Dimethyl Fumarate G.L. Pharma
Oral immunomodulator for relapsing-remitting multiple sclerosis
Dimethyl fumarate G.L. Pharma is a prescription oral immunomodulator used to treat relapsing-remitting multiple sclerosis (RRMS) in adults. It works by activating the Nrf2 antioxidant pathway and modulating immune cell activity to reduce the frequency of relapses, slow disability progression, and decrease the formation of new brain lesions. This medicine is a generic formulation of the original dimethyl fumarate product and contains the same active ingredient at identical strengths.
Quick Facts
Key Takeaways
- Dimethyl fumarate G.L. Pharma is an oral disease-modifying therapy for relapsing-remitting multiple sclerosis (RRMS) in adults, taken as gastro-resistant capsules twice daily.
- The starting dose is 120 mg twice daily for one week, then 240 mg twice daily as maintenance; always take with food to reduce flushing and stomach upset.
- Regular blood count monitoring is essential because dimethyl fumarate can lower lymphocyte counts, which increases the risk of infections including the rare but serious brain infection PML.
- The most common side effects are flushing and gastrointestinal symptoms; these usually decrease within the first month of treatment.
- This medicine should not be used during pregnancy; women of childbearing potential must use effective contraception during treatment and for at least 4 weeks after stopping.
What Is Dimethyl Fumarate G.L. Pharma and What Is It Used For?
Dimethyl fumarate G.L. Pharma belongs to a class of drugs known as immunomodulators. It is specifically approved for the treatment of adult patients with relapsing-remitting multiple sclerosis (RRMS), the most common form of multiple sclerosis (MS). This generic formulation, produced by G.L. Pharma, contains the same active ingredient and therapeutic profile as the original branded product, offering patients an equivalent treatment option.
Multiple sclerosis is a chronic autoimmune disease in which the immune system mistakenly attacks the protective myelin sheath that covers nerve fibers in the brain and spinal cord. This damage disrupts the normal flow of electrical impulses along the nerves, leading to a wide range of neurological symptoms. In the relapsing-remitting form, patients experience periods of new or worsening symptoms (relapses) followed by periods of partial or complete recovery (remissions).
The active substance, dimethyl fumarate, works through a dual mechanism of action. Firstly, it activates the nuclear factor (erythroid-derived 2)-like 2 (Nrf2) antioxidant response pathway, which upregulates the expression of cytoprotective genes that protect nerve cells from oxidative stress and inflammatory damage. Secondly, it modulates the immune system by shifting T-cell populations from pro-inflammatory Th1 and Th17 profiles toward anti-inflammatory Th2 responses, reducing the immune-mediated attack on myelin.
Clinical trials have demonstrated that dimethyl fumarate significantly reduces the annualized relapse rate by approximately 44–53% compared with placebo, decreases the risk of sustained disability progression by about 38%, and reduces the number of new or newly enlarging T2-hyperintense lesions on MRI by approximately 71–85%. These efficacy results were established in the landmark DEFINE and CONFIRM pivotal Phase III trials involving over 2,600 patients with RRMS.
After oral administration, dimethyl fumarate is rapidly and extensively converted by esterases in the gastrointestinal tract to its primary active metabolite, monomethyl fumarate (MMF). MMF is responsible for the pharmacological activity of the drug. Peak plasma concentrations of MMF are typically reached within 2 to 2.5 hours. The terminal half-life is approximately 1 hour, and the drug is primarily eliminated through exhalation of carbon dioxide (CO2), with only a small amount excreted by the kidneys.
What Should You Know Before Taking Dimethyl Fumarate G.L. Pharma?
Several important medical considerations apply before initiating treatment with dimethyl fumarate G.L. Pharma. Your prescribing neurologist will conduct a thorough medical evaluation, including blood tests and a review of your current medications, to determine whether this treatment is appropriate for you. It is crucial that you provide your doctor with a complete medical history and disclose all medicines, supplements, and herbal products you are currently taking.
Contraindications
Dimethyl fumarate G.L. Pharma must not be used in the following situations:
- Hypersensitivity: If you are allergic to dimethyl fumarate or any of the other ingredients in this medicine. Allergic reactions can include symptoms such as difficulty breathing, hives, swelling of the face, lips, tongue, or throat.
- Suspected or confirmed progressive multifocal leukoencephalopathy (PML): Patients with suspected or confirmed PML must not begin or continue treatment with dimethyl fumarate.
