Accelerated elimination

An accelerated elimination procedure may be needed to eliminate teriflunomide from the body very quickly. This is typically done for women of childbearing age who wants to fall pregnant or has fallen pregnant. It may also be done when switching treatments.

After stopping treatment with teriflunomide:

1. Cholestyramine 8 g is administered 3 times daily for a period of 11 days, or cholestyramine 4 g three times a day can be used. The 4g protocol is only recommended if cholestyramine 8 g three times a day is not well tolerated.
2. Alternatively, 50 g of activated powdered charcoal is administered every 12 hours for a period of 11 days.

In the case of a women wanting to fall pregnant the effectiveness of the accelerated elimination procedure can be verified by two tests at an interval of at least 14 days and a waiting period of one-and-a-half months between the first occurrence of a plasma concentration below 0.02 mg/l and fertilisation is required.

Please not that both cholestyramine and activated powdered charcoal may influence the absorption of oestrogens and progestogens such that the oral contraceptive pill cannot be guaranteed during the accelerated elimination procedure. During this period use of alternative contraceptive methods is recommended.