The side effects of Aubagio are one of the first things newly diagnosed multiple sclerosis patients research after receiving a prescription — and for good reason. This oral disease-modifying therapy has proven effective at reducing MS relapses, but the side effects of Aubagio come with a risk profile that every patient and caregiver deserves to understand in full before starting treatment.
Understanding the side effects of Aubagio matters not just at the start of therapy, but throughout the entire treatment journey. Symptoms can evolve, new reactions can emerge, and knowing what to expect at every stage empowers patients to stay on track safely.
This guide goes beyond the standard drug label. It breaks down not just what can happen, but why it happens, how often, what to monitor, and what options exist for people who find themselves unable to afford or tolerate this medication long-term.
The side effects of Aubagio (teriflunomide) most commonly include hair thinning, diarrhea, nausea, elevated liver enzymes, and a reduced white blood cell count. Serious risks include liver toxicity, severe infections, and fetal harm. Regular blood tests are required. Most mild effects improve after the first few months of treatment.
What Is Aubagio and How Does It Work?
Aubagio is the brand name for teriflunomide, an oral immunomodulatory drug approved by the FDA for relapsing forms of multiple sclerosis, including clinically isolated syndrome, relapsing-remitting MS (RRMS), and active secondary progressive MS. It’s manufactured by Sanofi and typically prescribed once daily in either a 7 mg or 14 mg tablet.
Its mechanism is relatively unique among MS therapies. Teriflunomide inhibits an enzyme called dihydroorotate dehydrogenase (DHODH), which lymphocytes — the immune cells most implicated in MS lesion formation — rely on heavily for rapid cell division. By selectively reducing the proliferation of activated T and B cells, Aubagio dampens the autoimmune attack on myelin without fully suppressing the immune system.
This selective action is part of why Aubagio is considered safer than some more aggressive MS therapies like alemtuzumab or cladribine — but understanding the side effects of Aubagio in depth remains essential for anyone starting or considering this medication. Patients who go in informed are far better positioned to recognize warning signs early and respond appropriately.
The Most Common Side Effects of Aubagio
Clinical trials and real-world data have identified a consistent set of adverse effects in patients taking teriflunomide. Knowing the most common side effects of Aubagio before starting treatment allows patients to distinguish expected reactions from concerning ones. These are the Aubagio side effects most patients will encounter at some point during treatment:
Hair thinning (alopecia) This is perhaps the most distressing of all side effects of Aubagio, especially early in treatment. Roughly 10–15% of people in clinical studies reported noticeable hair thinning. The good news: it is almost always temporary. Hair typically returns to its normal density within the first 6 months as the body adjusts to the medication. In severe cases, doctors may consider dose adjustment.
Gastrointestinal symptoms Nausea, diarrhea, and abdominal discomfort are among the side effects of Aubagio reported most frequently in the first month. Taking Aubagio with food can help minimize these side effects. These symptoms usually diminish as treatment continues.
Elevated liver enzymes (ALT/AST) One of the more medically significant side effects of Aubagio is a rise in liver enzyme levels. This is why liver function tests are required before starting Aubagio and at monthly intervals for the first six months of treatment. Mild elevations are common and often self-resolving, but persistent or significant increases may require discontinuation. Patients with pre-existing liver disease should discuss risks carefully with their neurologist.
Peripheral neuropathy Some patients report tingling, numbness, or burning sensations in the hands and feet — symptoms that can overlap with MS itself, making it important to track their onset relative to when treatment began. When these sensations appear shortly after starting the drug, they are more likely connected to the side effects of Aubagio than to the underlying disease.
High blood pressure (hypertension) A modest but documented increase in blood pressure has been observed in patients taking teriflunomide. This should be monitored regularly, particularly in patients who already have cardiovascular risk factors.
Reduced white blood cell count Aubagio’s immunomodulatory effect extends to mildly reducing lymphocyte counts. This increases susceptibility to certain infections, particularly respiratory ones. A complete blood count (CBC) is recommended before treatment starts and should be monitored throughout.
Flu-like symptoms and upper respiratory infections These were among the most frequently reported side effects of Aubagio in phase III trials (TEMSO and TOWER). While typically mild, they should not be ignored if they become recurrent or severe.
Serious and Potentially Life-Threatening Aubagio Side Effects
Beyond the common and manageable side effects of Aubagio, the prescribing information — available through the FDA drug label — contains several Black Box Warnings and serious risks that require clear understanding. Every patient should review these side effects of Aubagio with their neurologist before the first dose:
Hepatotoxicity (Liver toxicity) Aubagio carries a Black Box Warning for liver toxicity. While rare, severe liver injury — including cases requiring liver transplantation — has been reported. This is why monthly liver enzyme monitoring is non-negotiable for the first six months, followed by periodic testing thereafter. Signs of liver problems to watch for include jaundice (yellowing of skin or eyes), dark urine, unusual fatigue, and right-sided abdominal pain. Contact your doctor immediately if any of these occur.
Teratogenicity — Fetal Harm Risk (Black Box Warning) This is perhaps the most serious of all side effects of Aubagio. Teriflunomide is classified as Pregnancy Category X — meaning it is absolutely contraindicated during pregnancy. Animal studies have shown it causes major fetal abnormalities. Because teriflunomide can remain in the bloodstream for up to two years after stopping the drug (due to extensive enterohepatic recirculation), women of childbearing potential must use effective contraception while on Aubagio and after stopping it until blood levels are confirmed to be below 0.02 mg/L.
Men who wish to father children should also discuss elimination procedures with their doctor.
An accelerated elimination procedure using activated charcoal or cholestyramine over 11 days can clear the drug from the system more quickly when needed.
Serious infections While the side effects of Aubagio do not include severe immunosuppression like some MS biologics, the drug does lower immune vigilance enough to increase the risk of serious bacterial, viral, and fungal infections. Tuberculosis reactivation is a specific concern — patients should be screened for latent TB before starting treatment. Patients who develop serious infections during treatment may need to temporarily or permanently stop Aubagio.
Peripheral neuropathy (severe) A small number of patients have developed severe peripheral neuropathy requiring discontinuation. While mild tingling may be tolerable, new onset or worsening neuropathic symptoms should always be reported promptly.
Severe skin reactions Rare but serious dermatological reactions — including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) — have been reported in post-marketing surveillance. These are medical emergencies. Patients should discontinue the drug and seek immediate care if they develop blistering rashes, skin peeling, or mucosal lesions.
Interstitial lung disease Cases of interstitial lung disease and pulmonary hypertension have been reported during treatment. Patients with new onset or worsening shortness of breath should be evaluated promptly. This is one of the less discussed side effects of Aubagio, but it warrants attention in patients with any pre-existing respiratory conditions.
Monitoring Requirements: What Your Doctor Should Be Checking
Because of the documented side effects of Aubagio, responsible prescribing involves a structured monitoring schedule. Here’s what evidence-based practice looks like for patients on teriflunomide:
Before starting treatment:
- Complete blood count (CBC) with differential
- Liver function tests (ALT, AST, bilirubin)
- Blood pressure measurement
- Latent tuberculosis screening (TST or IGRA)
- Pregnancy test for women of childbearing potential
- Hepatitis B and C screening
During the first 6 months:
- Monthly liver enzyme tests to catch side effects of Aubagio on liver health early
- Blood pressure monitoring at each visit
- CBC monitoring if signs of infection develop
Ongoing:
- Periodic liver function tests
- Regular blood pressure checks
- Monitoring for signs of infection, neuropathy, or skin reactions
Patients who remain in good communication with their neurologist and follow this schedule are far more likely to catch side effects of Aubagio early — before they become serious.
Managing Side Effects of Aubagio: Practical Strategies That Work
Most patients do not discontinue treatment due to side effects of Aubagio alone. The key is proactive management. With the right strategies, many of the most disruptive side effects of Aubagio can be minimized or resolved without interrupting therapy. Here are approaches that have helped patients navigate the most challenging aspects of teriflunomide treatment:
For hair thinning, many patients find that gentle hair care practices — avoiding heat styling, using volumizing shampoos, and supplementing with biotin — help minimize visible thinning during the adjustment period. Reassurance is important: the hair almost always grows back.
For GI symptoms, taking the pill with a full meal, avoiding spicy or fatty foods during the first weeks, and eating smaller, more frequent meals can significantly reduce nausea and diarrhea. If symptoms persist beyond the first 4–6 weeks, speak with your neurologist — a temporary dose reduction may be appropriate.
For blood pressure increases, lifestyle modifications (reducing sodium, increasing physical activity, managing stress) are first-line. Some patients may require antihypertensive medication if readings remain elevated.
For infection prevention, standard hygiene practices go a long way: hand washing, avoiding close contact with sick individuals, keeping vaccinations up to date (noting that live vaccines should be avoided during treatment), and reporting any signs of infection early.
For liver protection, avoid alcohol or limit it strictly. Review all other medications — including over-the-counter drugs and supplements — with your doctor, as some can increase liver stress when combined with Aubagio.
How Long Do the Side Effects of Aubagio Last?
