Strategies for Managing Common Side Effects1-3

Empower your patients from the start by setting expectations around flushing and
GI symptoms

Most Common Adverse Events: Flushing and GI events. Please see adverse events for additional information.

Over-the-Counter Options Foods


Taking non-enteric coated aspirin (up to 325 mg) 30 minutes before taking TECFIDERA may reduce the incidence or severity of flushing.

Taking TECFIDERA with a meal may help with flushing.*

GI Events2,3

Fox E, et al 2016 Study Design: In a multicenter, open-label, single-arm, small 233-patient study, patients self-reported GI symptoms over 12 weeks using an eDiary. In the study, patients who regularly took TECFIDERA with food reported some reduction in severe GI events when compared with patients who did not take food.


Limitations: This was a retrospective, observational, post hoc analysis without randomization or a placebo group, and was not designed to assess the efficacy of symptomatic therapies. MS GI symptoms and regular dosing of TECFIDERA with food or use of alcohol/tobacco were not controlled for. Patient selection may have been biased.


Recommended therapies for GI symptoms include antacids, bismuth subsalicylate, acid-secretion blockers, and antidiarrheals.

Taking TECFIDERA with fatty food may help mitigate GI events.*

Dose Adjustment

Temporary dose reductions to 120 mg twice daily may help in managing tolerability for individuals who cannot tolerate the maintenance dose.

  • The 240-mg twice daily dose should be resumed within 4 weeks
    • If the maintenance dose still proves to be a challenge, discontinuation of TECFIDERA should be considered


*A high-fat, high-calorie meal did not affect the overall exposure to TECFIDERA.

Nurse Educators can help

Nurse Educators can:

  • Help your patients understand what to expect during treatment
  • Give information that may help manage common side effects
  • Provide education about available resources

A Nurse Educator can come to your office and educate your staff on how they can help support your patients. Nurse Educators can also provide patients with supplemental side-effect mitigation strategies and communicate with you about your patients' start date and any treatment challenges they have expressed.