Your Guide to Mayzent for Multiple Sclerosis

Written by Patricia Weiser, PharmD
Medically Reviewed by Laurel Riemann, PharmD on November 18, 2025

Some treatments for multiple sclerosis (MS) help ease day-to-day symptoms, while others can help control an attack (relapse). Other medicines are designed to limit further damage to the nervous system. Medicines that can slow the progression, or worsening, of MS are known as disease-modifying treatments, or DMTs for short. 

DMTs cannot cure the disease, but they can slow it. Over time, this means fewer relapses and more delayed progression than if the disease were left untreated.

Many DMT options are available, including pills, injections, and intravenous infusions. There is no single option that works best for everyone because each person’s MS may respond differently. When choosing a treatment, you and your health care provider will consider factors such as how active the disease is, possible risks and side effects, other medical conditions, and your preferences.

One DMT for treating relapsing forms of MS is called Mayzent (siponimod). The Food and Drug Administration (FDA) approved Mayzent in 2019. It’s a once-daily tablet that you take by mouth, which some people may find easier or more convenient than medicines that are given by injection. 

This article covers frequently asked questions about taking Mayzent for MS.

Mayzent is FDA-approved to treat relapsing forms of MS, including:

  • Relapsing-remitting MS (RRMS): This is the most common type of MS. If you have RRMS, you have flare-ups (relapses) where your symptoms get worse for days to weeks. You also have time between relapses when your symptoms get better or go away (remission). During times of remission, the disease does not get worse.
  • Clinically isolated syndrome (CIS): CIS is an episode of MS-like symptoms (such as dizziness, numbness, and weakness) lasting at least 24 hours. It may be a one-time problem that you recover from, but for some people it can be a first sign of MS. 
  • Active secondary progressive MS (SPMS): Many people with RRMS go on to develop SPMS. If you have active SPMS, you may have more frequent relapses or worsening symptoms. You may also have new or changing lesions on MRI Scan.

Mayzent is specifically approved for use in adults. It is not known if the medicine is safe or effective for treating MS in children or adolescents. Mayzent may be used for other conditions as determined by your health care provider.

Mayzent is a type of medicine called a sphingosine 1‐phosphate (S1P) receptor modulator. Although the exact way these medicines work is not fully known, it is thought to involve limiting the movement of immune cells called lymphocytes. 

Lymphocytes are part of the immune activity that mistakenly attack the central nervous system in people with MS. When fewer of these cells enter the brain, there is less opportunity for inflammation and damage.

Mayzent works by attaching to specific S1P receptors 1 and 5. This stops lymphocytes from leaving your lymph nodes. By keeping lymphocytes inside your lymph nodes, Mayzent can reduce how many lymphocytes reach your central nervous system and can make relapses less frequent.

You and your health care provider will discuss the possible risks and benefits of taking Mayzent to decide if it is right for you. Before you start Mayzent, you will complete several tests to make sure the medicine is safe for you, including the following.

  • Genetic testing: Certain genes affect how your body processes medicines, including Mayzent. You will have a test to check your CYP2C9 genotype. The results help your health care provider choose the right dose and determine whether Mayzent is safe for you.
  • Heart evaluation: You will have an EKG to look for any heart rhythm concerns. Some people may need to see a heart specialist (cardiologist). Your provider will also review any medicines you take that may slow your heart rate. Make sure to tell your health care provider about all medicines that you take, especially any medicines for blood pressure, an abnormal heart rhythm, or other heart problems.
  • Blood tests: You will have a test to check your blood cell counts (such as white blood cells, red blood cells, and others). You may also need a blood test to check the health of your liver.
  • Eye exam: An eye doctor will test your vision and check the health of your eyes.
  • Skin check: A health care provider will check your skin. Any concerning spots may need to be monitored or treated by a skin specialist (dermatologist).
  • Medication review: Combining certain medicines with Mayzent could weaken your immune system too much and raise your risk of infections. Make sure to tell your health care provider about all medicines you take. Your health care team will review your current and past medicines to check for any medicines that lower your immune system. They will let you know if you need to stop or adjust any medicines before starting Mayzent.
  • Chickenpox immunity: You may be tested to see if you are immune to varicella zoster virus (chickenpox virus). If you are not immune, you may need to get a vaccine and wait four weeks for the vaccine to be fully effective before starting Mayzent.

