Gilenya and Heartrate

[jersey4ever]

I was optimistic about the switch from Copaxone to Gilenya. My neuro didn't feel the Copaxone was working well enough and wanted something stronger. Ty is not an option - my JC index is 1.27 and I weight 110 pounds - given the research on body-weight and PML risk and the "fairly high" index - well - I just wan't going to go there.

I went for my EKG then got the call that my heartrate - 59 - making Gileyna not a suitable choice. My neuro said I could try to get clearance from a cardiologist - but she doubted any would agree to OK it.

Is she being overly cautious (she is a very caution) or does a resting heartrate of 59 really take you out of the running for Gilenya.

She is now suggesting Tec.

Thoughts?

[MSer102]

A low heart rate might not take you completely out of the running but it's risky and it sounds like it's more risk than your neurologist wants to take on for either one of you. My resting heart rate is 54 so I'm really not a good candidate for Gilenya.

My doctor said that during the first 24 hours (for most people it's the first 6) the heart rate can drop by 10 to 15 beats per minute. That could put you all the way down to 44 where you could be at risk for heart failure. That's kind of a big risk to take when there are other medicines available.

And the heart rate can stay reduced by some amount for up to a month. While the risk of heart failure goes down there's still the chance that the heart won't be pumping enough blood fast enough to the brain which can cause dizziness or fainting and fatigue. Fainting doesn't sound good and I don't know of anybody who needs more fatigue!

You might be able to find a neurologist and cardiologist who will clear you for Gilenya but it still sounds risky. It might not be worth the trade off with other medicines available. For me and my 54 heart rate it's "don't even think about it".