Dimethyl fumarate Vivanta: Uses, Dosage & Side Effects
An oral disease-modifying therapy for relapsing-remitting multiple sclerosis (RRMS) in adults, activating the Nrf2 pathway to reduce inflammation and protect nerve cells
Dimethyl fumarate Vivanta is a prescription oral medication used for the treatment of relapsing-remitting multiple sclerosis (RRMS) in adults. It belongs to a class of drugs known as immunomodulators and works by activating the nuclear factor erythroid 2-related factor 2 (Nrf2) pathway, which helps protect nerve cells from oxidative stress and reduces damaging inflammation in the central nervous system. The medication is taken as gastro-resistant hard capsules twice daily, with a starting dose of 120 mg for the first seven days, followed by the full maintenance dose of 240 mg twice daily. Clinical trials have shown that dimethyl fumarate significantly reduces relapse rates, new brain lesions on MRI, and slows disability progression in people with RRMS.
Quick Facts: Dimethyl fumarate Vivanta
Key Takeaways
- Dimethyl fumarate Vivanta is an oral disease-modifying therapy approved for relapsing-remitting multiple sclerosis (RRMS) in adults, reducing relapse rates by approximately 44-53% compared to placebo.
- The medication is taken twice daily as gastro-resistant capsules, starting at 120 mg for one week before increasing to the maintenance dose of 240 mg twice daily.
- The most common side effects are flushing and gastrointestinal symptoms (nausea, diarrhea, abdominal pain), which typically improve after the first month of treatment.
- Regular blood monitoring is essential, as dimethyl fumarate can lower lymphocyte counts, potentially increasing the risk of infections including rare cases of progressive multifocal leukoencephalopathy (PML).
- Taking capsules with food and using a gradual dose titration can significantly reduce the severity of flushing and gastrointestinal side effects during the initial treatment period.
What Is Dimethyl fumarate Vivanta and What Is It Used For?
Dimethyl fumarate Vivanta contains the active substance dimethyl fumarate, which belongs to a group of medicines known as immunomodulators. These are disease-modifying therapies (DMTs) specifically designed to alter the course of multiple sclerosis by targeting the underlying immune processes that cause damage to the central nervous system. Dimethyl fumarate Vivanta is a generic version of dimethyl fumarate products, containing the same active ingredient at the same strengths and approved for the same therapeutic indication.
Multiple sclerosis (MS) is a chronic autoimmune disease in which the body's immune system mistakenly attacks the protective myelin sheath that surrounds nerve fibers in the brain and spinal cord. This damage disrupts communication between the brain and the rest of the body, leading to a wide range of neurological symptoms including fatigue, numbness, tingling, muscle weakness, vision problems, and difficulties with balance and coordination. In relapsing-remitting MS, the most common form of the disease, patients experience episodes of new or worsening symptoms (relapses) followed by periods of partial or complete recovery (remissions).
Dimethyl fumarate exerts its therapeutic effects primarily through activation of the nuclear factor erythroid 2-related factor 2 (Nrf2) transcriptional pathway. This pathway is a master regulator of cellular antioxidant responses, and its activation leads to increased production of protective antioxidant enzymes and proteins. By enhancing the cell's ability to defend against oxidative stress, dimethyl fumarate helps protect neurons and oligodendrocytes (the cells that produce myelin) from immune-mediated damage. Additionally, the drug modulates immune cell function by shifting the balance from pro-inflammatory Th1 and Th17 responses toward anti-inflammatory Th2 responses, reducing the overall inflammatory burden on the central nervous system.
Clinical evidence supporting the use of dimethyl fumarate in RRMS comes from several large-scale, randomized, double-blind, placebo-controlled trials. The DEFINE and CONFIRM studies, which enrolled over 2,600 patients with RRMS, demonstrated that dimethyl fumarate 240 mg twice daily significantly reduced the annualized relapse rate by approximately 44-53% compared to placebo. The drug also significantly reduced the number of new or enlarging T2-hyperintense lesions on MRI by up to 85%, and reduced the number of gadolinium-enhancing lesions (a marker of active inflammation) by up to 90%. Furthermore, dimethyl fumarate was associated with a 38% relative reduction in the risk of confirmed disability progression sustained for 12 weeks.