Your health care provider will look at all your test results to determine if Mayzent is safe for you. You will need to get some of these tests regularly while taking Mayzent to help monitor for possible side effects during treatment.

Gene variations can affect the activity of CYP2C9, which is an enzyme that breaks down some medicines in your body, including Mayzent. Some gene variations (genotypes) could lead to higher or lower levels of the medicine than what’s intended. This could increase side effects or make the medicine less effective.

For this reason, you will have a genetic test before starting Mayzent. The results will help your health care provider determine if the medicine is safe for you and what dosage is right for you.

You will take Mayzent once daily. Swallow the tablet whole (not split, chewed, or crushed). 

Your exact dosage of Mayzent will depend on the results of a genetic test, as explained above. 

Based on your test results, your health care provider may prescribe a maintenance dosage of 1 mg once daily or 2 mg once daily.

Before you start the maintenance dosage, you will start with a low dose that increases each day for the first four days. Your first Mayzent prescription will probably come in a starter pack. The packaging is designed to guide you through your first week of treatment.

If you have a low heart rate or heart condition, your first dose of Mayzent may need to be given in a medical facility where your heart can be closely monitored. This is because Mayzent can temporarily slow your heart rate when you start treatment. Your pulse, blood pressure, and heart rhythm may be checked for about 6 hours after your first dose. If concerns arise, monitoring may continue longer, overnight, and for the next dose. Your health care provider will let you know if you need heart monitoring.

Like most medicines, Mayzent can cause side effects. But not everyone experiences them. Most people were able to tolerate Mayzent in clinical studies. Overall, 8.5% of participants ended up stopping Mayzent due to side effects, compared to about 5% of those taking a placebo (a tablet with no active medicine). Always talk to your health care provider before you stop Mayzent or any other medicines. 

The information below describes some of the side effects of Mayzent seen in studies and possible ways to prevent or manage them. This is not a complete list of side effects. Tell your health care provider if these side effects bother you or do not go away. They may let you know about other ways to prevent or manage Mayzent side effects.

Headache. Headache was the most common side effect seen in studies. Headache was reported by 15% of people taking Mayzent and 14% of those taking a placebo. Some people reported tension headaches or sinus headaches. Try the following strategies to help prevent or get rid of headaches while taking Mayzent.

  • Drink plenty of fluids to stay hydrated.
  • Eat a nutritious snack or drink a caffeinated beverage, such as a cup of tea. 
  • Massage your temples or neck for a few minutes.
  • Do some stretches and deep breathing to help release muscle tension.
  • Take a warm shower or place a warm compress on the back of your head or neck to ease muscle tension.
  • Lie down in a dark, quiet room or take a short nap. 
  • Ask your health care provider or pharmacist to recommend an over-the-counter pain reliever that is safe for you. Common examples are acetaminophen (Tylenol) and ibuprofen (Advil, Motrin). 

High blood pressure. In studies, high blood pressure was common, affecting 13% of people taking Mayzent. Your health care provider will check your blood pressure before you start Mayzent and will monitor it regularly during treatment. They may prescribe medicines to control your blood pressure. 

To help manage this side effect, you can check your blood pressure at home, keep track of your numbers, and report any significant changes. Lifestyle changes can support healthy blood pressure. This includes limiting salt intake, staying as active as possible, managing stress, limiting alcohol, and not smoking. 

Risk of infection. Taking Mayzent can lower your immune system and may raise your risk of getting infections. Examples of infections that were reported by people taking Mayzent in studies were shingles, herpes, bronchitis, sinus infections, and fungal skin infections. The following tips may be helpful for reducing your risk of infections:

  • Wash your hands frequently with soap and water. This is especially important after using the restroom, changing diapers, or touching surfaces in public places. Carry alcohol-based hand sanitizer with you when handwashing isn’t possible. 
  • Try not to touch your mouth, nose, or eyes to avoid spreading germs.
  • Don’t share drinks, lip balm, or cosmetics with other people.
  • Keep your distance from other people when they’re ill. If someone in your household is sick, try to increase ventilation in your home and clean surfaces with disinfectant. 

Other, more serious side effects are possible while taking Mayzent. It’s important to keep all blood test appointments and office visits so that your health care team can monitor you for side effects. If you miss an appointment, contact your doctor’s office to reschedule. If you are having new or worsening side effects that bother you or feel severe, tell your health care provider or seek medical care right away.

