Drug General Information (ID: DDIPGU8LS2)
Drug Name			Dimethyl fumarate		Drug Info		Monomethyl fumarate		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Selective Immunosuppressants				Selective Immunosuppressants
Structure

Mechanism of Dimethyl fumarate-Monomethyl fumarate Interaction (Severity Level: Major)
Increased risk of hepatotoxicity Click to Show/Hide Mechanism Graph
Drug Name		Dimethyl fumarate				Monomethyl fumarate
Mechanism		Hepatotoxicity				Hepatotoxicity
Key Mechanism Factor 1
		Factor Name		Hepatotoxicity
		Factor Description		Combination of drugs that can induce hepatotoxicity may increase the risk of liver injury. Symptoms vary depending on the level of exposure and the total extent of liver damage, and may cause few symptoms if the damage is mild, and eventually lead to liver failure in patients with severe damage.
Mechanism Description		Increased risk of hepatotoxicity by the combination of Dimethyl fumarate and Monomethyl fumarate

Recommended Action
Management		Coadministration of monomethyl fumarate, dimethyl fumarate, or diroximel fumarate with one another is considered contraindicated. According to the prescribing information, treatment with monomethyl fumarate may be initiated the day following discontinuation of dimethyl fumarate or diroximel fumarate. Likewise, diroximel fumarate may be started the day after stopping dimethyl fumarate.

References
1	Product Information. Tecfidera (dimethyl fumarate). Biogen Inc, Cambridge, MA.
2	Product Information. Vumerity (diroximel fumarate). Alkermes, Inc, Cambridge, MA.