Warnings and Precautions
Speak with your doctor or pharmacist before taking dimethyl fumarate G.L. Pharma if any of the following apply to you:
- Lymphopenia: Dimethyl fumarate may cause a significant and sustained decrease in lymphocyte counts. A complete blood count (CBC) including lymphocyte count must be obtained before starting treatment, at 3-month intervals during treatment, and as clinically indicated. Treatment should be interrupted if lymphocyte counts fall below 0.5 × 109/L for more than 6 months.
- Progressive multifocal leukoencephalopathy (PML): Cases of PML, a rare but potentially fatal opportunistic brain infection caused by the JC virus, have been reported in patients taking dimethyl fumarate who had prolonged moderate to severe lymphopenia. If PML is suspected, dimethyl fumarate must be withheld immediately and appropriate diagnostic evaluation performed.
- Severe active gastrointestinal disease: Use with caution in patients with active gastritis, gastric ulcers, or inflammatory bowel disease, as the medicine may worsen gastrointestinal symptoms.
- Liver injury: Clinically significant cases of liver injury have been reported. Serum aminotransferase, alkaline phosphatase, and total bilirubin levels should be checked before starting treatment and during treatment as clinically indicated.
- Renal impairment: Cases of Fanconi syndrome (a disorder of renal tubular function) have been reported during post-marketing use. Kidney function should be assessed before initiating treatment and monitored periodically.
- Severe active infections: Initiation of treatment should be delayed until active infections have resolved. If a patient develops a serious infection during treatment, consideration should be given to suspending treatment until the infection resolves.
- Flushing: Flushing is a very common side effect. Taking the medicine with food and a gradual dose titration at the start of treatment can reduce the incidence and severity. Acetylsalicylic acid (aspirin) 325 mg taken 30 minutes before dosing may also help reduce flushing in the early weeks of treatment.
Dimethyl fumarate can cause lymphopenia (low white blood cell count), which increases the risk of infections including progressive multifocal leukoencephalopathy (PML), a rare but serious and potentially fatal brain infection. Regular blood count monitoring is mandatory. Report any new or worsening neurological symptoms to your doctor immediately.
Pregnancy and Breastfeeding
Dimethyl fumarate G.L. Pharma is not recommended during pregnancy. Animal studies have shown adverse effects on fetal development, including decreased fetal body weight and delayed ossification at doses associated with maternal toxicity. There is limited data from human pregnancies. Women of childbearing potential should use effective contraception during treatment and for at least 4 weeks after stopping dimethyl fumarate.
If a patient becomes pregnant while taking this medicine, treatment should be discontinued promptly and the patient should be referred to a neurologist to discuss alternative treatment options and the potential risks to the fetus. Pregnancy registries exist to monitor outcomes in women inadvertently exposed to dimethyl fumarate during pregnancy.
It is not known whether dimethyl fumarate or its metabolites are excreted in human breast milk. A risk to the breastfed infant cannot be excluded. A decision must be made whether to discontinue breastfeeding or to discontinue the therapy, taking into account the benefit of breastfeeding for the child and the benefit of therapy for the mother.
Driving and Using Machines
Dimethyl fumarate G.L. Pharma is not expected to significantly affect the ability to drive or use machines. However, no studies on the effects on driving ability have been conducted. Patients who experience dizziness or other neurological symptoms during treatment should exercise caution when driving or operating machinery until the symptoms resolve.
How Does Dimethyl Fumarate G.L. Pharma Interact with Other Drugs?
Although no formal drug–drug interaction studies have been conducted with dimethyl fumarate G.L. Pharma in humans, certain combinations require special attention due to theoretical pharmacological interactions and post-marketing observations. Because dimethyl fumarate is rapidly converted to monomethyl fumarate (MMF) in the gut and does not undergo significant cytochrome P450-mediated metabolism, direct pharmacokinetic interactions are considered unlikely. However, pharmacodynamic interactions related to immune system modulation are clinically significant.
Concurrent use of dimethyl fumarate with other disease-modifying therapies for MS (such as fingolimod, natalizumab, teriflunomide, or other immunosuppressants) has not been studied in clinical trials and is generally not recommended. Combining immunosuppressive agents can lead to additive or synergistic suppression of the immune system, increasing the risk of infections, including opportunistic infections and PML.
When switching from another MS therapy to dimethyl fumarate, or vice versa, a washout period may be required depending on the previous treatment’s mechanism and duration of action. Your neurologist will determine the appropriate washout period based on the specific drug involved and your current lymphocyte counts.