The medication is indicated exclusively for adult patients (18 years and older) with relapsing-remitting multiple sclerosis. It is not approved for primary progressive MS or secondary progressive MS without relapses. Treatment decisions should be made by a neurologist experienced in managing multiple sclerosis, taking into account the individual patient's disease activity, prognostic factors, and treatment goals.
What Should You Know Before Taking Dimethyl fumarate Vivanta?
Contraindications
Dimethyl fumarate Vivanta must not be used in certain situations where the risks clearly outweigh the potential benefits. Understanding these contraindications is essential for both patients and healthcare providers to ensure safe prescribing practices.
- You are allergic to dimethyl fumarate, any of the other ingredients in this medicine, or other fumaric acid esters
- You have severe gastrointestinal disease (such as gastric or duodenal ulcers)
- You have severe hepatic (liver) impairment
- You have severe renal (kidney) impairment
The contraindication in severe gastrointestinal disease is particularly important because dimethyl fumarate is known to cause gastrointestinal side effects including nausea, vomiting, diarrhea, and abdominal pain, which could significantly worsen pre-existing gastrointestinal conditions. Similarly, since the drug and its metabolites are partially processed by the liver and kidneys, severe impairment of these organs could lead to unpredictable drug accumulation and toxicity.
Warnings and Precautions
Before and during treatment with dimethyl fumarate Vivanta, several important safety precautions must be observed. Your neurologist will conduct specific tests and monitoring to minimize risks.
- Lymphocyte monitoring: A complete blood count (CBC) including lymphocyte count must be obtained before treatment initiation, then every 6-12 months, and whenever clinically indicated. Dimethyl fumarate can cause prolonged lymphopenia (low lymphocyte counts), which has been associated with rare cases of progressive multifocal leukoencephalopathy (PML).
- PML risk: PML is a rare but serious viral brain infection caused by the JC virus. Cases have been reported in patients taking dimethyl fumarate, predominantly in those with lymphocyte counts below 0.5 x 109/L for more than 6 months. If sustained lymphopenia develops, treatment discontinuation should be considered.
- Liver function: Hepatic transaminases and bilirubin should be checked before starting treatment and during treatment as clinically indicated. Clinically significant liver injury has been reported in rare cases.
- Flushing management: Flushing (redness and warmth of the skin) is very common and can be managed by taking the capsules with food and, if needed, by taking a non-enteric coated aspirin (325 mg) 30 minutes before the dose.
Patients currently receiving immunosuppressive or immunomodulatory therapies should not start dimethyl fumarate without an appropriate washout period, as concurrent use may increase the risk of infections and other immune-related complications. Similarly, patients with active severe infections should not begin treatment until the infection has resolved. If a patient develops a serious infection while on dimethyl fumarate, temporary suspension of treatment should be considered.
Prior to starting treatment, a recent MRI scan of the brain (typically within 3 months) should be available as a baseline reference. This is important both for monitoring treatment efficacy and for early detection of any suspicious changes that could suggest PML or other complications. Regular follow-up MRI scans are typically performed annually or as clinically indicated.
Pregnancy and Breastfeeding
Dimethyl fumarate Vivanta should not be used during pregnancy unless clearly necessary and the potential benefit justifies the potential risk to the fetus. Animal studies have shown adverse effects on embryo-fetal development at doses higher than those used clinically, including reduced fetal body weight and increased incidence of skeletal variations.
Women of childbearing potential should use effective contraception during treatment and for at least four weeks after discontinuation. If a patient discovers she is pregnant while taking dimethyl fumarate, she should contact her neurologist immediately to discuss the benefits and risks of continuing treatment. Pregnancy registries exist to collect data on outcomes in women exposed to MS therapies during pregnancy, and patients should be encouraged to enroll.
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, so a decision must be made whether to discontinue breastfeeding or discontinue the drug, taking into account the benefit of breastfeeding for the child and the benefit of therapy for the mother.
How Does Dimethyl fumarate Vivanta Interact with Other Drugs?
