Formulary
Etrasimod: Indications, Dosing, Side Effects and Interactions
Etrasimod is a sphingosine-1-phosphate receptor modulator, which prevents movement of lymphocytes out of lymph nodes, thereby limiting inflammation in the...
MedNext Academy | 3 min read
Etrasimod: Indications, Dosing, Side Effects and Interactions
Etrasimod is a sphingosine-1-phosphate receptor modulator, which prevents movement of lymphocytes out of lymph nodes, thereby limiting inflammation in the...
Drug action
Etrasimod is a sphingosine-1-phosphate receptor modulator, which prevents movement of lymphocytes out of lymph nodes, thereby limiting inflammation in the intestine.
Indications and dose
**Ulcerative colitis (initiated under specialist supervision)**
- **Adult** (By Mouth): 2 mg once daily.
**Ulcerative colitis (initiated under specialist supervision) for etrasimod**
- **Child 16-17 years** (By mouth): 2 mg once daily.
Cautions
Administration of vaccinations; arrhythmias requiring treatment with Class Ia or Class III anti-arrhythmic drugs; asthma; body-weight less than 40 kg (increased risk of exposure); cerebrovascular disease; chronic obstructive pulmonary disease; diabetes mellitus (increased risk of macular oedema); elderly (limited information available); heart failure; immunosuppression or other risk factors for infection; myocardial infarction; patients receiving QT-prolonging or heart rate-lowering drugs, including beta-blockers and heart rate-lowering calcium-channel blockers; pulmonary fibrosis; recurrent syncope; retinal disease (increased risk of macular oedema); second-degree Mobitz type I AV block; severe respiratory disease; severe untreated sleep apnoea; significant QT prolongation (QTc equal to or greater than 470 milliseconds in females, or QTc equal to or greater than 450 milliseconds in males); sinus bradycardia (heart rate below 50 beats per minute); uncontrolled hypertension; uveitis (increased risk of macular oedema) Cautions, further information Bradycardia and cardiac rhythm disturbance Etrasimod may cause transient bradycardia, AV conduction delays and heart block after the first dose. It is not recommended in patients with a history of cardiac arrest, cerebrovascular disease, symptomatic bradycardia or recurrent syncope, unstable ischaemic heart disease, uncontrolled hypertension, severe untreated sleep apnoea, or significant QT prolongation or other risk factors for QT prolongation unless the anticipated benefits outweigh the potential risks, and advice from a cardiologist (including monitoring advice) is sought before initiation. M Vaccinations Vaccination may be less effective during and for up to 2 weeks after stopping treatment. Live attenuated vaccines should be avoided during and for 2 weeks after stopping treatment; if they are required they should be given at least 1 month prior to initiation. M
Contraindications
Active malignancy; decompensated heart failure (requiring inpatient treatment) in the previous 6 months; heart failure (New York Heart Association class III or IV) in the previous 6 months; immunodeficiency; myocardial infarction in the previous 6 months; phototherapy with UV-B radiation or PUVA-photochemotherapy (increased risk of cutaneous neoplasm); posterior reversible encephalopathy syndrome (suspected or confirmed); progressive multifocal leukoencephalopathy; second-degree Mobitz type II AV block, third-degree AV block, sick sinus syndrome or sino-atrial block, if the patient does not have a pacemaker; severe active infection; stroke (including transient ischaemic attack) in the previous 6 months; unstable angina in the previous 6 months
Side effects
Common or very common Arrhythmias; cystitis; dizziness; headache; hypercholesterolaemia; hypertension; increased risk of infection; lymphopenia; neutropenia; visual impairment Uncommon Atrioventricular block; macular oedema Frequency not known Hepatic disorders
Pregnancy
Avoid (toxicity in animal studies and limited human data suggests increased risk of abnormal pregnancy outcomes). M
Breast feeding
Specialist sources indicate use with caution, especially if breast-feeding a newborn or preterm infant (no information available). High plasma-protein binding suggests limited excretion into milk.
Hepatic impairment
Caution when history of significant liver disease (no information available); avoid in severe impairment. M
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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