Major Interactions
| Drug / Drug Class | Interaction Type | Clinical Significance |
|---|---|---|
| Other immunosuppressants (e.g., azathioprine, methotrexate, cyclosporine) | Additive immunosuppression | Increased risk of severe lymphopenia, infections, and PML. Concomitant use is not recommended. |
| Other MS disease-modifying therapies (e.g., fingolimod, natalizumab, teriflunomide, ocrelizumab) | Additive immunomodulation | Risk of compounded immune suppression. Combination use has not been studied and should be avoided. |
| Live vaccines (e.g., MMR, varicella, BCG, yellow fever) | Reduced vaccine efficacy / risk of vaccine-associated infection | Live vaccines should be avoided during treatment and for at least 4 weeks after discontinuation. Inactivated vaccines can be administered. |
| Nephrotoxic drugs (e.g., aminoglycosides, NSAIDs, contrast agents) | Additive nephrotoxicity | May increase the risk of renal adverse effects including Fanconi syndrome. Monitor kidney function closely if co-administration is necessary. |
Minor Interactions
| Drug / Drug Class | Interaction Type | Clinical Significance |
|---|---|---|
| Acetylsalicylic acid (aspirin) | Beneficial co-administration | Non-enteric-coated aspirin (325 mg) taken 30 minutes before dimethyl fumarate may reduce flushing severity. Considered safe for short-term use. |
| Oral contraceptives | No significant interaction expected | Dimethyl fumarate has not been shown to affect the efficacy of oral contraceptives. Contraception should be maintained during treatment. |
| Inactivated vaccines (e.g., influenza, pneumococcal, COVID-19 mRNA) | Potentially reduced immune response | Inactivated vaccines may be administered; however, immune response may be diminished in patients with lymphopenia. Vaccination before starting treatment is preferred where possible. |
| Gastro-resistant coating-affecting drugs (e.g., high-dose antacids, proton pump inhibitors) | Potential altered drug release | Theoretical concern that drugs significantly altering gastric pH could affect the dissolution of the gastro-resistant capsule. Clinical significance is likely minimal, but no formal studies have been conducted. |
When transitioning between MS disease-modifying therapies, appropriate washout periods are essential to avoid overlapping immunosuppression. The duration of the washout period depends on the previous drug’s half-life and duration of pharmacodynamic effect. Your neurologist will provide specific guidance based on your individual treatment history and current immune status.
What Is the Correct Dosage of Dimethyl Fumarate G.L. Pharma?
The dosage of dimethyl fumarate G.L. Pharma follows a titration schedule designed to minimize initial gastrointestinal and flushing side effects. Treatment should be initiated and supervised by a physician experienced in the management of multiple sclerosis. Adherence to the recommended dosing schedule and the practice of taking capsules with food are crucial for tolerability and treatment success.
Adults
Starting Dose (Week 1)
120 mg (one capsule) taken twice daily – once in the morning and once in the evening, with food. This initial lower dose helps your body adjust to the medication and reduces the likelihood of flushing and gastrointestinal discomfort.
Maintenance Dose (Week 2 onwards)
240 mg (one capsule) taken twice daily – once in the morning and once in the evening, with food. This is the recommended maintenance dose for long-term treatment. The total daily dose is 480 mg.
A temporary dose reduction to 120 mg twice daily may be considered in patients who experience persistent flushing or gastrointestinal adverse events. The full maintenance dose of 240 mg twice daily should be resumed within 4 weeks. If the patient cannot tolerate the return to the maintenance dose, discontinuation of treatment should be considered.
| Patient Group | Starting Dose | Maintenance Dose | Notes |
|---|---|---|---|
| Adults (18+ years) | 120 mg twice daily for 7 days | 240 mg twice daily | Take with food. Swallow whole. |
| Elderly (65+ years) | 120 mg twice daily for 7 days | 240 mg twice daily | No dose adjustment required. Limited data in patients over 55. Monitor renal and hepatic function. |
| Children and adolescents (<18 years) | Not established | Not established | Safety and efficacy have not been established in pediatric patients. Use is not recommended. |
| Renal impairment | Standard dosing | Standard dosing | No dose adjustment needed. Monitor renal function periodically. Use with caution in severe impairment. |
| Hepatic impairment | Standard dosing | Standard dosing | No dose adjustment needed. Dimethyl fumarate is not metabolized via the liver’s cytochrome P450 system. |
Children
The safety and efficacy of dimethyl fumarate in children and adolescents below 18 years of age have not been established. No data are available, and therefore this medicine should not be used in this age group. Clinical trials to evaluate the use of fumarate compounds in pediatric MS populations are ongoing, but no approved pediatric dosing has been determined at this time.
