Zeposia (ozanimod) is a prescription drug that’s used to treat multiple sclerosis and ulcerative colitis. Zeposia can cause side effects that range from mild to serious. Examples include upper respiratory infection and increased liver enzymes.

Specifically, Zeposia is used to treat the following conditions in adults:

The active ingredient in Zeposia is ozanimod. (An active ingredient is what makes a drug work.) The drug comes as an oral capsule.

Keep reading to learn about the common, mild, and serious side effects that Zeposia can cause. For a general overview of the drug, including details about its uses, see this article.

Some people taking Zeposia may experience mild or serious side effects during treatment. Examples of commonly reported side effects include:

Side effects can vary depending on the condition you’re taking Zeposia to treat. Some of the more common side effects in people taking Zeposia for ulcerative colitis (UC) include:

  • increased liver enzyme levels*
  • headache*

Some of the more common side effects in people taking Zeposia for multiple sclerosis (MS) include:

These aren’t all the side effects Zeposia may cause. Ask your doctor or pharmacist for more information about what to expect with Zeposia treatment.

* To learn more about this side effect, see the “Side effects explained” section below.

Mild side effects have been reported with Zeposia, such as:

In most cases, these side effects should be temporary. And some may be easily managed. If you have symptoms that are ongoing or bothersome, talk with your doctor or pharmacist. But don’t stop taking Zeposia unless your doctor recommends it.

Zeposia may cause mild side effects other than the ones listed above. See the Zeposia prescribing information for details.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you’d like to notify the FDA about a side effect you’ve had with Zeposia, visit MedWatch.

* To learn more about this side effect, see the “Side effects explained” section below.

Serious side effects have been reported with Zeposia. Although serious side effects are rare, your risk of experiencing them may be higher if you’re taking certain other medications with Zeposia or if you have other serious health conditions.

Serious side effects that have been reported with Zeposia include:

The following serious side effects can occur after you stop taking Zeposia:

If you develop serious side effects while taking Zeposia, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

* To learn more about this side effect, see the “FAQ about Zeposia’s side effects” section just below.
† To learn more about this side effect, see the “Side effects explained” section below.

Below are answers to some frequently asked questions about Zeposia.

Can Zeposia cause eye-related side effects?

Yes. In studies of Zeposia, some people experienced macular edema. This refers to fluid buildup in the macula of the eye. The macula is located in the center of the retina. Macular edema can cause blurry vision or other vision changes.

People with diabetes or uveitis may be at higher risk of this side effect. Autoimmune conditions, such as inflammatory bowel disease (IBD), can also cause eye-related problems.

Be sure to let your doctor know if you have diabetes or a history of eye-related problems. These may increase your risk of macular edema while taking Zeposia. Your doctor will likely have you get an eye exam before you begin Zeposia and during treatment, as needed.

Does Zeposia cause dizziness?

Yes. In studies of the drug, some people experienced dizziness. This may be due to other side effects of Zeposia, such as slowed heart rate or low blood pressure.

If you experience dizziness when you start taking the drug, be careful when you stand up or change positions. Also, until you become used to the effects of Zeposia, be careful when:

  • operating machinery
  • doing other tasks that require alertness

Ask your doctor what you can do to minimize dizziness while taking Zeposia.

Can Zeposia cause herpes infection?

Taking Zeposia may increase your risk of getting a herpes infection if you’re exposed to the herpes virus. This is a rare side effect of the drug.

You may be at higher risk of developing a herpes infection if you don’t have antibodies to the varicella-zoster virus. This is why your doctor will ask you about your history of chickenpox. They’ll also want to know if you’ve been fully vaccinated against the varicella-zoster virus, which causes chickenpox and shingles.

Your doctor will talk with you about your immunization history and whether you need any vaccines before starting Zeposia.

Learn more about some of the side effects Zeposia may cause.

Trouble breathing

Zeposia may cause shortness of breath. In studies of the drug, some people taking Zeposia had reduced lung function, which caused trouble breathing.

Zeposia may also increase your risk of respiratory infections, which can also worsen breathing difficulties.

If you have a lung condition, such as asthma or chronic obstructive pulmonary disease (COPD), tell your doctor. Also be sure your doctor knows if you have sleep apnea. These conditions may worsen breathing difficulties with Zeposia. Your doctor will evaluate your lung function if needed and will determine the safety of Zeposia for you.

What might help

If you have trouble breathing after starting Zeposia, call your doctor immediately. They’ll check to see if you have a decrease in lung function or another serious breathing problem. They’ll let you know the best options for managing your breathing issues and whether Zeposia is safe to take.

