May 30, 2017
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"Teriflunomide (Aubagio, Genzyme/Sanofi), a once-daily oral medication approved for relapsing-remitting multiple sclerosis (RRMS), significantly slows brain volume loss in these patients, a reanalysis of imaging data has shown.






Three cases of overdose were reported in controlled clinical trials with AMPYRA, involving two MS patients. The first patient took six times the currently recommended dose (60 mg) and was taken to the emergency room with altered mental state. The second patient took 40 mg doses on two separate occasions. In the first instance, she experienced a complex partial seizure and, in the second instance, a period of confusion. Both patients recovered by the following day without sequelae.

Several cases of overdose are found in the scientific literature in which various formulations of dalfampridine were used, resulting in numerous adverse events including seizure, confusion, tremulousness, diaphoresis, and amnesia. In some instances, patients developed status epilepticus, requiring intensive supportive care and were responsive to standard therapy for seizures. In one published case report, an MS patient who ingested 300 mg of 4-aminopyridine (dalfampridine) developed a condition that resembled limbic encephalitis. This patient developed weakness, reduced awareness, memory loss, hypophonic speech, and temporal lobe hyperintensities on MRI. The patient's speech and language and ambulation improved over time, and an MRI at 4 months after the overdose no longer showed signal abnormalities. At one year, the patient continued to have difficulty with short term memory and learning new tasks.


The use of AMPYRA is contraindicated in the following conditions:

  • History of seizure
  • Moderate or severe renal impairment (CrCl≤50 mL/min)
  • History of hypersensitivity to AMPYRA or 4-aminopyridine
This monograph has been modified to include the generic and brand name in many instances.

Last reviewed on RxList: 5/1/2017


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