Elderly
Clinical trials of dimethyl fumarate did not include sufficient numbers of patients aged 55 and older to determine whether they respond differently from younger patients. No dose adjustment is required based on age alone. However, given the age-related decline in renal and hepatic function, along with the higher likelihood of concomitant diseases and other drug therapies in elderly patients, cautious dosing and more frequent monitoring of kidney function, liver enzymes, and complete blood counts may be prudent.
Missed Dose
If you miss a dose, take it as soon as you remember. However, if it is almost time for your next scheduled dose, skip the missed dose and take the next dose at the regular time. Do not take a double dose to make up for a forgotten capsule. If you miss multiple doses and are unsure how to resume your dosing schedule, contact your neurologist or pharmacist for guidance.
Overdose
There is limited clinical experience with overdose of dimethyl fumarate. In the event of an overdose, symptoms are likely to include an exacerbation of the known adverse effects, particularly flushing, gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal pain), headache, and tachycardia. There is no specific antidote for dimethyl fumarate. Treatment should be symptomatic and supportive, including monitoring of vital signs and observation of the clinical status of the patient. Contact your local poison control center or seek emergency medical attention immediately if you suspect an overdose.
Always take dimethyl fumarate with food (preferably a substantial meal). This significantly reduces flushing and GI side effects. Taking non-enteric-coated aspirin (325 mg) 30 minutes before dosing during the first few weeks may also help reduce flushing. Never open, crush, or chew the capsules, as the gastro-resistant coating is designed to minimize stomach irritation.
What Are the Side Effects of Dimethyl Fumarate G.L. Pharma?
Like all medicines, dimethyl fumarate G.L. Pharma can cause side effects, although not everybody gets them. The most frequently reported adverse reactions in clinical trials were flushing and gastrointestinal events, which typically occurred during the first month of treatment and tended to decrease in frequency and intensity over time. The following information is based on data from the pivotal DEFINE and CONFIRM clinical trials, as well as post-marketing surveillance.
It is important to distinguish between common, manageable side effects and those that require immediate medical attention. Flushing and mild gastrointestinal symptoms, while uncomfortable, are generally not dangerous and often improve with continued use. However, persistent low lymphocyte counts, signs of serious infections, or symptoms suggestive of PML (such as progressive weakness on one side of the body, clumsiness, vision changes, confusion, or personality changes) require urgent medical evaluation.
Very Common (affects more than 1 in 10 patients)
- Flushing (warmth, redness, itching, or burning sensation of the skin)
- Diarrhea
- Nausea
- Abdominal pain or cramping
Common (affects 1 to 10 in 100 patients)
- Vomiting
- Dyspepsia (indigestion)
- Gastritis (inflammation of the stomach lining)
- Gastrointestinal disorder
- Pruritus (itching)
- Rash
- Erythema (skin redness)
- Hot flush (feeling of heat)
- Lymphopenia (low lymphocyte count)
- Leukopenia (low white blood cell count)
- Proteinuria (protein in the urine)
- Feeling of burning sensation
- Elevated liver enzymes (AST, ALT)
- Albumin in urine
Uncommon (affects 1 to 10 in 1,000 patients)
- Severe lymphopenia (lymphocyte count <0.5 × 109/L)
- Hypersensitivity reactions
- Angioedema (swelling beneath the skin)
Rare (affects fewer than 1 in 1,000 patients)
- Progressive multifocal leukoencephalopathy (PML)
- Anaphylaxis
- Fanconi syndrome (renal tubular dysfunction)
- Drug-induced liver injury (hepatotoxicity)
- Herpes zoster (shingles) in the context of lymphopenia
Flushing typically manifests as a warmth, redness, itching, or burning sensation of the skin, most commonly affecting the face, neck, and upper chest. It usually begins within 30 minutes of taking a dose and lasts from a few minutes to several hours. In clinical trials, approximately 40% of dimethyl fumarate-treated patients experienced flushing, compared with 6% of placebo-treated patients. The incidence and severity typically decrease substantially after the first month of therapy.
Gastrointestinal adverse events include diarrhea, nausea, upper abdominal pain, and vomiting. These also tend to be most pronounced during the initial weeks of treatment and usually become less frequent over time. Taking the medicine with a full meal (not just a light snack) significantly reduces the incidence and severity of these symptoms.
