Should I hold off on taking Gilenya before or after my surgery?

Question:
I am currently on Gilenya for my MS and am being considered for a knee replacement surgery. I know I can't be without my Gilenya for more than 14 days or I have to complete the observation process again. Because Gilenya lowers my lymphocytes, should I be holding the Gilenya before and/or after my surgery?

Answer:
I know of no evidence that Gilenya alters healing from surgery, increases the rate of common bacterial infections associated with surgery or increases the risk of bleeding with surgery The surgical team and particularly the anesthesiologists should review the FDA package insert for Gilenya and pay particular attention to the following:

1. Your low white blood count and lymphocyte count on Gilenya is expected and not abnormal. 
2. Avoid the use of class I and IIIa anti-arrhythmic drugs
3. Drugs that can prolong the heart’s QT interval  should only be initiated cautiously

Based on the information you’ve provided , there is no reason to stop taking the Gilenya before your surgery. It takes 1-2 months for the pharmacodynamic effects of the drug to wear off after your last dose, and stopping it for this long of an interval places you at an unnecessary risk for a relapse. The final decision should be made by your own physicians who have a more intimate knowledge of your medical condition and concurrent medications.
Good luck
​
Revere (Rip) Kinkel MD
Professor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego