[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Multiple sclerosis disease-modifying therapies](https://durgical.com/en/pharmacology/classes/multiple-sclerosis-disease-modifying-therapies/) › Ozanimod

# Ozanimod

## Multiple sclerosis disease-modifying therapies?

Multiple sclerosis disease-modifying therapies

An oral S1P receptor modulator that keeps lymphocytes inside lymph nodes. Used for relapsing MS and ulcerative colitis; it slows the heart at the start.

Updated Nov 1, 2026

## Quick facts

**Group**
[Multiple sclerosis disease-modifying therapies](https://durgical.com/en/pharmacology/classes/multiple-sclerosis-disease-modifying-therapies/)

**Target**
Sphingosine-1-phosphate receptor 1 (S1PR1)

**Used for**
Relapsing forms of multiple sclerosis

**Key effects**
Upper respiratory and urinary infections · Back pain

**Monitor**
ECG before starting · Blood count · Blood pressure

**ATC**
L04AE02

No doses: the clinician sets them by the current guideline.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## Mechanism of action

◎**Sphingosine-1-phosphate receptor 1 (S1PR1)**Ozanimod

ⓘ The figure shows ozanimod bound to the human S1P1 receptor coupled to its Gi protein.

**Target in 3D:** Sphingosine-1-phosphate receptor 1 (S1PR1). PDB structure 7EW0 (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/7EW0) · Drag to rotate · pinch to zoom

Ozanimod acts directly (it is not a prodrug) and has high affinity for the S1P1 and S1P5 receptors. Like other S1P receptor modulators it behaves as a functional antagonist: it causes the S1P1 receptor to be internalized and degraded, so lymphocytes no longer follow the S1P signal that lets them leave lymph nodes. Fewer lymphocytes reach the brain or the colon.

- Ozanimod binds S1P1 on lymphocytes
- The receptor is internalized and degraded
- Lymphocytes stay trapped in lymph nodes
- Less inflammation in the CNS or the colon

## Indications

- Relapsing forms of multiple sclerosis (including clinically isolated syndrome and active secondary progressive disease) [Multiple sclerosis →](https://durgical.com/en/conditions/multiple-sclerosis/)
- Moderate to severe ulcerative colitis [Ulcerative colitis →](https://durgical.com/en/conditions/ulcerative-colitis/)

## Adverse effects

### Common

- Upper respiratory and urinary infections
- Back pain
- Dizziness on standing, mainly at the start
- Raised liver enzymes

### Serious (rare, important)

- Slow heartbeat or heart block, mainly when starting
- Serious infections, including meningitis and progressive multifocal leukoencephalopathy (PML)
- Macular oedema (blurred vision, a blind spot in the centre of vision)
- Liver injury
- Posterior reversible encephalopathy syndrome (sudden severe headache, confusion, seizures)
- Skin cancer
- Severe worsening of MS after stopping
- High blood pressure

## Contraindications

- Heart attack, unstable angina, stroke, TIA or heart failure in the previous 6 months
- Some heart rhythm disorders without a pacemaker
- Severe untreated sleep apnoea
- Active infection

## Key interactions

**MAO inhibitors, opioids, SSRIs, SNRIs and tricyclic antidepressants**
Risk of a hypertensive reaction through the MAO-B-inhibiting metabolite

**Tyramine-rich foods (aged, smoked or fermented foods)**
Risk of a serious rise in blood pressure

**Medicines that slow the heart**
More bradycardia

**Live vaccines**
Not given during treatment and for 3 months after the last dose without the treating team's advice

## What is monitored

- ECG before starting
- Blood count, liver tests and eye examination (macula) before and during treatment
- Blood pressure
- Skin checks for cancer
- Varicella immunity before starting

## Administration and safety

- Oral capsule, raised over the first week
- Bradycardia is most likely in the first 8 days

## Pregnancy and breastfeeding

It may harm the fetus; effective contraception is used during treatment and for 3 months after the last dose.

## Nursing care

- Measure pulse and blood pressure, especially in the first week
- Teach to get up slowly at first (dizziness on standing)
- Give the tyramine-restricted food list
- Teach the signs of infection, which can occur up to 3 months after stopping
- Advise effective contraception during treatment and for 3 months after

## Pharmacokinetics

**Absorption**
Oral, with good bioavailability

**Metabolism**
To several active metabolites, one of which inhibits MAO-B

**Half-life**
The effect lasts much longer than the parent drug because of its active metabolites

## Memory aid

«OZANIMOD = Ozone Zone: lymphocytes locked in the nodes»; and its metabolite hits MAO-B, so beware tyramine.

## Test yourself

Think of the answer, then tap the question to see it.

## How do S1P receptor modulators such as ozanimod reduce inflammation?

They internalize S1P1 receptors and keep lymphocytes trapped in lymph nodes.

## Why must people on ozanimod watch tyramine and certain antidepressants?

One active metabolite inhibits MAO-B, which can cause hypertensive reactions.

## Besides MS, which disease is ozanimod approved for?

Ulcerative colitis.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/ozanimod/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## Connections

## Related drugs 3

- [Fingolimod](https://durgical.com/en/pharmacology/fingolimod/)
- [Siponimod](https://durgical.com/en/pharmacology/siponimod/)
- [Natalizumab](https://durgical.com/en/pharmacology/natalizumab/)

## Related conditions 2

- [Multiple sclerosis](https://durgical.com/en/conditions/multiple-sclerosis/)
- [Ulcerative colitis](https://durgical.com/en/conditions/ulcerative-colitis/)

[← Back to the class: Multiple sclerosis disease-modifying therapies](https://durgical.com/en/pharmacology/classes/multiple-sclerosis-disease-modifying-therapies/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [Ozanimod: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a620029.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=L04AE02) (WHO Collaborating Centre for Drug Statistics Methodology, 2026); [RCSB PDB - 7EW0: Cryo-EM structure of ozanimod -bound Sphingosine-1-phosphate receptor 1 in complex with Gi protein](https://www.rcsb.org/structure/7EW0) (RCSB Protein Data Bank, 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/ozanimod/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/ozanimod/