Aubagio (Teriflunomide): Uses, Dose, MOA, Side effects

Aubagio (Teriflunomide)

Aubagio is the trade name of Teriflunomide, marketed by Genzyme Corporation Sanofi Aventis. Teriflunomide is the active metabolite of Leflunomide, a drug commonly used to treat autoimmune rheumatic diseases like Rheumatoid Arthritis.

Teriflunomide was approved in 2012 by the FDA for the treatment of relapsing form of Multiple Sclerosis.

It is one of the few oral drugs used as a maintenance therapy for MS. It acts by inhibiting dihydroorotate dehydrogenase in the mitochondria resulting in the inhibition of pyrimidine synthesis.

Aubagio is a strong immunomodulating drug that is why patients of MS being treated with Aubagio should take extra precautions to not get any sort of infections.

Viral, bacterial, fungal, and more importantly getting mycobacterial tuberculosis can be very serious and lead to a rapid decline in health.

Vaccination against all available bacterial infections should be considered before starting the therapy.

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Uses of Aubagio (Teriflunomide)

Adults with some types of multiple sclerosis, which includes:

  • relapsing-remitting disease,
  • clinically isolated syndrome, and
  • active secondary progressive disease

are treated with Aubagio.

Aubagio affects the immune system of the body and the brain in specific and improves the edema and inflammation of the brain, hence improving the symptoms of MS. It does not cure the disease.

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Directions to use Aubagio (Teriflunomide) Tablets:

Get all the information about the safety of the drugs and how to store them from your pharmacist.

When you are prescribed the medicine, it must be clear that you do not have any sort of an infection.

The tablets are recommended to be taken once daily with or without food. If your stomach is sensitive, it is better to take it with meals to lessen the gastrointestinal side effects.

Your health situation and treatment response are taken into account while determining the dose. For maximum effectiveness, use this medicine as prescribed.

Take it at the same time every day to help yourself remember.

Your doctor could advise a different medication (such as cholestyramine or activated charcoal powder) to accelerate the elimination of Aubagio from your body when therapy is ended.

If you experience severe side effects, or you are a woman of reproductive age or are a male who intends to father a child, you should avoid using Aubagio (Teriflunomide) because the drug is very teratogenic.

You should not plan pregnancy for up to two years because the drug may stay in your blood for up to two years.

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Aubagio (Teriflunomide) Dose:

The dose suggested for Aubagio is 7mg or 14 mg per day. It is taken once daily with or without food. The dose is decided based on the patient’s symptoms and progression of the disease.

Side effects of Aubagio (Teriflunomide)

Keep in mind that your doctor has recommended this medicine because they believe it will help you more than it will harm you. Many users of this medicine report no significant negative effects.

Common side effects include [Ref]:

Common Side effectsUncommon side effects
Hair LossHypertension
Raised Liver EnzymesAllergic reactions

Gastrointestinal side effects may improve when the drug is taken with meals or an antacid is taken with it.

Hair loss is usually temporary. After the treatment is stopped, hair regrow.

If you experience any severe side effects, such as easy bleeding or bruising, new or worsening shortness of breath, new or worsening numbness/tingling in your hands or feet, pain in your side (flank pain), or signs of high potassium blood levels (such as muscle weakness, a slow or irregular heartbeat, or unusual fatigue), contact your doctor right away.

Paraesthesias may manifest as tingling, burning, numbness, or prickling in your skin. Supportive treatment is usually enough in such cases.

A rash may appear that usually resolves by itself. However, with concomitant symptoms of hypotension, hospital admission and emergency visit may be necessary.

Your resistance to infections might be weakened by this drug. While on Teriflunomide treatment, you are prone to infections.

Get your vaccination schedule up to date. In case of fever, cough, shortness of breath, diarrhea, or any other symptom suggestive of an infection, you should call your doctor.

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Warnings & precautions:

  • Allergies:

If you have any allergies, for example to teriflunomide, leflunomide, or other substances, let your doctor or pharmacist know before taking Aubagio.

This product can have inactive components that could lead to allergic reactions or other issues. For further information, see your pharmacist.

  • Medical conditions:

Inform your doctor or pharmacist about all of your current medical conditions, particularly any of the following before taking this medication:

  • high blood pressure,
  • liver issues,
  • immune system disorders (caused by cancer or HIV infection, for example),
  • lung disease, and
  • bone marrow or blood disorders.
  • Infections:

You may become more susceptible to infections if you take Aubagio, or any infections you already have may get worse.

As much as possible, stay away from persons who may be infected (such as chickenpox, measles, or flu). For additional information or if you believe you may have been exposed to an illness, speak with your doctor.

Before receiving any shots or vaccines, inform your healthcare provider that you are on Aubagio. People who have just received live immunizations should stay away from each other (such as flu vaccine inhaled through the nose).

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Mechanism of action of Aubagio (Teriflunomide)

Aubagio works in multiple sclerosis through an unknown specific mechanism. Aubagio is known to block the mitochondrial enzyme dihydroorotate dehydrogenase, which in turn inhibit nucleic acid synthesis by blocking Pyrimidine.

It has a strong immunomodulatory effects in multiple sclerosis as it reduce the total number of activated lymphocytes in the brain.

Metabolism of Aubagio: The major hydrolysis process for Aubagio produces minor metabolites.

Pathway of elimination: Aubagio is mostly removed by bile and remains unaltered. Particularly, 37.5% and 22.6% are excreted in the urine and feces, respectively.

Maximum Plasma concentration: The drug reaches its maximum plasma concentrations after 4 hours of ingestion.

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The effect of Aubagio on drugs:

The plasma levels of the following drugs may increase of decrease if you are taking Aubagio (teriflunamide):

Increase plasma levels

Decrease Plasma Levels


In addition, the plasma levels of Bupropion (Wellbutrin) is not affected by taking Teriflunomide.

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What do you think?

Written by Dr. Ahmed

I am Dr. Ahmed (MBBS; FCPS Medicine), an Internist and a practicing physician. I am in the medical field for over fifteen years working in one of the busiest hospitals and writing medical posts for over 5 years.

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