title: Dalfampridine: a medication to improve walking in patients with multiple sclerosis.
abstract: OBJECTIVE
  To review the pharmacology, pharmacokinetics, efficacy, and safety of dalfampridine.
  
  
  METHODS
  A search of PubMed (1966-March 2012) was conducted using the words dalfampridine and Ampyra. Bibliographies of retrieved articles were reviewed to identify additional references.
  
  
  METHODS
  All identified studies published in English involving the efficacy and safety of dalfampridine were reviewed.
  
  
  RESULTS
  Dalfampridine (Ampyra) is a broad-spectrum potassium channel blocker that is indicated as a treatment to improve walking in patients with multiple sclerosis (MS). Dalfampridine is the only medication approved for this indication. Efficacy has been demonstrated in 2 Phase 3 trials involving patients with MS. Dalfampridine 10 mg twice daily improved walking, as shown by a higher proportion of timed walk responders in the dalfampridine-treated group (42.9% and 35%) versus the placebo-treated group (9.3% and 8%) during the 2 studies (p < 0.001). The maximum recommended dose of dalfampridine is 10 mg twice daily; higher doses are associated with an increased risk of seizures. At doses greater than 10 mg twice daily, the frequency of other adverse reactions and discontinuations was greater and showed no additional benefit. The average wholesale price of a 10-mg dalfampridine tablet is $21.12, which would make a 1-month supply of therapy cost $1267.20.
  
  
  CONCLUSIONS
  In clinical trials, dalfampridine improved walking speed in approximately one third of patients with MS. The risk of seizures appears to be dose-related and the incidence is low at doses of 10 mg twice daily. Because of the cost, dalfampridine should be reserved for patients who meet criteria for the drug and continued only if they have an adequate response.
authors: Department of Pharmacy, Louis Stokes Cleveland Veterans Affairs Medical Center, OH, USA.
authors: Theodore E
authors: TE
authors: Pikoulas
authors: Matthew A
authors: MA
authors: Fuller
mesh_terms: D015761:4-Aminopyridine / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D000818:Animals; D006801:Humans; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D026902:Potassium Channel Blockers / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D016138:Walking
chemical_list: D026902:Potassium Channel Blockers; D015761:4-Aminopyridine