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Because natalizumab carries some serious potential risks, patients who take this medication must enroll in a special program that helps the FDA monitor side effects of the drug. The most serious side effect is increased risk for a rare neurological condition called progressive multifocal leukoencephalopathy (PML), which can lead to death or severe disability. Other serious side effects of natalizumab include allergic reactions, and increased susceptibility to infections including serious herpes infections. In general, natalizumab should not be used by patients who are currently taking immunosuppressant drugs.
Natalizumab may cause liver injury within a week of starting the drug. Other less serious side effects may include headache, fatigue, urinary tract infections, joint and limb pain, rash, and infusion reactions.
Other Medications
Antibiotics. Antibiotics may be used as a first-line treatment for fistulas, bacterial overgrowth, abscesses, and any infections around the anus and genital areas. Standard antibiotics include ciprofloxacin (Cipro) and metronidazole (Flagyl). Ciprofloxacin is the antibiotic of choice.
Over time, metronidazole can cause peripheral neuropathy, a nerve disorder that can cause numbness and tingling in the hands and feet. Other side effects associated with metronidazole include nausea, vomiting, diarrhea, loss of appetite, dizziness, and headaches.
Although ciprofloxacin causes fewer side effects than metrondizaole, it can interact with antacids (Rolaids, Tums) and vitamin and mineral supplements that contain calcium, iron, or zinc. Do not take antacids or vitamin supplements at the same time as the ciprofloxacin dose.
Anti-Diarrheal Drugs. Mild-to-moderate diarrhea may be reduced by daily use of psyllium (Metamucil). Standard anti-diarrheal medications include loperamide (Imodium) or a combination of atropine and diphenoxylate (Lomotil). In some cases, codeine may be prescribed.
Review Date: 09/28/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine,
Harvard Medical School; Physician, Massachusetts General Hospital.
Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M.,
Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