Dimethyl fumarate is rapidly converted to its active metabolite monomethyl fumarate (MMF) through presystemic hydrolysis by esterases before reaching the systemic circulation. MMF is then metabolized via the tricarboxylic acid (TCA) cycle, without involvement of the cytochrome P450 (CYP) enzyme system. This metabolic profile means that dimethyl fumarate is unlikely to affect the plasma concentrations of co-administered drugs that are metabolized by CYP enzymes, and conversely, CYP inhibitors or inducers are unlikely to alter the pharmacokinetics of dimethyl fumarate.
Despite the favorable pharmacokinetic profile, there are several clinically important considerations regarding concomitant medication use. The immunomodulatory effects of dimethyl fumarate on lymphocyte counts and immune function mean that combining it with other medications that affect the immune system requires careful evaluation.
Major Interactions
| Interacting Drug / Class | Interaction Effect | Clinical Recommendation |
|---|---|---|
| Other immunosuppressants (e.g., azathioprine, methotrexate, cyclosporine) | Additive immunosuppression, increased risk of infections including opportunistic infections | Avoid concurrent use. Allow appropriate washout period before switching therapies. |
| Other MS disease-modifying therapies (e.g., fingolimod, natalizumab, teriflunomide) | Additive immunomodulatory effects, increased risk of lymphopenia and infections | Do not use concurrently. Follow recommended washout periods when switching DMTs. |
| Live attenuated vaccines (e.g., MMR, varicella, yellow fever) | Risk of disseminated infection from live vaccine strains due to immunomodulation | Avoid live vaccines during treatment and for at least 4 weeks after discontinuation. Inactivated vaccines can be given. |
| Anti-neoplastic or immunosuppressive cancer therapies | Severe immunosuppression, significantly increased risk of serious infections and PML | Contraindicated in combination. Thorough immune reconstitution required before starting DMF. |
Minor Interactions
| Interacting Drug / Class | Interaction Effect | Clinical Recommendation |
|---|---|---|
| Aspirin (non-enteric coated, 325 mg) | No pharmacokinetic interaction; may reduce flushing symptoms via prostaglandin pathway inhibition | Can be taken 30 minutes before DMF dose to reduce flushing. Safe for short-term use. |
| Oral contraceptives | No clinically significant pharmacokinetic interaction identified | No dose adjustment needed. Oral contraceptives remain effective during DMF treatment. |
| Nephrotoxic drugs (e.g., aminoglycosides, NSAIDs) | Potential additive effect on renal function; DMF can cause proteinuria and changes in renal function | Monitor renal function more closely when used concomitantly. |
| Interferons or glatiramer acetate (prior therapy) | No direct interaction, but residual immunomodulatory effects may overlap during transition period | No washout strictly required, but verify CBC and lymphocyte counts are within normal range before initiating DMF. |
Patients should always inform their neurologist and pharmacist about all medications they are currently taking, including over-the-counter drugs, herbal supplements, and vitamins. Although dimethyl fumarate has limited direct pharmacokinetic interactions, the overall assessment of a patient's medication profile is important for ensuring safe and effective treatment.
What Is the Correct Dosage of Dimethyl fumarate Vivanta?
Dimethyl fumarate Vivanta is available as gastro-resistant hard capsules in two strengths: 120 mg (for initiation) and 240 mg (for maintenance therapy). The gastro-resistant formulation is designed to protect the active ingredient from degradation in the stomach and to release it in the small intestine, which helps reduce gastrointestinal irritation. It is crucial that the capsules are swallowed whole and not crushed, chewed, or opened, as this would destroy the gastro-resistant coating and could lead to increased gastrointestinal side effects and altered drug absorption.
Adults
Standard Adult Dosing (18 years and older)
Initiation Phase (Week 1): 120 mg taken orally twice daily (morning and evening) with food.
Maintenance Phase (Week 2 onwards): 240 mg taken orally twice daily (morning and evening) with food.
The dose titration during the first week is recommended to reduce the incidence and severity of flushing and gastrointestinal side effects that are commonly experienced when starting treatment. Taking the capsules with food further helps to mitigate these effects. Some clinicians may recommend a slower titration over 2-4 weeks in patients who are particularly sensitive to gastrointestinal symptoms.