Lymphopenia is a pharmacologically predictable effect related to the immune-modulating mechanism of dimethyl fumarate. In the first year of treatment, mean lymphocyte counts decrease by approximately 30% from baseline, then plateau. Approximately 6% of patients experience severe lymphopenia (grade 3 or higher, with lymphocyte counts below 0.5 × 109/L). Prolonged severe lymphopenia is associated with an increased risk of infections, including the rare but serious PML. This is why regular complete blood count monitoring every 3 months is mandatory.
Contact your doctor or seek emergency medical help immediately if you experience: signs of a severe allergic reaction (difficulty breathing, facial swelling, severe rash); symptoms suggestive of PML (progressive weakness, clumsiness, vision changes, thinking difficulties, personality changes); signs of severe infection (high fever, persistent cough, confusion); or symptoms of liver injury (yellowing of skin or eyes, dark urine, severe fatigue).
How Should You Store Dimethyl Fumarate G.L. Pharma?
Proper storage of dimethyl fumarate G.L. Pharma is essential to maintain the integrity, safety, and efficacy of the medicine. Incorrect storage conditions can degrade the active ingredient or compromise the gastro-resistant coating, potentially affecting both drug effectiveness and tolerability.
- Temperature: Store below 30°C (86°F). Do not refrigerate or freeze the capsules. The medicine should be kept at room temperature in a dry location.
- Light protection: Keep the capsules in the original blister packaging until ready to take. The packaging protects the medicine from light exposure, which could degrade the active ingredient.
- Moisture protection: Do not store in damp or humid environments such as bathrooms. The gastro-resistant coating can be affected by excessive moisture.
- Expiry date: Do not use this medicine after the expiry date stated on the carton and blister. The expiry date refers to the last day of that month.
- Keep out of reach of children: Store this medicine in a place where children cannot see or reach it.
- Disposal: Do not dispose of medicines via household waste or wastewater. Ask your pharmacist about how to dispose of medicines you no longer use. These measures help protect the environment.
When travelling, keep your medication in your carry-on luggage rather than checked baggage, as cargo holds may experience extreme temperatures. If you are travelling to hot climates, be mindful that temperatures inside vehicles or in direct sunlight can exceed the recommended storage temperature. A medication travel pouch with insulation (not a cold pack) can help maintain appropriate temperature ranges during transit.
What Does Dimethyl Fumarate G.L. Pharma Contain?
Active Ingredient
The active substance is dimethyl fumarate (also known as dimethyl (E)-butenedioate). Each capsule contains either 120 mg or 240 mg of dimethyl fumarate. This is the same active ingredient found in the original branded reference product, and the bioequivalence of this generic formulation has been demonstrated in accordance with regulatory requirements.
Inactive Ingredients (Excipients)
The excipients serve various pharmaceutical functions including binding, filling, protecting, and coating the capsules to ensure proper drug delivery and stability:
- Capsule contents: Microcrystalline cellulose, croscarmellose sodium, talc, colloidal anhydrous silica, magnesium stearate, methacrylic acid – ethyl acrylate copolymer (1:1), triethyl citrate
- Capsule shell: Gelatin, titanium dioxide (E171), brilliant blue FCF (E133), yellow iron oxide (E172) (for the 120 mg capsule); gelatin, titanium dioxide (E171), brilliant blue FCF (E133), iron oxide yellow (E172), iron oxide red (E172) (for the 240 mg capsule)
- Printing ink: Shellac, iron oxide black (E172), propylene glycol, ammonium hydroxide
Appearance
The 120 mg capsule is a green and white hard gastro-resistant capsule printed with a product identification marking. The 240 mg capsule is a green hard gastro-resistant capsule printed with a product identification marking. The capsules contain white to off-white gastro-resistant micro-tablets (pellets). Each blister pack contains a specific number of capsules as listed on the outer carton.
Manufacturer
Dimethyl fumarate G.L. Pharma is manufactured and marketed by G.L. Pharma GmbH, based in Lannach, Austria. G.L. Pharma is a pharmaceutical company specializing in the development and manufacturing of generic medicines. The product is authorized and distributed across European markets under mutual recognition or decentralized procedures.
