Yes, teriflunomide can cause diarrhea
Diarrhea is a recognized and common side effect associated with teriflunomide (brand name Aubagio), a medication used to treat relapsing forms of multiple sclerosis (MS). According to prescribing information and clinical trial data, diarrhea is one of the most frequently reported adverse reactions, along with headache, nausea, and hair thinning.
Clinical trial results provide a clear picture of the prevalence of this side effect. In placebo-controlled studies, approximately 13-14% of patients on teriflunomide experienced diarrhea, compared to around 8% of those on a placebo. This indicates that the medication, and not just the condition or other factors, is a direct cause of the gastrointestinal distress. The severity of the diarrhea was typically described as mild to moderate and was usually transient, with many patients seeing their symptoms subside over the course of treatment. However, some individuals, such as those with underlying lactose intolerance, may experience more persistent issues.
How does teriflunomide cause diarrhea?
Teriflunomide is an immunomodulatory drug that works by inhibiting an enzyme crucial for the synthesis of pyrimidine nucleotides, which are essential for the proliferation of activated lymphocytes. While this mechanism helps reduce the inflammatory activity central to MS, it can also disrupt other cellular processes in the body, including those within the gastrointestinal tract. The exact pathway leading to diarrhea is not fully understood, but it is thought to be related to the drug's effect on rapidly dividing cells, potentially including those lining the gut. Another factor identified in a case report is that some teriflunomide formulations contain lactose, which can exacerbate or induce diarrhea in patients with lactose malabsorption or intolerance.
Managing diarrhea from teriflunomide
Most cases of teriflunomide-induced diarrhea are mild and can be managed effectively with dietary adjustments and lifestyle changes. Patients should not stop taking their medication without consulting a healthcare provider, especially as the diarrhea often improves with time.
Simple dietary and lifestyle tips include:
- Stay hydrated: Drink plenty of fluids, such as water, broth, or oral rehydration solutions, to replace lost electrolytes and prevent dehydration.
- Follow the BRAT diet: Bananas, rice, applesauce, and toast are bland foods that can help firm up stools and are easy on the digestive system.
- Eat small, frequent meals: Instead of three large meals, try eating smaller portions more often throughout the day.
- Avoid trigger foods: Limit or avoid foods that can aggravate diarrhea, such as spicy, greasy, or high-fiber foods, as well as caffeine and alcohol.
- Consider probiotics: Some healthcare providers may recommend adding probiotics to help restore a healthy balance of gut bacteria.
When to contact your doctor
While most cases are mild, it is important to contact a healthcare professional if the diarrhea is persistent, severe, or is accompanied by other concerning symptoms. Severe symptoms requiring immediate medical attention include:
- Unusual bruising or bleeding
- Signs of infection like fever and chills
- Persistent nausea or vomiting
- Severe abdominal pain
- Dark urine or yellowing of the skin or eyes (signs of liver issues)
In rare cases, if diarrhea becomes severe and chronic, your doctor may consider temporarily stopping the medication or initiating an accelerated elimination procedure to quickly lower the drug concentration in your blood, as was done in a case study involving a patient with severe diarrhea associated with high teriflunomide levels.
Teriflunomide side effects comparison
To put the incidence of teriflunomide-induced diarrhea into perspective, the table below compares the occurrence of common adverse events in clinical trials between teriflunomide and placebo groups:
| Adverse Reaction | Teriflunomide Tablets 14 mg | Placebo |
|---|---|---|
| Headache | 16% | 15% |
| Increase in Alanine aminotransferase (ALT) | 15% | 9% |
| Diarrhea | 14% | 8% |
| Alopecia (hair loss) | 13% | 5% |
| Nausea | 11% | 7% |
| Paresthesia (numbness/tingling) | 9% | 7% |
| Hypertension | 4% | 2% |
This table highlights that while diarrhea is more common with teriflunomide than with a placebo, the incidence is still relatively modest and is not the most frequent side effect reported. Nonetheless, it remains a significant consideration for patients starting the medication.
Conclusion
For those wondering, “does teriflunomide cause diarrhea?”, the answer is a definitive yes. Diarrhea is a well-documented and common side effect of this MS medication, with clinical trials showing a higher incidence in patients taking teriflunomide compared to placebo. However, the good news is that most cases are mild to moderate in severity and tend to be temporary, especially during the initial months of treatment. Effective management strategies, including staying hydrated, adopting a bland diet, and avoiding trigger foods, can significantly alleviate symptoms. It is important to monitor symptoms and communicate any persistent or severe issues to a healthcare provider. They can help determine if the diarrhea is related to a medication intolerance, like lactose, or if other medical interventions are necessary, all while ensuring the patient remains safely on their disease-modifying therapy.
