Aubagio: Side effects, use for MS, cost, and more

If you live with multiple sclerosis (MS), you’ve probably learned two universal truths:
(1) your immune system is a little too enthusiastic, and (2) medication names sound like they were invented
by a committee that hates vowels. Aubagio (teriflunomide) is one of the better-known oral
disease-modifying therapies (DMTs) for relapsing forms of MS. It’s a once-daily pillconvenient, common,
and genuinely helpful for many people.

But Aubagio also comes with two very loud “read-me-first” warnings: liver safety and
pregnancy risk. This guide breaks down what Aubagio is used for, how it works, side effects
(from annoying to serious), what monitoring usually looks like, and how people think about cost and savings.
We’ll keep it practical, human, and free of medical-mystery jargon.

Quick facts about Aubagio

What is Aubagio used for in MS?

Aubagio is prescribed to treat relapsing forms of multiple sclerosis. “Relapsing” doesn’t always mean
you feel dramatic symptoms every week; it means the disease has periods of new or worsening neurological problems
(relapses) and/or evidence of ongoing inflammatory activity, often seen on MRI.

What it’s meant to do

• Reduce relapse frequency (how often new flare-ups happen)
• Lower MRI activity (new or enlarging lesions)
• Slow disability progression for some people over time

Important note: Aubagio is a disease-modifying therapy, not a “quick symptom fixer.” It won’t
instantly erase fatigue, numbness, or balance issues. Think of it more like a long-term security system than a fire extinguisher.

How does Aubagio work?

Aubagio contains teriflunomide, which blocks an enzyme involved in making pyrimidinesbuilding blocks
cells use to multiply. In plain English: it helps slow the growth of certain activated immune cells that are thought to
drive inflammation in MS. It’s not the same as “wiping out” the immune system; it’s more like telling the most
over-caffeinated immune cells to take a seat.

How well does Aubagio work?

In major clinical studies, teriflunomide reduced the annualized relapse rate compared with placebo and
lowered the number of new MRI lesions. Some trials also showed benefits in measures of disability worsening.
The degree of benefit varies by personMS is famously individualso neurologists usually weigh Aubagio against
other DMTs based on disease activity, MRI findings, safety considerations, lifestyle, and family planning.

A practical way to think about effectiveness

If your MS has been very active (frequent relapses, many new MRI lesions), your clinician may discuss higher-efficacy
therapies. If your MS activity is mild-to-moderate and you want an oral option with long track record, Aubagio may be
on the shortlist. The “right” choice is the one that balances risk, benefit, and real life (work schedules, needles,
travel, lab access, pregnancy plans, andyesinsurance realities).

Dosage: How to take Aubagio

Aubagio is taken once daily, with or without food. It comes in 7 mg and 14 mg tablets.
Your prescriber chooses the dose based on your situation and tolerance.

If you miss a dose

Many clinicians advise taking it when you remember (if it’s not too close to the next dose) and then returning to your regular schedule.
Don’t double up unless your prescriber specifically tells you to. If missed doses happen often, the fix is usually systems,
not guilt: phone alarms, a pill organizer, or linking it to an existing habit (coffee, toothbrushing, or feeding the pet who never lets you forget anything).

Common Aubagio side effects

Most people who take Aubagio experience either mild side effects or none that are deal-breakers. Still, it helps to know what’s common
so you’re not surprised by something that feels alarming but is usually manageable.

Commonly reported side effects

• Headache
• Diarrhea or other GI upset (including nausea)
• Hair thinning (alopecia) often described as more shedding than “bald patches”
• Increased liver enzymes on blood tests (often without symptoms)

Tips that can make mild side effects less annoying

• GI issues: Taking the pill with food, staying hydrated, and using a prescriber-approved anti-diarrheal when needed may help.
• Headaches: Track triggers (dehydration, sleep, stress). Ask your clinician which pain relievers are safest for you.
• Hair thinning: Gentle hair care (less heat, fewer tight styles) and patience can helpmany people report it improves over time.

Serious side effects and warnings (the “don’t ignore this” section)

Aubagio has boxed warningsthe FDA’s strongest label warningrelated to liver injury and
embryo-fetal toxicity (risk of major birth defects). It can also cause other serious problems in rare cases.
This doesn’t mean it’s “a bad drug.” It means it’s a drug that requires smart screening, monitoring, and fast action if red flags appear.

1) Liver injury (hepatotoxicity)

Serious, sometimes life-threatening liver injury has been reported. Your clinician will usually check liver function tests before you start
and monitor closely early in treatment. Risk can increase if you already have liver disease or take other medications that can stress the liver.

Call your clinician urgently if you develop symptoms such as yellowing skin/eyes, dark urine, severe fatigue, persistent nausea, or right-upper-abdominal pain.

2) Pregnancy and birth defect risk

Aubagio is not safe during pregnancy. People who can become pregnant typically need a negative pregnancy test before starting,
plus reliable contraception during treatment. If pregnancy occurs, the medication is usually stopped and an accelerated elimination procedure
(often called a “washout”) is started to remove the drug faster.

3) Infections and lowered white blood cells

Teriflunomide can lower white blood cell counts and may increase infection risk. You may be screened for infections (including latent TB) before starting.
Let your care team know promptly if you develop signs of infectionfever, chills, worsening cough, burning with urination, or wounds that don’t heal.

4) Serious skin reactions and allergic reactions

Rare but severe skin reactions (like Stevens-Johnson syndrome or toxic epidermal necrolysis) and serious allergic reactions can occur.
Seek emergency care for widespread rash with blistering/peeling, swelling of face/throat, or trouble breathing.

5) Peripheral neuropathy (nerve symptoms)

Some people develop peripheral neuropathytingling, numbness, burning pain, or weakness in hands/feet. Because MS can also cause sensory symptoms,
it’s important to tell your clinician about any new or clearly worsening “pins and needles” patterns.

6) Increased blood pressure

Aubagio can raise blood pressure. Many clinicians check your blood pressure at baseline and periodically during treatment.
If you already have hypertension, this doesn’t automatically rule Aubagio out, but it does raise the importance of monitoring and control.

7) Lung problems (respiratory effects)

Rarely, interstitial lung disease or other serious lung issues may occur. Report unexplained shortness of breath, persistent cough, or chest tightnessespecially if it’s new.

Monitoring: What tests are usually needed?

Monitoring isn’t punishment. It’s how you and your clinician catch problems earlyoften before you feel anything at all.
While plans differ, a common checklist includes:

Before starting Aubagio

• Liver tests (transaminases/ALT and bilirubin)
• Pregnancy test for people who can become pregnant
• Complete blood count (CBC)
• Blood pressure
• Screening for infections (often including TB)

After starting

• Liver monitoring is usually most frequent early on (often monthly for the first several months)
• Ongoing blood pressure checks
• Symptom monitoring for infection, neuropathy, or rash

Drug interactions and things to avoid

Aubagio is well-studied, but it still has meaningful interactions. Always share a full medication listprescriptions, over-the-counter meds,
vitamins, and supplementsbecause “natural” products can still affect the liver or drug metabolism.

Interactions that commonly come up in real life

• Leflunomide (a related arthritis medication): generally avoided with teriflunomide.
• Other hepatotoxic meds (certain antibiotics, antifungals, high-dose acetaminophen, some seizure meds, etc.): may increase liver risk.
• Warfarin: teriflunomide can affect INR, so closer monitoring may be needed.
• Some diabetes meds (for example, certain CYP2C8 substrates): levels may change and might need monitoring.
• Rosuvastatin: dosing limits or adjustments may be recommended.
• Oral contraceptives: teriflunomide can change exposure to some hormone components, so your clinician may review your birth control choice.

A quick example

Imagine you’re stable on Aubagio and your primary care clinician starts a new cholesterol medication. Your neurologist might ask:
“Which statin? What dose? Any recent liver tests?” That’s not medical overprotectivenessit’s coordination.
It’s how you keep MS treatment from colliding with everything else in your life.

Stopping Aubagio: Why “washout” matters

Teriflunomide can stay in the body for a long timesometimes many monthsunless you use an accelerated elimination procedure.
This matters most if:

• You become pregnant or want to become pregnant soon
• You develop serious side effects (especially liver injury or severe skin reactions)
• You need to switch quickly to another therapy for safety reasons

What a washout typically involves

Clinicians often use cholestyramine or activated charcoal for about 11 days to speed drug removal.
The exact regimen is prescribed and monitored by your care team. Do not self-start a washoutit’s a medical plan, not a detox trend.

Aubagio and family planning (pregnancy, partners, breastfeeding)

Family planning is where Aubagio gets very serious, very fast. Because of embryo-fetal toxicity risk, people who can become pregnant generally need:
(1) pregnancy excluded before starting, (2) effective contraception during treatment, and (3) a washout if pregnancy occurs or pregnancy is planned.

What about men who want to father a child?

Teriflunomide can be detected in semen, and some guidance recommends men discontinue teriflunomide and consider an accelerated elimination procedure
when planning to father a child. This is a conversation to have earlypreferably before the “surprise timeline” becomes “surprise pregnancy.”

Breastfeeding

Decisions about breastfeeding while on MS therapies can be complex. If breastfeeding is part of your plan, bring it up with your neurologist and OB/GYN
so they can discuss benefits, unknowns, and alternatives.

Cost: What Aubagio (and teriflunomide) may cost in the U.S.

Let’s talk about the elephant in the room: MS medications are expensive. The out-of-pocket cost you actually pay depends on:
whether you’re using brand-name Aubagio or generic teriflunomide, your insurance plan’s formulary, specialty pharmacy rules, deductibles,
coinsurance, manufacturer assistance, and whether you have Medicare/Medicaid.

Brand vs. generic

Generic versions of Aubagio (teriflunomide) are available, and many insurers prefer the generic. For some people, that can
meaningfully reduce costespecially when combined with discount programs (where allowed) or plan-specific copay structures.