Urinary tract infection

Zeposia can cause frequent or painful urination. This may be a sign of a urinary tract infection (UTI). In studies of Zeposia, people had more frequent UTIs while taking this medication.

Zeposia can increase your risk of infections, including UTI, for up to 3 months after you stop taking the drug.

Your doctor will order a complete blood count (CBC) test before starting Zeposia. This can show whether you currently have an infection, including a UTI. If you have a UTI, you’ll wait to start Zeposia until it’s gone.

If you have an active infection, you’ll wait to start Zeposia until it’s gone. If you develop a UTI during treatment with Zeposia, your doctor will treat your infection. They may pause or stop your Zeposia treatment if you develop a serious infection.

What might help

Be sure to tell your doctor if you have a history of UTIs or any other type of infection. And if you develop UTI symptoms while taking Zeposia, such as frequent or painful urination, contact your doctor.

You can also try things at home to help prevent or treat UTI, such as drinking plenty of water.

Liver problems

In studies, Zeposia increased liver enzyme levels in some people. This was a common but mild side effect.

In rare cases, there is a risk of serious liver damage with Zeposia use.

Symptoms of increased liver enzymes include:

What might help

Your doctor will have you take a liver function test before you start Zeposia. They’ll also check you for signs of liver-related problems during your treatment.

Contact your doctor right away if you have any symptoms of liver problems.

Back pain

You may experience back pain when you start treatment with Zeposia. This was one of the more common side effects reported in studies. Be sure to tell your doctor if you have back pain, since this may be caused by:

What might help

Your doctor may do blood tests to check whether your back pain could be caused by a UTI or liver-related problems before you start treatment. They may recommend an over-the-counter pain medication or ice or heat therapy for mild back pain relief.

Headache

Headache is a common side effect of Zeposia.

Let your doctor know if you have a history of migraine or chronic headaches. They may suggest other options for you instead of Zeposia.

What might help

If you get a mild headache while taking Zeposia, your doctor may suggest taking an over-the-counter pain reliever. But if your headache is severe or frequent, contact your doctor. They may have you stop Zeposia and will suggest other treatments.

If you have a headache with any of the following symptoms, contact your doctor right away:

These could be symptoms of a more serious condition.

Allergic reaction

Like most drugs, Zeposia can cause an allergic reaction in some people. Symptoms can be mild or serious and can include:

  • rash
  • itchiness
  • flushing (temporary warmth, redness, or deepening of skin color)
  • swelling under your skin, usually in your eyelids, lips, hands, or feet
  • swelling of your mouth, tongue, or throat, which can make it hard to breathe

What might help

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest the following to help you manage your symptoms:

If your doctor confirms you had a mild allergic reaction to Zeposia, they’ll decide if you should continue taking it.

If you have symptoms of a severe allergic reaction, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

If your doctor confirms you had a serious allergic reaction to Zeposia, they may have you switch to a different treatment.

Keeping track of side effects

During your Zeposia treatment, consider keeping notes on any side effects you’re having. Then, you can share this information with your doctor. This is especially helpful to do when you first start taking new drugs or using a combination of treatments.

Your side effect notes can include things such as:

  • what dose of the drug you were taking when you had the side effect
  • how soon you had the side effect after starting that dose
  • what your symptoms were
  • how it affected your daily activities
  • what other medications you were taking
  • any other information you feel is important

Keeping notes and sharing them with your doctor will help your doctor learn more about how Zeposia affects you. And your doctor can use this information to adjust your treatment plan if needed.

Zeposia may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before you take Zeposia. The list below includes factors to consider.

High or low blood pressure: Zeposia can change your blood pressure, so be sure to tell your doctor if you have blood pressure problems. Zeposia can raise your blood pressure to dangerous levels in some cases. It may also cause low blood pressure when you stand up. Due to these risks, your doctor may monitor your blood pressure more frequently if you take Zeposia. They’ll determine whether the drug is safe for you to take.

Allergic reaction: If you’ve had an allergic reaction to Zeposia or any of its ingredients, your doctor will likely not prescribe it for you. Ask your doctor what other medications may be better options for you.

Diabetes: If you have diabetes, taking Zeposia may increase your risk of macular edema. Your doctor may have you get eye exams, both before starting Zeposia and while taking it. They may also recommend checking your blood sugar levels more often during treatment. Depending on how severe your diabetes and any eye conditions are, your doctor may recommend a different treatment for you.

