology team, especially when symptoms change, side effects show up, or lab results shift. Many also mention practical issues like giving the medication time, keeping up with testing, and getting help with insurance or copay costs.

1

Keep track of side effects and tell your doctor about them.
“The Zeposia raised my blood pressure so high that it felt like my heart was going to jump out of my chest!”
2

Ask about copay help or financial assistance if cost is a problem.
“Zeposia has a financial assistance portal. I filled out their form and qualified for assistance to get it free.”
3

Ask your doctor about lab changes while you’re taking Zeposia.
“I started Zeposia in February, been four months and it has been GREAT. Took blood test and my WBC is depleted.”

Zeposia Side Effects

In clinical studies of Zeposia for relapsing forms of multiple sclerosis in adults, the most common side effects occurred in about 4 percent to 26 percent of people. These include:

Upper respiratory infection (like a cold)
Liver enzyme increases (changes in liver blood tests)
Orthostatic hypotension (drop in blood pressure when standing up)
Urinary tract infection
Back pain
High blood pressure

Serious Side Effects and Warnings

Zeposia can cause serious side effects that require immediate medical attention. These include:

Serious infections — Zeposia can lower certain white blood cells, which can make it easier to get infections, including rare, life-threatening infections.
Progressive multifocal leukoencephalopathy (PML) — This is a rare brain infection that can lead to severe disability or death.
Reduction in heart rate — Heart rate may slow, especially when starting Zeposia.
Atrioventricular conduction delays — These are heart rhythm or conduction problems.
Liver injury — This can be serious, including liver failure.
Fetal harm — Zeposia may harm your baby if you are pregnant.
Increased blood pressure — Blood pressure may rise during treatment.
Respiratory problems — Lung function may decrease, which can cause new or worsening shortness of breath.
Macular edema — Swelling in the back of the eye can affect vision.
Cutaneous malignancies — These are skin cancers, including basal cell carcinoma, squamous cell carcinoma, and melanoma.
Posterior reversible encephalopathy syndrome (PRES) — This is a rare brain condition that can cause severe headache, confusion, vision changes, or seizures.
Severe worsening of multiple sclerosis after stopping Zeposia — Rare rebound worsening of MS symptoms can happen.

Get medical help right away if you think you are having a serious reaction.

How To Save on Zeposia

Bristol Myers Squibb, the manufacturer of Zeposia, offers the Zeposia Co-Pay Program. Eligible people with commercial insurance may pay as little as $0 per 30-day supply.

The Zeposia 360 Support program also provides help from a Support Coordinator, including assistance with navigating insurance benefits, exploring savings options, and managing delays or coverage issues for eligible, commercially insured people. It can also help coordinate routine tests needed before starting Zeposia for eligible, commercially insured people. To learn more, visit the Zeposia 360 Support program, or call 833-937-6742.

What To Know Before Taking Zeposia

Before starting Zeposia, your doctor will test or check for:

A heart rhythm test (ECG)
A complete blood count, including your lymphocyte count
Liver blood tests (transaminases and bilirubin)
An eye exam of the back of the eye, including the macula
A skin exam
Your current or past medicines, including medicines that affect your immune system or slow your heart rate
Whether you need a chickenpox virus test or vaccine

You should not get live vaccines during Zeposia treatment, for at least one month before starting Zeposia, or for three months after stopping it.

Tell your doctor if you have any allergies to ozanimod or any ingredients in Zeposia.

Tell your doctor about all medicines you take, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements.

Also tell your doctor if you have or have had:

An infection or fever
Slow or irregular heartbeat
Heart problems, including heart attack or chest pain
History of stroke
High blood pressure
Liver problems
Breathing problems, including sleep apnea
Diabetes
Eye inflammation
Skin cancer, including basal cell carcinoma, melanoma, or squamous cell carcinoma

Do not take Zeposia if you had a heart attack, unstable angina, stroke, mini-stroke, or certain types of heart failure in the last six months. Do not take it if you have certain heart rhythm problems unless you have a working pacemaker. Do not take it if you have severe untreated sleep apnea or take a monoamine oxidase (MAO) inhibitor.

Zeposia is also FDA approved to treat adults with moderately to severely active ulcerative colitis.

If you miss a dose during the first two weeks of treatment, you will need to restart the seven-day starter schedule. If you miss a dose after the first two weeks, continue as planned.

If you are pregnant, planning to become pregnant, or breastfeeding while taking Zeposia, talk with your doctor about the risks and benefits.

If you can become pregnant, use effective birth control during treatment and for three months after stopping Zeposia. A pregnancy registry is available for women with multiple sclerosis who become pregnant while taking Zeposia. To learn more, visit the Zeposia Pregnancy Registry, or call 877-301-9314.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is Zeposia?
In two studies of adults with relapsing forms of multiple sclerosis, Zeposia lowered yearly relapse rates compared with interferon beta-1a.

In the first study, the yearly relapse rate was 0.181 with Zeposia and 0.350 with interferon beta-1a. This was a 48 percent relative reduction.

In the second study, the yearly relapse rate was 0.172 with Zeposia and 0.276 with interferon beta-1a. This was a 38 percent relative reduction.

Zeposia also lowered the number of new or growing brain lesions seen on MRI. It reduced these lesions by 48 percent in the first study and 42 percent in the second study. Zeposia also reduced gadolinium-enhancing lesions by 63 percent and 53 percent in the two studies.

Zeposia did not show a statistically significant difference in confirmed disability progression over three or six months.

How long does Zeposia take to work for multiple sclerosis?
Studies of Zeposia looked at relapse rates and MRI changes over time. These studies did not report exactly when people may start to feel better after starting Zeposia. Zeposia lowers certain white blood cells, called lymphocytes, to about 45 percent of their starting level by about three months.

It is not known exactly when symptom changes may occur.

What tests or monitoring are needed with Zeposia for multiple sclerosis?
Before starting Zeposia, your doctor will perform:

A test of your heart called an ECG
A blood test called a complete blood count, including lymphocyte levels
Liver blood tests
An eye exam, including the back of the eye (macula)
A skin exam
An assessment for whether you need chickenpox testing (varicella-zoster virus)

During treatment, your doctor will:

Check your blood pressure.
Monitor for signs of infection during treatment and for three months after stopping.
Check liver blood tests during treatment and for up to two months after stopping.
Repeat eye exams during treatment and any time you have vision changes.
Check your lung function, if needed.