A common concern among newly treated patients is whether the side effects of Aubagio are permanent. The answer for most: no. The majority of the most common side effects of Aubagio — hair thinning, gastrointestinal discomfort, mild fatigue — typically peak during the first 3 months and then diminish significantly as the body adapts.
Elevated liver enzymes often normalize within months even without discontinuing the drug, though this requires monitoring. Reduced lymphocyte counts also tend to stabilize over time.
For patients who must stop treatment due to side effects of Aubagio, the accelerated elimination procedure (cholestyramine 8g three times daily for 11 days, or activated charcoal 50g every 12 hours for 11 days) can rapidly clear teriflunomide from the system. This is particularly important for women who wish to become pregnant or for anyone experiencing a serious adverse reaction.
Aubagio vs. Other MS Medications: Comparing Side Effect Profiles
Patients and caregivers often ask how the side effects of Aubagio compare to other disease-modifying therapies in terms of tolerability. Here’s an honest look:
Compared to interferon beta medications (Avonex, Rebif, Betaseron), Aubagio is oral and avoids the injection-site reactions and flu-like post-injection symptoms that make interferons difficult for some patients. However, interferons have a longer safety track record and do not carry the fetal harm concerns seen with the side effects of Aubagio.
Compared to dimethyl fumarate (Tecfidera), both are oral first-line therapies. Tecfidera causes flushing and GI symptoms in many patients, while the side effects of Aubagio center more on hair thinning and liver monitoring requirements. Neither is appropriate during pregnancy.
Compared to natalizumab (Tysabri) or alemtuzumab (Lemtrada), Aubagio is considerably milder in its immunosuppressive effects, making it preferable for patients who need to balance efficacy with infection risk. The side effects of Aubagio, while real, are generally more predictable and easier to manage than those of high-efficacy biologics.
Compared to glatiramer acetate (Copaxone), both are considered similarly effective for RRMS, but Copaxone requires injections and is associated with injection-site reactions rather than the systemic side effects of Aubagio. Understanding this landscape helps patients and their neurologists make informed, individualized decisions. If you’re exploring your options, our guide on navigating MS medications and costs for American patients can provide broader context.
The Financial Reality: Why Many MS Patients Explore Alternatives
It would be incomplete to discuss the side effects of Aubagio without addressing a harsh reality: cost. In the United States, Aubagio can cost between $6,000 and $9,000 per month without insurance — and even with commercial coverage, many patients face co-pays that run into the hundreds or thousands of dollars monthly.
This financial burden leads many patients to either ration doses, skip treatment entirely, or begin researching alternatives. One increasingly common option: purchasing Aubagio legally at licensed international pharmacies in Mexico, where the same branded or equivalent medication may be available at a dramatically lower cost.
This isn’t a gray area — Aubagio is manufactured by the same global pharmaceutical company and sold through legitimate, licensed pharmacies in Mexico. The key is doing it safely, with proper guidance. Many Americans are now working with structured medical tourism services that help them travel to Tijuana and other border cities, verify pharmacy credentials, confirm their prescription validity, and return home with their medications — legally and affordably.
If you’re among the millions of Americans struggling with the cost of MS therapy, our article on how to safely buy prescription medications in Mexico walks through the process in detail, including what to look for in a licensed pharmacy and how medical tourism services protect patients throughout the journey.
For authoritative information on approved MS treatments and clinical guidelines, the National Multiple Sclerosis Society maintains up-to-date resources patients and caregivers can trust.
Final Thoughts: Living Well Despite the Side Effects of Aubagio
The side effects of Aubagio are real, but for the majority of patients, they are manageable — especially with proper monitoring, open communication with a neurologist, and lifestyle strategies that reduce their impact. Hair thinning resolves. GI symptoms improve. Blood pressure can be managed. And the hepatotoxicity risk, while serious, is mitigated substantially by following the recommended monitoring schedule.
What should not be accepted is suffering in silence — or skipping treatment because the cost is simply out of reach.
Whether you’re newly prescribed Aubagio, reconsidering it after experiencing the side effects of Aubagio firsthand, or trying to figure out how to afford it long-term, you have more options than you may realize. Our team specializes in helping Americans navigate the landscape of high-cost MS medications safely and affordably — including guided access to licensed pharmacies in Tijuana, Mexico, where many patients find the same quality medications at a fraction of U.S. prices.
Ready to learn more about your options? Reach out today and let us show you how hundreds of patients just like you are staying on their treatment plans without financial devastation.
This article is intended for informational purposes only and does not constitute medical advice. Always consult your neurologist or healthcare provider before making any changes to your treatment plan.
