Dalfampridine

Indications

Dalfampridine is used for: Multiple Sclerosis

Adult Dose

Multiple Sclerosis Indicated to improve walking in patients with multiple sclerosis by increasing walking speed 10 mg PO bid with or without food; take doses 12 hr apart Extended-release tablet; swallow tablet whole and do not chew, crush, divide, or dissolve tablets

Child Dose

<18 years: Safety and efficacy not established

Renal Dose

Renal impairment Moderate-to-severe (CrCl <50 mL/min): Contraindicated due to increased risk of seizures Mild (CrCl 51-80 mL/min): Risk of seizure unknown, but plasma levels may be similar to levels of 15 mg PO bid, a dose that is possibly associated with increased seizure risk

Administration

Contra Indications

Hypersensitivity Moderate or severe renal impairment (CrCl ≤50 mL/min) History of seizure

Precautions

Seizures reported; permanently discontinue if seizure occurs; majority of seizures happened within days to weeks after starting the recommended dose and occurred in patients having no history of seizures Age-related decreases in renal function, and mild renal impairment is common after age 50 yr, plasma levels may approach those seen at dose of 15 mg twice daily, a dose that may be associated with an increased risk of seizures; even when serum creatinine is normal, renal function should be assessed by estimating creatinine clearance Do not take with other forms of 4-aminopyridine (4-AP, fampridine) to avoid adverse reaction due to the same active ingredient Estimate CrCl before initiating (see Contraindications and Renal Impairment) Do not double dose or take extra if dose missed Anaphylaxis and severe allergic reactions; signs and symptoms have included respiratory compromise, urticaria, and angioedema of the throat and or tongue; discontinue immediately and do not restart (see Contraindications) UTIs reported more frequently in clinical trials vs. placebo

Pregnancy-Lactation

Pregnancy There are no adequate data on developmental risk associated with use in pregnant women Animal data Administration to animals during pregnancy and lactation resulted in decreased offspring viability and growth at clinically relevant doses Lactation There are no data on presence of drug in human milk, effects on breastfed infant, or on milk production; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed infant from drug or from underlying maternal condition

Interactions

Contraindicated (0) Serious (1) trilaciclib

Adverse Effects

Side effects of Dalfampridine : >10% Urinary tract infection (12%) 1-10% Insomnia Dizziness Headache Nausea Asthenia Back pain Balance disorder Multiple sclerosis relapse Paresthesia Nasopharyngitis Constipation Dyspepsia Pharyngolaryngeal pain Dose-related increased risk of seizures

Mechanism of Action

Mechanism not completely understood, but in animal studies shown to block potassium channels, to delay repolarization and to increase duration of action potentials in demyelinated axons Does not prolong QTc interval