For patients who experience persistent flushing, taking a non-enteric-coated aspirin (up to 325 mg) approximately 30 minutes before each dose of dimethyl fumarate may help reduce the severity. However, long-term daily use of aspirin for this purpose should be weighed against the risks of aspirin, including gastrointestinal bleeding.
Children
Pediatric Use
The safety and efficacy of dimethyl fumarate in children and adolescents below 18 years of age have not been established. There are limited data available in this age group, and dimethyl fumarate Vivanta is not currently approved for use in pediatric patients. Treatment of pediatric MS should be managed by specialists experienced in pediatric neurology, using therapies with established evidence in this population.
Elderly
Use in Patients Over 65 Years
Clinical trials of dimethyl fumarate did not include sufficient numbers of patients aged 65 and over to determine whether they respond differently from younger patients. In general, dose selection for an elderly patient should be cautious, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. No specific dose adjustment is recommended based on age alone, but careful monitoring of renal function, liver function, and complete blood counts is advised.
Missed Dose
If you forget to take a dose of dimethyl fumarate Vivanta, do not take a double dose to make up for the missed one. If the missed dose is remembered within a few hours of the scheduled time, take it with food as soon as possible. If it is close to the time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Maintaining a consistent twice-daily schedule, ideally at the same times each day, helps ensure stable drug levels and optimal therapeutic benefit.
Overdose
There is limited clinical experience with dimethyl fumarate overdose. In the event of overdose, patients should be monitored for signs and symptoms of adverse reactions, particularly gastrointestinal symptoms, flushing, and any changes in laboratory parameters. There is no specific antidote for dimethyl fumarate. Treatment should be supportive and symptomatic, focusing on managing any acute symptoms that develop. Due to the rapid presystemic hydrolysis of dimethyl fumarate, traditional measures such as gastric lavage or activated charcoal are unlikely to be beneficial unless administered very shortly after ingestion.
If you suspect an overdose, contact your local poison control center or emergency medical services immediately. Do not wait for symptoms to appear before seeking medical attention.
What Are the Side Effects of Dimethyl fumarate Vivanta?
Like all medicines, dimethyl fumarate Vivanta can cause side effects, although not everybody gets them. The side effect profile has been well characterized through clinical trials involving thousands of patients, as well as extensive post-marketing surveillance data collected since the original approval of dimethyl fumarate products. Understanding the frequency and nature of potential side effects allows patients and healthcare providers to make informed treatment decisions and implement appropriate management strategies.
The most commonly reported adverse reactions are flushing and gastrointestinal events, which typically occur early in treatment and tend to diminish in frequency and severity over the first two to three months. These side effects are a major reason for treatment discontinuation in clinical practice, but with proper patient education and management strategies, most patients can continue therapy successfully.
Very Common
Affects more than 1 in 10 patients
- Flushing (warmth, redness, itching, or burning sensation of the skin, most commonly of the face and upper body)
- Diarrhea
- Nausea
- Abdominal pain (upper abdominal pain, abdominal discomfort)
Common
Affects 1 in 10 to 1 in 100 patients
- Vomiting
- Dyspepsia (indigestion, bloating, gastric discomfort)
- Gastritis (inflammation of the stomach lining)
- Gastrointestinal disorder
- Hot flush (distinct from flushing; sensation of heat without visible skin changes)
- Burning sensation
- Pruritus (itching)
- Rash (including erythematous rash)
- Proteinuria (protein in urine)
- Lymphopenia (decreased lymphocyte count)
- Leukopenia (decreased white blood cell count)
- Elevated liver enzymes (AST, ALT, GGT)
- Albumin in urine
- Feeling hot
- Ketones in urine
Uncommon
Affects 1 in 100 to 1 in 1,000 patients
- Hypersensitivity reactions (angioedema, dyspnea, urticaria)
- Herpes zoster (shingles)
Rare
Affects fewer than 1 in 1,000 patients
- Progressive multifocal leukoencephalopathy (PML) (a rare, serious brain infection caused by JC virus, predominantly in patients with prolonged severe lymphopenia)
- Anaphylaxis (severe, potentially life-threatening allergic reaction)
- Severe prolonged lymphopenia (lymphocyte count below 0.5 x 109/L persisting for more than 6 months)
- Liver injury (clinically significant hepatotoxicity including elevated transaminases >5x upper limit of normal)
Flushing and gastrointestinal side effects are most troublesome during the first month of treatment and typically diminish significantly over 2-3 months. Practical strategies to minimize these effects include: taking capsules with food (particularly a meal containing some fat); adhering to the gradual dose titration (120 mg twice daily for the first week); and taking a non-enteric-coated aspirin (325 mg) 30 minutes before the dose if flushing is bothersome. Some patients also find that taking a small snack between meals before their dose and avoiding spicy foods or alcohol around dosing times can help reduce symptoms.