Liver problems: Zeposia may increase liver enzymes, which may be a sign of liver damage. If you have a history of liver problems, talk with your doctor. They’ll check your liver function before you start taking Zeposia and also during treatment. In some cases, your doctor may suggest other treatment options for your condition.

Eye problems: Zeposia can cause an eye problem called macular edema. If you have diabetes or a history of eye inflammation, such as uveitis, your risk of developing macular edema is higher. Talk with your doctor about your eye health history. They may have you get an eye exam before and during Zeposia treatment, as needed.

Slowed heart rate: Zeposia can cause a slowing of your heart rate. If you already have a slow heart rate, Zeposia can make this condition worse. In this case, your doctor may start you on a low dose of Zeposia and slowly increase it over time. They’ll monitor your heart rate during treatment and may suggest other options if needed.

Breathing problems: Before starting Zeposia, tell your doctor if you have any breathing problems, including sleep apnea. This medication can cause breathing trouble, such as shortness of breath. If you have breathing problems, talk with your doctor about the safety of Zeposia for you.

Heart problems: Tell your doctor if you have any heart problems, such as an irregular heartbeat. Zeposia may not be safe for you if you’ve had any of the following in the past 6 months:

Zeposia may worsen your heart condition. Ask your doctor for more information about the safety of Zeposia if you have heart problems.

Taking a monoamine oxidase inhibitor (MAOI) drug: Due to the risk of extremely high blood pressure, your doctor will probably not prescribe Zeposia if you’re taking an MAOI. Talk with them about other treatment options that might be better for you if you take an MAOI.

Vaccination: Zeposia can increase your risk of infection, which may be serious. It’s important that you not get any live vaccines* during Zeposia treatment and for 3 months after stopping it. If you have any immunizations planned, be sure to get them at least 1 month before starting Zeposia. This will help reduce your risk of vaccine-related infection. Talk with your doctor if you have any questions about live vaccines and immunizations.

Active infection: If you have an active infection, your doctor will recommend treating it before you start Zeposia. This medication can worsen an active infection, such as herpes or a UTI. Tell your doctor if you have any signs of infection during Zeposia treatment and for 3 months after you’ve finished it.

Zeposia may have warnings other than the ones listed above. See the Zeposia prescribing information for details.

* Live vaccines contain a small amount of weakened live virus or bacteria. Examples include the measles, mumps, and rubella (MMR), varicella (chickenpox), and rotavirus vaccines.

Alcohol use and Zeposia

Zeposia may interact with alcoholic drinks that are high in tyramine, such as certain types of wine and beer. This can increase your risk of certain side effects with Zeposia, including high blood pressure.

If you drink alcohol, ask your doctor how much, if any, and what types are safe to drink while taking Zeposia.

Pregnancy and breastfeeding while taking Zeposia

It’s not known if Zeposia is safe to take during pregnancy or while breastfeeding.

If you’re able to become pregnant, your doctor will recommend using an effective type of birth control. You’ll need to do this while you’re taking Zeposia and for 3 months after stopping treatment.

If you have questions about the risks of Zeposia during pregnancy or while breastfeeding, talk with your doctor.

Zeposia can help you manage your ulcerative colitis (UC) and multiple sclerosis (MS) symptoms. But you may experience some side effects from this medication. Your side effects may depend on factors such as the severity of your condition, your overall health, and any other medications you take.

For more information about Zeposia treatment, talk with your doctor or pharmacist. Here are a few questions to consider asking:

  • I have high blood pressure. Will this increase my risk of side effects from Zeposia?
  • What would lower my risk of having an allergic reaction with Zeposia?
  • How can I manage side effects of Zeposia?

To learn more about Zeposia, see these articles:

To get information on different conditions and tips for improving your health, subscribe to any of Healthline’s newsletters. You may also want to check out the online communities at Bezzy. It’s a place where people with certain conditions can find support and connect with others.

Q:

I get frequent urinary tract infections (UTIs). Will Zeposia increase my risk of getting them?

Anonymous

A:

Yes, Zeposia can increase your risk of getting UTIs. This was one of the most common side effects reported in studies of Zeposia.

Your doctor will have you get a complete blood count (CBC) blood test before starting Zeposia. This can show whether you currently have an infection, including a UTI. If you have a UTI, your doctor may delay starting your treatment until the infection resolves.

Call your doctor right away if you have signs of a UTI, such as frequent and painful urination. Infections such as UTIs are more likely during your treatment with Zeposia and for three months following your last dose. If you get frequent UTIs, talk with your doctor about the safety of Zeposia for you.

The Healthline Pharmacist TeamAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
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Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.