A study called EXPAND tested the effectiveness of Mayzent in adults with secondary progressive multiple sclerosis (SPMS) who had shown signs of their disability getting worse over the past two years. People aged 18-60 years could enter the study if they had not had a relapse in the past three months before joining. They also needed to have moderate to advanced disability, measured using the Expanded Disability Status Scale (EDSS). The EDSS is a scale that ranges from 0 to 10, where higher numbers mean more disability. To qualify, patients needed an EDSS score between 3.0 and 6.5 at the screening visit. A score of 3.0 reflects moderate disability in one major function or mild disability in several areas, whereas a score of 6.5 means you need two-sided assistance (such as a walker) to walk at least 20 meters.

People could not join the study if they had certain health issues. These included major problems with the immune system, heart, or lungs; ongoing macular edema (swelling in a certain area in the eye); uncontrolled diabetes; a certain gene variant (CYP2C9*3/*3 genotype); or lack of immunity to the varicella zoster virus.

Here are some details about the 1,651 people who took part in the study.

  • Ages ranged from 21 to 61 years, with an average age of 48.
  • About 60% of the people were female and the rest were male.
  • Most people were White (95%), and no race information was reported for the other people.
  • On average, people had been diagnosed with MS for about 12 years, had had MS symptoms for about 17 years, and had been living with SPMS for about three years before joining the study.
  • Disability levels at the start of the study were moderate to advanced, with a median EDSS score of 6.0 on the scale of 0 to 10. (“Median” is the middle value in a set of results.)
  • Most people had used a DMT for MS in the past.
  • About 78% of people had had no relapses in the year before joining the study, and about 64% had had no relapses in the two years before. (Having less frequent relapses can be a sign that the disease is progressing to non-active SPMS.)

People in the study were randomly assigned to start taking Mayzent or a placebo. Neither the people nor the researchers knew the group assignment. During the study, people had regular checkups every three months. MRI scans were done at the start of the study and then yearly.

People stayed in the study for a median of 21 months. People took Mayzent for a median of 18 months. Some only took it for a short time, while others took it for three years or longer.

The main goal of the EXPAND study was to see how long it took for disability to worsen and stay worse for at least three months. To count as confirmed disability progression (CDP), a person’s disability score (on the EDSS) had to worsen by 0.5 or 1 point, and this worsening had to be confirmed at a follow-up visit at least three months later. 

  • Results: Using this measure, 26% of people taking Mayzent had confirmed disability progression, compared with 32% of people taking placebo. The difference was statistically significant (meaning the difference is unlikely to be due to chance).

The study aimed to see how long it took for a person’s walking speed to get at least 20% slower on a timed 25-foot walk test, and for that slower walking speed to stay worse for at least three months. This is similar to the main disability measure, but it focuses specifically on walking. 

  • Results: 40% of people taking Mayzent and 41% of people taking placebo had confirmed worsening of walking speed, which was not a meaningful difference.

The study also looked at MRI scans to see how T2 lesion volume changed over time. T2 lesions are areas of the brain that show signs of MS activity or damage. 

  • Results: Over the first two years, the adjusted average increase in T2 lesion volume was 184 mm³ in the Mayzent group and 879 mm³ in the placebo group. These results were based on 995 people taking Mayzent and 495 taking placebo; people with incomplete MRI data were not included.

Overall, the study results found that Mayzent reduced the risk of worsening disability in people with SPMS. Your results may differ from study results. Talk with your health care provider about what to expect during treatment.

Mayzent typically stays in your system for up to 10 days after your last dose. For some people, the medicine could stay in your body even longer depending on genetic variations and other medicines you may be taking.

Some effects on your immune system can last for three to four weeks after your last dose. During this time, your lymphocytes (a type of white blood cell) may still be low. This raises the risk of infection, and taking other medicines that weaken the immune system during this time can further increase your risk of infection.

Stopping Mayzent can sometimes lead to a sudden and serious worsening of MS symptoms. While rare, the disease may become more active after the medicine is stopped. Do not stop taking Mayzent on your own. Always talk to your health care provider first, so you can stop safely and plan next steps for managing your MS.

A cost assistance program from Novartis, the company that makes Mayzent, may help lower your out-of-pocket costs. Visit this website to see if you are eligible for Mayzent copay savings. You can also call 800-277-2254 to speak with a representative about financial support options.

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