Patients should contact their healthcare provider immediately if they experience symptoms that could suggest PML, such as progressive weakness on one side of the body, clumsiness, visual disturbances, confusion, or personality changes that persist over days to weeks. Early detection of PML is crucial for improving outcomes. Similarly, any signs of serious infection, severe allergic reactions (difficulty breathing, swelling of the face or throat, hives), or yellowing of the skin or eyes (suggesting liver problems) should be reported promptly.
It is important to note that while the list of side effects may appear concerning, the majority of patients tolerate dimethyl fumarate well, with the most common side effects being manageable and time-limited. The benefit of reducing MS relapse rates and slowing disability progression generally outweighs the risks for most patients with active RRMS. Your neurologist will help you weigh these benefits and risks based on your individual circumstances.
How Should You Store Dimethyl fumarate Vivanta?
Proper storage of dimethyl fumarate Vivanta is essential to maintain the efficacy and safety of the medication. The gastro-resistant capsules are sensitive to moisture and light, which can degrade the active ingredient and compromise the integrity of the gastro-resistant coating. Exposure to excessive heat can also alter the formulation, potentially affecting drug release and absorption.
The capsules should be stored at a temperature not exceeding 30°C (86°F). They should be kept in the original blister packaging until the time of use to protect them from moisture and light. Do not transfer the capsules to another container, pill box, or daily organizer for extended periods, as this can expose them to conditions that may degrade the medication.
Keep dimethyl fumarate Vivanta out of the sight and reach of children. Do not use this medicine after the expiry date, which is stated on the blister, bottle, and carton after "EXP." The expiry date refers to the last day of that month. Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use, as these measures will help protect the environment.
If you notice any visible changes in the appearance of the capsules, such as discoloration, unusual odor, or damage to the blister packaging, do not use them and consult your pharmacist. Damaged capsules should not be handled with bare hands as the contents may cause skin irritation.
What Does Dimethyl fumarate Vivanta Contain?
Dimethyl fumarate Vivanta capsules contain the active substance dimethyl fumarate, a methyl ester of fumaric acid. The drug substance is formulated as gastro-resistant (enteric-coated) hard capsules to protect the active ingredient from degradation in the acidic environment of the stomach and to reduce gastrointestinal irritation by ensuring the drug is released in the more alkaline environment of the small intestine.
The 120 mg capsules and 240 mg capsules contain identical excipients in proportional amounts. The inactive ingredients (excipients) in the capsule formulation may include:
- Capsule contents: Microcrystalline cellulose, croscarmellose sodium, talc, silica colloidal anhydrous, magnesium stearate, triethyl citrate, methacrylic acid - methyl methacrylate copolymer (1:1), methacrylic acid - ethyl acrylate copolymer (1:1) dispersion, simethicone, sodium lauryl sulfate, polysorbate 80
- Capsule shell: Gelatin, titanium dioxide (E171), brilliant blue FCF (E133), and may contain iron oxide yellow (E172) depending on the strength
The gastro-resistant coating (enteric coating) is a critical component of the formulation, typically composed of methacrylic acid copolymers that remain intact in the acidic environment of the stomach (pH 1-3) but dissolve in the higher pH environment of the small intestine (pH >5.5). This coating technology is well-established in pharmaceutical manufacturing and ensures consistent and predictable drug release.
Patients with known allergies or intolerances to any of the listed excipients should discuss this with their prescriber or pharmacist before starting treatment. The capsules do not contain gluten, lactose, or sucrose, making them suitable for patients with celiac disease or lactose intolerance. However, the capsule shell does contain gelatin, which is derived from animal sources and may not be suitable for patients who avoid animal products for dietary or religious reasons.
