Vumerity dosage, forms, and strengths

Vumerity is a brand-name treatment for relapsing forms of multiple sclerosis. It is taken twice daily and reduces the incidence of MS relapses and the formation of new lesions in the central nervous system. Its active ingredient is diroximel fumarate. The body metabolizes this drug into another drug called monomethyl fumarate. This is the active form of Vumerity (called the “active metabolite”) that reduces inflammation and oxidative stress, which are the primary mechanisms that injure nerves in people with MS during an MS flare-up. 

Vumerity forms and strengths

Vumerity is available in only one dosage form and strength:

• Capsules: 231 mg

Vumerity dosage for adults

The FDA approved Vumerity as a treatment to reduce relapses and lesion formation in adults with relapsing multiple sclerosis. Patients will begin with a starting dose and then after one week, transition to a maintenance dose.

Vumerity is contraindicated in people with a history of an allergic reaction to diroximel fumarate or dimethyl fumarate, which is a nearly identical drug called Tecfidera. 

Vumerity dosage for relapsing multiple sclerosis

Vumerity treats relapsing multiple sclerosis in adults.

Multiple sclerosis is an inflammatory disorder in which the immune system attacks healthy nerves in the brain and spine. As nerves in the central nervous system lose their protective sheath, people experience neurological problems such as vision changes, weakness, numbness, tingling, cognitive impairment, and other issues.

Relapsing multiple sclerosis is the most common form of multiple sclerosis, accounting for close to four out of five cases. Symptomatic flare-ups are followed by periods of remission in which symptoms go away. 

There are several types of relapsing MS: clinically isolated relapsing MS (a single flare-up of symptoms without any previous history of flare-ups), relapsing-remitting MS or RRMS (recurring cycles of flare-ups and remissions), and secondary progressive MS (more rapid cycles of flare-ups and remissions). The only form of non-relapsing MS is called primary progressive MS, in which symptoms are essentially continuous without any intervening remissions. 

Although the active ingredient in Vumerity is diroximel fumarate, it is not the drug that prevents active MS. Instead, the body converts it into monomethyl fumarate (MMF). Healthcare professionals do not know the clear mechanism of action. Still, they know that MMF reduces inflammation and oxidative stress, the two primary mechanisms that damage the nerves during MS flare-ups. Although the immune system causes both inflammation and oxidative stress, MMF is not an immunosuppressant.. 

The drug Tecfidera (dimethyl fumarate) works the same way. The body converts dimethyl fumarate to MMF, so dimethyl fumarate and diroximel fumarate are bioequivalent drugs.

Doses are taken twice daily. Initially, patients will begin with a 231 mg capsule twice daily.The dose will then be increased to the full maintenance dose of 462 mg twice daily. Since capsules are not sold at regular pharmacies, patients will receive a starter bottle in the mail from a specialty pharmacy to cover the first week’s doses. 

If side effects become a problem, the doctor may reduce the maintenance dose to 231 mg twice daily for four weeks. After four weeks, the dose will return to the recommended maintenance dose.

The healthcare provider must perform regular blood tests throughout Vumerity treatment to monitor its effects on blood counts, lymphocyte counts, and liver function.

• Standard Vumerity dosage for relapsing MS: 462 mg taken orally twice daily

• Maximum Vumerity dosage for erectile dysfunction: 462 mg taken orally twice daily

Vumerity dosage for children

The FDA has not approved Vumerity for use in children.

Vumerity dosage restrictions

Healthcare providers do not modify Vumerity dosages for people with kidney problems (renal impairment) or liver dysfunction. However, Vumerity is not recommended in people with moderate to severe renal impairment. 

The dosage may be reduced to 231 mg twice daily in people with significant problems with adverse effects.

How to take Vumerity

Vumerity capsules are taken twice daily.

• Your healthcare provider will tell you how much medicine to use. Take Vumerity exactly as directed, and do not use more than directed.

• When you receive your prescription, carefully read the prescription label and information leaflets that come with your prescription.

• If you have questions or concerns, ask the healthcare provider, the Biogen Support Coordinator, or the Nurse Educator.

• Vumerity can be taken with or without food.

  • If it is taken with food, take it with a meal or snack with less than 700 calories and less than 30 grams of fat.

