Fingolimod is a disease modifying drug for patients with relapse remitting multiple sclerosis (RRMS). The molecule is a sphingosine phosfate analog that because of its mechanism of action causes a decrease in heart rate during the administration of the fi rst dosis and a slight increase in blood pressure in the second month of treatment in 0.5% of patients. We review in this article the cellular mechanisms by which fi ngolimod causes these events and report safety recommendations based on US Food and Drug Administration (FDA) for initiating treatment with this drug.