Ways people commonly lower their costs

• Ask for generic teriflunomide if your prescriber agrees and your plan prefers it.
• Check your plan’s prior authorization rules (many MS meds require documentation and renewals).
• Use manufacturer or foundation assistance when eligible (rules vary by insurance type).
• Compare specialty pharmacies if your insurance allows choiceprices and service can differ.
• Review Medicare Part D planning if you’re Medicare-eligible: the timing of deductibles and annual out-of-pocket caps can change what you pay across the year.

One cost reality check: you may see wildly different numbers onlineanything from “coupon-level” cash prices for generic teriflunomide
at certain pharmacies to very high list prices for brand-name Aubagio. Those differences reflect the complicated U.S. pricing system
(insurance negotiations, rebates, pharmacy contracts, and assistance programs), not your personal worthiness for affordable medication.

Frequently asked questions

Does Aubagio cause weight gain?

Weight gain is not typically listed as a common Aubagio side effect. If your weight changes, it may be related to activity changes,
steroids used during relapses, thyroid issues, mood, or other medicationsso it’s worth discussing rather than guessing.

Is hair loss permanent?

Many people describe hair thinning rather than permanent hair loss, and it often improves after the first months.
If it’s severe or distressing, tell your cliniciansometimes dose changes, timing, or switching therapies is considered.

Can I drink alcohol on Aubagio?

Because Aubagio can affect the liver, many clinicians advise caution with alcohol. Your safest move is to ask your prescriber what’s reasonable
based on your liver tests, health history, and overall risk.

Can I get vaccines while taking Aubagio?

Many people with MS receive routine vaccines while on DMTs, but timing and vaccine type can matter. Tell your neurologist about upcoming vaccines.
Some clinicians avoid certain live vaccines during immunomodulatory therapy. Your care team can personalize guidance.

Real-world experiences with Aubagio (about )

Clinical trials and prescribing information tell us what happened on average. Real life adds the details: work schedules, lab appointments,
“Is this tingling my MS or my medication?”, and the very human desire to live without feeling like your calendar is sponsored by a phlebotomy lab.
Below are common themes people report when starting or living with Aubagio. These are not promisesand they’re not medical advice
but they can help you know what questions to ask and what patterns to watch for.

“I love that it’s a once-daily pill.”

Convenience is a big deal. People who have used injectable MS therapies often describe Aubagio as a relief simply because it removes needles from the
daily or weekly routine. That convenience can improve adherence, which matters because DMTs only help when you actually take them.
A common “best practice” people share is building the pill into an existing habitmorning coffee, brushing teeth, or a nightly phone alarm
so it becomes boringly automatic (boring is good in medication land).

Hair thinning is the side effect that gets the most attention.

Even when it’s medically mild, hair thinning can feel emotionally loud. People often describe more shedding in the shower or brush,
especially in the first few months. What helps psychologically is knowing two things: (1) it’s a known effect, and (2) many people say it improves
over time. Some switch shampoos or reduce heat styling. Others simply decide the tradeoff is worth it. The key is to tell your clinician if it’s
severebecause quality of life matters, and you have options.

GI symptoms are common, but often manageable.

Mild diarrhea or nausea comes up frequently in early treatment stories. People trade practical tips: take it with food, stay hydrated,
avoid experimenting with spicy food the day you start (this is not the time for “ghost pepper curiosity”), and ask about safe symptom relief.
If GI issues persist or lead to dehydration or missed doses, that’s a sign to loop in your care team rather than toughing it out.

Monitoring can be reassuringonce you get past the “more blood tests” stage.

Many people initially feel annoyed by frequent liver monitoring. Over time, some come to view labs as a safety net:
“If something changes, we’ll catch it early.” A practical approach that patients often like is batching appointmentslab work the same day as
other errandsand keeping a simple note of recent results so you can spot trends and ask better questions.

Family planning changes the conversation immediately.

People of reproductive potential often describe Aubagio as a “planning-required” medication. If pregnancy is possible or desired,
the topic becomes urgent: contraception choices, timelines, and the reality that teriflunomide can linger unless a washout is done.
People who feel best supported are usually those whose neurologist and OB/GYN communicate clearly and early.
In other words: if a baby could be in your futurenear or farbring it up now, not after you’ve already started imagining nursery paint colors.

The bottom line from real-world experience is simple: Aubagio can be a good fit, especially for people who value an oral option and can commit
to safety monitoring. If side effects or life plans make it a poor match, there are many alternative MS therapies. The best outcome is the one
that’s both medically sound and livable.

Conclusion

Aubagio (teriflunomide) is a once-daily oral DMT used for relapsing forms of MS. For many people, it offers a practical balance:
easier administration than injections, meaningful reduction in relapse activity, and a long track record. The tradeoff is that it requires
careful attention to safetyespecially liver monitoring and strict pregnancy precautionsplus awareness of infections, blood pressure changes,
and potential nerve or skin reactions.

If Aubagio is on your radar, the most useful next step is a focused conversation with your neurologist:
“What is my MS activity level? What are my pregnancy plans? What labs do we need? How will we handle cost?” When those questions are answered,
the decision becomes a lot less intimidatingand a lot more personal in the best way.