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Medications for Multiple Sclerosis (MS)

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
With multiple sclerosis (MS), medications are given to suppress or modulate the immune system and control symptoms. Medications only help in managing the condition, and some slow the disease process. They do not cure MS.

Over-the-Counter Medications

Prescription Medications

Disease-Modifying Therapies (DMTs)
Immunomodulating Drugs
Common names include:
  • Interferon beta-1a or 1b
  • Glatiramer acetate
  • Fingolimod
  • Teriflunomide
  • Dimethyl fumarate
  • Cladribine
  • Natalizumab
  • Alemtuzumab
  • Daclizumab
  • Rituximab
  • Ocrelizumab
Immunomodulating drugs are used to modify the immune system. Immunomodulators usually decrease the number of flare-ups and slow progression of physical disabilities. Some may limit the destruction of the myelin sheath. Others, like finglimod, affect the blood cells in the lymph nodes by blocking their movement to the brain and spinal cord. These drugs can be given as an injection or taken by mouth. When starting fingolimod, patients may have a decrease in heart rate. Increased risk of infections and serious eye problems are also possible side effects. Some drugs may work faster than others. For example, glatiramer acetate may need to be taken for months before benefits are seen.
Possible side effects include:
  • Fever and chills
  • Headache
  • Fatigue
  • Diarrhea
  • Back pain
  • Sweating
  • Skin tenderness
  • Cough
  • Muscle aches or spasms
  • Depression
  • Increased risk of infection
  • Kidney and liver damage
  • Progressive multifocal leukoencephalopathy (a potentially fatal viral infection of the brain)—natalizumab
  • Systemic reactions after injections, such as flushing, shortness of breath, palpitations, sweating, and anxiety
Immunosuppressive Drugs
Common names include:
  • Azathioprine
  • Mitoxantrone
  • Cyclophosphamide
  • Methotrexate
Immunosuppressive drugs inhibit the effects of the immune system on the body. These immunosuppressive drugs may be given to try to prevent a relapse or progression of MS. These drugs may produce serious side effects. Some of these are used by doctors who specialize in treating MS, but they may not be approved by the Food and Drug Administration (FDA) for treating MS.
Possible side effects include:
  • Nausea and vomiting
  • Diarrhea
  • Fever
  • Fatigue
  • Hair loss
  • Increased risk of infection
  • Menstrual problems
  • Liver damage
  • Progressive multifocal leukoencephalopathy (a potentially fatal viral infection of the brain)—azathioprine
  • Systemic reactions after injections, such as flushing, shortness of breath, palpitations, sweating, and anxiety
Corticosteroids
Common names include:
  • Methylprednisolone
  • Prednisone
  • Betamethasone
Corticosteroids are used to reduce nerve tissue inflammation and shorten MS flare-ups. How these drugs work is not fully understood. These drugs are usually given short term. Do not suddenly stop taking these medications. Carefully follow your doctor’s instructions for tapering the dose or alternating the days you use them.
Possible side effects include:
  • Increased risk of infection
  • Weight gain
  • High blood pressure
  • High blood glucose
  • Mood swings
  • Difficulty sleeping
  • Bone density loss
  • Gastrointestinal problems
For people who do not respond well to corticosteroids, other therapies may be used. For example, immunoglobulin therapy involves injecting antibodies into the blood. So far, though, the study results are inconsistent. Another treatment is plasmapheresis. This involves exchanging plasma in the blood. The results have been inconsistent with this type of treatment too.
Anticonvulsant Medications
Common names include:
  • Gabapentin
  • Carbamazepine
Anticonvulsants are used to control tremors and seizure activity. They also may be ordered to treat nerve pain. In addition, gabapentin may be given to treat spasticity, as well as unusual sensations.
Possible side effects include:
  • Drowsiness
  • Nausea
Muscle Relaxers
GABA-B Agonists
A GABA-B agonist is used to control muscle spasticity. This drug may be taken by mouth or injected into the spinal canal. The benefits are usually short lived. Do not stop taking this medication without consulting your doctor.
Possible side effects include:
  • Drowsiness
  • Lightheadedness
  • Weakness
Noradrenergic Alpha-2 Agonists
Common names include:
  • Tizanidine
  • Clonidine
These medications affect nerve pathways and are used to treat spasticity. Clonidine may also help with insomnia. Your doctor may order regular lab tests to check liver function.
Possible side effects include:
  • Drowsiness
  • Dry mouth
  • Low blood pressure
Dantrolene
Dantrolene is used to control muscle cramps and spasms in patients who cannot walk. It tends to worsen muscle weakness. It is given at bedtime and may be increased to include doses during the day.
Possible side effects include:
  • Diarrhea
  • Nausea
  • Loss of appetite
Benzodiazepines
Common names include:
  • Diazepam
  • Clonazepam
Benzodiazepines relax the muscles and are used to control nighttime muscle spasms and spasticity in patients who cannot tolerate other drugs used to treat this symptom. Clonazepam can also help control tremors.
Possible side effects include:
  • Drowsiness
  • Lightheadedness
Botulinum Toxin
Botulinum toxin is made from a type of bacteria. Given as an injection, botox is injected into certain muscle groups that are causing painful contractions. The injection works by temporarily blocking the signal from the nerves to the muscles.
Side effects may include:
  • Nausea
  • Fatigue
  • Flu-like symptoms
  • Headache
Bladder Control Medications
Anticholinergic Drugs
Common names include:
  • Oxybutynin
  • Propantheline
Anticholinergic drugs may be ordered to control urinary urgency, frequency, and incontinence. These drugs increase bladder capacity and provide some relief of urinary urgency.
Possible side effects include:
Desmopressin
Desmopressin helps relieve frequent urination during the night that has not responded to other treatment. It produces more concentrated urine. It can decrease sodium levels, so blood tests may be ordered. This drug is a nasal spray used at bedtime.
Possible side effects include:
  • Headache
  • Nasal congestion
Medications Used to Treat Fatigue
Amantadine
Amantadine is an antiviral drug used to treat fatigue. It is usually taken twice daily.
Possible side effects include:
  • Nausea
  • Dizziness
  • Insomnia
Modafinil
Modafinil is used to treat fatigue. It is a wakefulness agent, taken in the morning. Possible side effects include headache.
Antidepressants
Common names include:
  • Amitriptyline
  • Trazodone
  • Fluoxetine
Antidepressants may be ordered to combat depression associated with MS. Some antidepressant drugs are also given to people with chronic pain for pain-relieving abilities. They may improve your pain threshold and help you to sleep. Antidepressants are not addictive.
Do not stop taking these drugs without checking with your doctor. Do not take an antidepressant if you have taken a MAO inhibitor in recent weeks.
Possible side effects include:
  • Blurred vision
  • Dry mouth
  • Weight loss or weight gain
  • Lightheadedness when standing up
Other Medications Used to Treat MS
Dalfampridine
Dalfampridine blocks potassium channels in neurons. This helps demyelinated axons (nerves that have lost or damaged myelin sheaths) transmit their signals better. In studies, Ampyra has improved walking in people with MS.
Common side effects include:

Over-the-Counter Medications

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Common names include:
  • Naproxen sodium
  • Ibuprofen
  • Aspirin
These drugs work to reduce inflammation and pain. Possible side effects include:
  • Gastrointestinal bleeding
  • Stomach upset
Pain Relievers
Common brand name: Acetaminophen
Acetaminophen relieves minor pain. It does not prevent future headaches or treat the cause of the headache. It can cause liver problems if taken with alcohol. Do not drink alcohol while taking this drug. Do not take more than the recommended dose. Acetaminophen is unlikely to cause side effects (stomach upset, bleeding ulcers) associated with other pain medications.

Special Considerations

If you are taking medications, follow these general guidelines:
  • Take the medication as directed. Do not change the amount or the schedule.
  • Ask what side effects could occur. Report them to your doctor.
  • Talk to your doctor before you stop taking any prescription medication.
  • Plan ahead for refills if you need them.
  • Do not share your prescription medication with anyone.
  • Medications can be dangerous when mixed. Talk to your doctor if you are taking more than one medication, including over-the-counter products and supplements.

When to Call Your Doctor

Call your doctor if your symptoms worsen or if new symptoms develop.

References

Ampyra. Ampyra website. Available at: https://ampyra.com/medication-guide.pdf. Updated December 2014. Accessed September 13, 2016.
Disease-modifying therapies for multiple sclerosis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T905968/Disease-modifying-therapies-for-multiple-sclerosis. Updated August 24, 2016. Accessed October 6, 2016.
Multiple sclerosis (MS). EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116285/Multiple-sclerosis-MS. Updated March 4, 2016. Accessed October 6, 2016.
NINDS multiple sclerosis information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/multiple%5Fsclerosis/multiple%5Fsclerosis.htm. Updated July 17, 2015. Accessed September 13, 2016.
Plasmapheresis. Johns Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/transplant/programs/kidney/incompatible/plasmapheresis.html. Accessed September 13, 2016.
Treatment of specific impairments in multiple sclerosis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T905969/Treatment-of-specific-impairments-in-multiple-sclerosis. Updated June 6, 2016. Accessed October 6, 2016.
2/18/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116285/Multiple-sclerosis-MS: Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry. 2010;71(10):1259-1272.

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