Frequently Asked Questions About Dimethyl fumarate Vivanta
Dimethyl fumarate Vivanta is used for the treatment of relapsing-remitting multiple sclerosis (RRMS) in adult patients. It is a disease-modifying therapy that works by modulating the immune system to reduce inflammation and protect nerve cells. It is not a cure for MS, but it significantly reduces the frequency of relapses (by approximately 44-53%) and slows the progression of disability. It is taken as oral capsules twice daily, making it a convenient alternative to injectable MS therapies.
Dimethyl fumarate begins to affect the immune system within days of starting treatment, but its full clinical benefits develop over weeks to months. In clinical trials, reductions in MRI lesion activity were observed as early as 12 weeks after starting treatment. However, the full effect on reducing relapse rates is typically assessed over 6-12 months of treatment. It is important to continue taking the medication as prescribed even if you feel well, as MS is a chronic disease that requires ongoing treatment to prevent relapses and disease progression.
There is no specific contraindication against alcohol consumption while taking dimethyl fumarate. However, alcohol can worsen flushing symptoms, which are already a common side effect of the medication. Drinking alcohol close to the time you take your dose may increase the intensity of flushing, redness, and warmth. If you choose to drink, it is advisable to avoid consuming alcohol within a few hours of your dose. Additionally, alcohol in excess can affect liver function, and since dimethyl fumarate can occasionally cause elevated liver enzymes, moderate alcohol consumption is recommended.
Flushing is a very common side effect that typically improves over the first 2-3 months of treatment. To manage flushing: always take your capsules with food (a meal containing some fat is particularly helpful); consider taking a non-enteric-coated aspirin (325 mg) about 30 minutes before your dose; avoid spicy foods, hot beverages, and alcohol around dosing times; and ensure you are following the recommended dose titration (starting at 120 mg twice daily for the first week). If flushing remains severe or intolerable despite these measures, speak with your neurologist, who may consider a slower dose escalation or other management strategies.
Dimethyl fumarate Vivanta is a generic version of the original dimethyl fumarate product. It contains the same active ingredient (dimethyl fumarate) at the same strengths (120 mg and 240 mg gastro-resistant capsules) and is approved for the same indication. Generic medicines must meet stringent regulatory requirements to demonstrate that they are bioequivalent to the reference product, meaning they deliver the same amount of active substance to the body at the same rate. While inactive ingredients (excipients) may vary slightly between brands, these differences do not affect the therapeutic efficacy or safety of the medication.
Before starting treatment, your doctor will order a complete blood count (CBC) including differential lymphocyte count, as well as liver function tests (ALT, AST, bilirubin) and kidney function tests. During treatment, a CBC with lymphocyte count should be repeated every 6-12 months and whenever clinically indicated. This monitoring is crucial because dimethyl fumarate can cause lymphopenia (low lymphocyte counts), which if prolonged and severe, may increase the risk of progressive multifocal leukoencephalopathy (PML). Liver function tests should also be monitored periodically. Your neurologist will advise on the specific monitoring schedule appropriate for your situation.
References
- European Medicines Agency (EMA). Dimethyl fumarate - Summary of Product Characteristics. Last updated 2025. Available from: www.ema.europa.eu
- Gold R, Kappos L, Arnold DL, et al. Placebo-controlled phase 3 study of oral BG-12 for relapsing multiple sclerosis (DEFINE study). 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 study). N Engl J Med. 2012;367(12):1087-1097. doi:10.1056/NEJMoa1206328
- 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
- Montalban X, Gold R, Thompson AJ, et al. ECTRIMS/EAN guideline on the pharmacological treatment of people with relapsing multiple sclerosis. Mult Scler. 2018;24(2):96-120. doi:10.1177/1352458517751049
- 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, 2023. Geneva: World Health Organization; 2023.
- U.S. Food and Drug Administration (FDA). Dimethyl fumarate - Prescribing Information. Available from: www.fda.gov
- National MS Society. Disease-Modifying Therapies for MS. Available from: www.nationalmssociety.org
- British National Formulary (BNF). Dimethyl fumarate. Available from: bnf.nice.org.uk
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