Frequently Asked Questions About Dimethyl Fumarate G.L. Pharma
Dimethyl fumarate G.L. Pharma is used to treat relapsing-remitting multiple sclerosis (RRMS) in adults. It is an oral disease-modifying therapy that reduces the frequency and severity of MS relapses, slows disability progression, and decreases the formation of new brain lesions visible on MRI. It works by activating the Nrf2 antioxidant pathway and modulating the immune response to reduce inflammation-mediated damage to the nervous system.
Take the capsules whole with food, ideally with a full meal, twice daily (morning and evening). Do not crush, chew, or open the capsules. The gastro-resistant coating is specifically designed to protect the medicine from stomach acid and to reduce gastrointestinal side effects. Breaking the coating would expose the active ingredient to the stomach, potentially increasing nausea and abdominal pain and reducing the medicine’s effectiveness.
Flushing is most common during the first month of treatment and typically decreases significantly over the first 4 to 6 weeks. In clinical trials, the incidence of flushing decreased from approximately 40% in the first month to less than 5% by the sixth month of treatment. Taking the medicine with a full meal and using non-enteric-coated aspirin (325 mg) 30 minutes before the dose can help reduce the severity and duration of flushing episodes.
A complete blood count (CBC) is required before starting treatment, then every 3 months during treatment, and as clinically indicated. Your doctor may also check liver function tests and kidney function periodically. These regular blood tests are essential to monitor for lymphopenia (low lymphocyte count), which can increase the risk of infections including the rare brain infection PML. If your lymphocyte count falls below a certain level, your doctor may need to adjust or discontinue your treatment.
Yes, dimethyl fumarate G.L. Pharma is a generic medicine that contains the same active ingredient (dimethyl fumarate) at the same strengths (120 mg and 240 mg) as the original branded reference product. The manufacturer has demonstrated bioequivalence, meaning it is absorbed into the body at the same rate and to the same extent as the original. The excipients (inactive ingredients) may differ slightly, but this does not affect the therapeutic efficacy or safety profile. The dosing, indications, and monitoring requirements are identical.
If you develop a serious infection during treatment, contact your neurologist immediately. Your doctor may decide to suspend or permanently discontinue dimethyl fumarate, depending on the nature and severity of the infection and your current lymphocyte count. Do not stop taking the medicine on your own without consulting your doctor, as MS relapses may occur if treatment is discontinued without a plan for alternative therapy. Signs of serious infection include high fever, persistent cough, confusion, significant fatigue, or any unusual neurological symptoms.
References
- European Medicines Agency (EMA). Dimethyl fumarate – Summary of Product Characteristics. Available from: EMA Medicines Database.
- Gold R, Kappos L, Arnold DL, et al. Placebo-Controlled Phase 3 Study of Oral BG-12 for Relapsing Multiple Sclerosis (DEFINE). N Engl J Med. 2012;367(12):1098–1107. doi:10.1056/NEJMoa1114287.
- Fox RJ, Miller DH, Phillips JT, et al. Placebo-Controlled Phase 3 Study of Oral BG-12 or Glatiramer in Multiple Sclerosis (CONFIRM). N Engl J Med. 2012;367(12):1087–1097. doi:10.1056/NEJMoa1206328.
- U.S. Food and Drug Administration (FDA). Dimethyl fumarate Prescribing Information. Available from: FDA Drug Label Database.
- Montalban X, Gold R, Thompson AJ, et al. ECTRIMS/EAN guideline on the pharmacological treatment of people with multiple sclerosis. Mult Scler. 2018;24(2):96–120. doi:10.1177/1352458517751049.
- Rae-Grant A, Day GS, Marrie RA, et al. Practice guideline recommendations summary: Disease-modifying therapies for adults with multiple sclerosis. Neurology. 2018;90(17):777–788. doi:10.1212/WNL.0000000000005347.
- Linker RA, Lee DH, Ryan S, et al. Fumaric acid esters exert neuroprotective effects in neuroinflammation via activation of the Nrf2 antioxidant pathway. Brain. 2011;134(Pt 3):678–692. doi:10.1093/brain/awq386.
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List. Geneva: WHO; 2023.
- Berkovich R, Weiner LP. Effects of dimethyl fumarate on lymphocyte subsets. Mult Scler Relat Disord. 2015;4(4):339–341. doi:10.1016/j.msard.2015.06.002.
- British National Formulary (BNF). Dimethyl fumarate. London: BMJ Group and Pharmaceutical Press. Available from: BNF Online.
Editorial Team
This article was written and reviewed by the iMedic Medical Editorial Team, comprising licensed specialist physicians with expertise in neurology, immunology, and clinical pharmacology.
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