Multiple sclerosis (MS) is damage that affects nerve cells in your brain and spinal cord. This damage is irreversible. It causes symptoms that gradually get worse as well as symptoms that come on suddenly after a period of being controlled (referred to as a relapse).
Medication for MS doesn’t cure the disease, but rather helps manage it. Management focuses on using medication that can modify the disease to reduce damage and disability. It also involves using other drugs to treat symptoms or complications of MS.
Drugs to modify damage
Interferon beta products
These drugs are made up of proteins that keep certain white blood cells from entering your central nervous system (your brain and spinal cord). It’s thought that these white blood cells damage your myelin cells, which form part of some nerves. Therefore, preventing their movement into your central nervous system can help slow the damage they do and reduce the number of relapses you have.
You inject these drugs yourself. Your healthcare provider will train you how to do so. The number of injections ranges according to the drug:
- Rebif: three times per week
- Betaseron: every other day
- Avonex: once per week
- Plegridy: every two weeks
The length of treatment can vary between a few months and years depending on how well the drugs work for you.
Glatiramer acetate (Copaxone)
Glatiramer acetate (Copaxone) is a man-made substance that resembles a basic protein of natural myelin. It’s thought to work by getting the white blood cells to attack it instead of the myelin cells. It’s used to treat relapsing remitting and progressive relapsing forms of MS.
You inject this drug yourself once per day — your healthcare provider will show you how.
In 2014, the U.S. Food and Drug Administration (FDA) approved a higher-dose version of the drug that you can give to yourself three times per week rather than daily.
This drug can cause many skin reactions. Of them, lipoatrophy and necrosis can be serious. Lipoatrophy is the permanent loss of fat tissue around the injection site. Necrosis is skin tissue death. In rare cases, it can happen around the injection site. Symptoms of necrosis at the injection site include:
- red, purple, and black skin discoloration
Natalizumab (Tysabri) is an antibody that blocks the movement of damaging white blood cells into your brain and spinal cord. It treats relapsing remitting and progressive relapsing forms of MS. A healthcare provider will give it to you through an intravenous (IV) tube over a long period as an intravenous infusion. You get this injection every four weeks.
If you have this treatment, your healthcare provider will watch you closely for side effects and infections. This treatment has been associated with a rare viral infection of the brain called progressive multifocal leukoencephalopathy. This infection can be fatal. The FDA recommends that everyone starting treatment with natalizumab first be tested to see if they’ve been exposed to the virus linked to this infection.
Mitoxantrone was originally used to treat cancer. Now it’s also used to treat people with secondary progressive, progressive relapsing, or worsening relapsing remitting MS after other drugs haven’t worked. It suppresses the immune system cells that are thought to attack myelin cells.
A healthcare provider gives you this drug by intravenous infusion once every three months.
Possible side effects of mitoxantrone include heart damage and a form of cancer. Due to the risk of these and other serious side effects, mitoxantrone is no longer prescribed very often. It’s only used as a last resort.
Fingolimod (Gilenya) is the first oral medication approved by the FDA for relapsing remitting and progressive relapsing forms of MS. It is an oral capsule that you take once per day. It causes the damaging white blood cells to remain within your lymph nodes. This reduces the chance that they’ll enter your brain and spinal cord and cause damage.
People who take this drug are monitored before and during treatment for serious complications such as heart and vision problems.
Teriflunomide (Aubagio) is an oral tablet that you take once per day. You use it to treat relapsing remitting and progressive relapsing forms of MS. It inhibits an enzyme that the white blood cells need. As a result, this drug helps decrease the number of damaging white blood cells.
This drug can increase the risk of certain infections. Your doctor should test you for tuberculosis before starting you on this drug. They should also regularly monitor your liver function and blood pressure. You shouldn’t take this drug if you’re pregnant or thinking of becoming pregnant.
Dimethyl fumarate (Tecfidera)
Dimethyl fumarate (Tecfidera) is an oral capsule that you take twice per day. It helps control disease progression in people with relapsing remitting and progressive relapsing forms of MS. It’s thought that this drug works by interfering with the activity of certain immune system cells and chemicals to reduce the risk of MS relapse.
Common side effects of dimethyl fumarate include flushing and a reduced number of white blood cells. Taking the drug with food may reduce how often you have flushing.
Symptom and complication treatments
Other drugs can be used to treat specific symptoms or complications from damage that MS has already caused.
For walking problems
Dalfampridine (Ampyra) is a tablet you take by mouth twice per day to help improve walking. This drug blocks the tiny pores in nerve cells called potassium channels. This action may help improve nerve impulse conduction in nerve cells that have been damaged by MS. This helps your brain and body’s messages get where they’re going. It also improves leg muscle strength.
Side effects may include urinary tract infection, insomnia, headache, and nausea. In 2012, the FDA issued a warning that seizures had been reported among some patients starting therapy with dalfampridine.
Your doctor should do kidney function testing during therapy. This drug is removed from your body through your kidneys. If you have or develop kidney disease while taking this drug, you could end up with higher levels of the drug in your blood than recommended. This can increase your risk of side effects, including seizures.
Inflammation is typical during MS relapse. It can lead to many of the other symptoms of MS. Corticosteroids reduce inflammation and the severity of MS attacks. Corticosteroids for MS treatment include:
For muscle stiffness or spasms
A doctor will often give muscle relaxants to people with MS who have painful muscle stiffness or muscle spasms. Drugs commonly used to treat these symptoms include:
- onabotulinumtoxinA (Botox)
- cyclobenzaprine (Flexeril)
- dantrolene (Dantrium)
- diazepam (Valium)
- tizanidine (Zanaflex)
Ongoing fatigue is a common problem for people with MS. For this symptom, your doctor may prescribe a drug such as:
Dysesthesia means “bad sensation.” It’s a type of pain that can feel like ongoing burning, wetness, itching, electric shock, or pins and needles. To treat dysesthesia, your doctor may prescribe:
- amitriptyline (Elavil)
- clonazepam (Klonopin)
- gabapentin (Neurontin)
- nortriptyline (Pamelor)
- phenytoin (Dilantin)
Some research has shown that people with MS are more likely to be clinically depressed than the general population. Drugs used to treat depression in people with MS include:
- bupropion (Wellbutrin)
- duloxetine (Cymbalta)
- fluoxetine (Prozac)
- paroxetine (Paxil)
- sertraline (Zoloft)
- venlafaxine (Effexor)
Constipation is another common complication of MS. Your doctor may prescribe one of the following drugs to treat it:
For bladder dysfunction
Bladder dysfunction is a common complication of MS. It may include frequent urination, incontinence, hesitancy in starting urination, or frequent nocturia (nighttime urination). Drugs to treat this symptom include:
- darifenacin (Enablex)
- oxybutynin (Ditropan)
- prazosin (Minipress)
- tamsulosin (Flomax)
- tolterodine (Detrol)
For erectile dysfunction
Although both men and women with MS tend to have higher rates of sexual dysfunction than the general population, erectile dysfunction in men is fairly common. Oral medications that may be prescribed to help treat erectile dysfunction include:
Older drugs that must be injected directly into the penis are also available. These drugs aren’t used as much now that oral drugs are available. They include:
- alprostadil (Caverject)
It’s important to work with your doctor to create a plan to manage your MS symptoms and to prevent further damage from the disease. Many different types of drugs are available, depending on the type of MS you have and the symptoms you experience. Once you’ve started treatment, it is important to:
- take your medications on schedule
- manage your side effects
- see your doctor for required follow-up procedures