• Swallow the delayed-release capsule whole. Do not crush or chew it. Do not open the capsule and sprinkle its contents on food.

• Do not drink alcohol at the same time a dose is taken.

• Store Vumerity at room temperature and out of the reach of children.

Vumerity dosage FAQs

How long does it take Vumerity to work?

Vumerity is a long-term treatment, and success is measured in months or years. The measure of success is how much it slows down disability progression associated with MS. Clinical trials lasted for two years. After 12 weeks, people taking Vumerity showed a significant slowing of disease progression compared to people on a placebo (inert drug). 

How long does Vumerity stay in your system?

Vumerity stays only a short time in the body. The active ingredient, diroximel fumarate, is converted to its active metabolite, MMF, before it reaches the bloodstream. MMF has a half-life of one hour and is primarily eliminated through breathing. So, Vumerity stays in the system for only a few hours and does not build up in the bloodstream like other drugs.

What happens if I miss a dose of Vumerity?

Ask the healthcare provider or the Biogen Support Coordinator what to do if a dose is missed. The manufacturer has not specified how missed or forgotten doses should be managed.

How long can you take Vumerity?

Vumerity is intended as a long-term, possibly lifelong, treatment. There are no side effects associated with long-term use. Clinical trials of the bioequivalent drug dimethyl fumarate have lasted 13 years. The participants experienced side effects more often in the first few months than in later years, though some dropped out during these studies because of side effects. 

How do I stop taking Vumerity?

Do not stop taking Vumerity until talking to the healthcare provider. Vumerity does not require a tapered dose before discontinuation, but a suitable alternative MS treatment should be established to prevent further progression of disability.

People stop taking Vumerity primarily because of side effects, including possible allergic reactions. In clinical studies, the most reported side effect that led to discontinuation of the medication was gastrointestinal issues.

The healthcare provider treating MS has many other medications that can slow the progress of the disease. These treatments are called disease-modifying therapies, and they include pills like Vumerity, monoclonal antibodies, and injections such as Copaxone (glatiramer acetate). Most work by suppressing the immune system, so infections are a common side effect. 

What is the maximum dosage for Vumerity?

The maximum dosage for Vumerity is 462 mg twice daily.

Can you overdose on Vumerity?

Although Vumerity’s prescribing information does not indicate symptoms of an overdose, if too much is taken, immediately go to a hospital or emergency room. 

What interacts with Vumerity?

Vumerity has very few drug interactions. Ensure the prescribing healthcare provider knows about all the drugs and supplements used. 

Vumerity is never combined with dimethyl fumarate, another MS treatment. The body converts dimethyl fumarate into MMF like Vumerity, so co-administration of the two is comparable to taking a double dose.

The healthcare provider may suggest taking non-enteric coated aspirin to prevent flushing. Make sure to take the aspirin 30 minutes before taking a dose of Vumerity.

What happens when you mix Vumerity and alcohol?

People can consume alcohol when on Vumerity. However, do not drink alcohol at about the same time a Vumerity dose is taken, or the effects of Vumerity will be decreased. 

Is it safe to take Vumerity during pregnancy?

Women who are pregnant or considering pregnancy should get medical advice from a healthcare provider. Healthcare providers do not know if Vumerity use during pregnancy is a risk, and there is no evidence that it can cause birth defects or problems during pregnancy.

Is it safe to take Vumerity while breastfeeding?

Women who are breastfeeding or planning to breastfeed should consult with a healthcare provider before starting Vumerity. It is unknown if diroximel fumarate or monomethyl fumarate is present in human breast milk or affects a nursing infant.

What Vumerity side effects can be expected?

The most common side effects of Vumerity are flushing (in about 40% of patients), abdominal pain, diarrhea, nausea, and vomiting. In clinical studies, most people who stopped the drug did so because of gastrointestinal adverse effects. Hair loss (alopecia) has been associated with Vumerity, but it is not common and may not be related to the drug.

What are the most serious side effects of Vumerity?

Severe side effects of Vumerity are rare, including serious infections such as progressive multifocal leukoencephalopathy (PML), herpes zoster infections, and opportunistic infections. Other severe adverse reactions include liver problems, low white blood cell counts (lymphopenia), severe allergic reactions such as anaphylaxis or angioedema, and severe and potentially fatal gastrointestinal conditions such as ulcers, bleeding, and perforation.