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Why does Zeposia (ozanimod) slow down your heart rate?

Medically reviewed by Carmen Pope, BPharm. Last updated on Sep 6, 2024.

Official answer

by Drugs.com

The reason Zeposia (ozanimod) may slow down your heart rate temporarily, especially for the first 8 days after you start taking it, is thought to be due to the action of Zeposia binding to one of the S1P receptors' subunits, S1P1R, which also has an effect of potassium channels in cardiac muscle cells. This reduces how responsive the cardiac cells are and reduces their firing rate, which slows down the heart.

Before starting Zeposia you will have a test to check the electrical activity of your heart called an electrocardiogram (ECG).

How does Zeposia affect your heart rate?

The reason a decrease in heart rate is seen with the very first dose of Zeposia is thought to be due to the presence of S1P receptors on cardiac muscle cells. So, in addition to binding to lymphocyte S1P receptors, Zeposia also influences cardiac muscle cell S1P receptors which activate inward potassium channels, reducing the excitability of muscle cells and decreasing how frequently they fire. This has the effect of slowing down the heart rate.

The reason this only happens temporarily – usually only with during the first week of Zeposia dosing and then not again – is thought to be explained by the cardiac muscle cell receptors becoming desensitized to Zeposia or internalization or degradation or the S1P receptor, meaning it no longer responds.

Many people experience short-lived decreases in heart rate when starting Zeposia. The incidence of this can be reduced by using a starting dose of 0.23mg ozanimod and increasing the dosage slowly over a week to the required maintenance dose.

Related questions

What should you do if Zeposia slows down your heart?

Although it is common for Zeposia to slow down your heart rate, call your healthcare provider if you experience the following symptoms of a slow heart rate:

  • dizziness
  • shortness of breath
  • lightheadedness
  • confusion
  • feeling like your heart is beating slowly or skipping beats
  • chest pain
  • tiredness.
References
  • Humphries ES, Dart C. Neuronal, and Cardiovascular Potassium Channels as Therapeutic Drug Targets: Promise and Pitfalls. J Biomol Screen. 2015;20(9):1055-1073. DOI:10.1177/1087057115601677 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4576507/
  • Tran JQ, Hartung JP, Olson AD, et al. Cardiac Safety of Ozanimod, a Novel Sphingosine-1-Phosphate Receptor Modulator: Results of a Thorough QT/QTc study. Clin Pharmacol Drug Dev. 2018;7(3):263-276. DOI:10.1002/cpdd.383 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5901414/
  • Zeposia Prescribing Information. Updated 08/2024. https://packageinserts.bms.com/pi/pi_zeposia.pdf

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