Self-injectable and oral medications for MS can be taken at home, while intravenous infusions must be administered in a clinical setting. Each treatment option has benefits and potential side effects.

There are a variety of treatments for multiple sclerosis (MS) designed to:

  • change how the disease progresses
  • manage relapses
  • help with symptoms
  • improve your overall quality of life

MS medications, also called disease-modifying therapies (DMTs), fall into three categories:

  • self-injectable
  • infusion
  • oral

With so many options, it can be hard to decide which treatment to try first. A healthcare professional can help you weigh the pros and cons of each and determine how they may affect your lifestyle.

Here’s more information on each type of medication to help you make an informed decision.

Many MS medications are self-injectable, meaning you can do them yourself. A healthcare professional can provide training to teach you the proper way to inject them safely.

The Food and Drug Administration (FDA) approved the following self-injectable medications for MS treatment:

  • glatiramer acetate (Copaxone, Glatopa), which is available in either a 20- or 40-milligram dose
  • interferon beta-1a (Avonex, Rebif)
  • interferon beta-1b (Betaseron, Extavia)
  • ofatumumab (Kesimpta)
  • peginterferon beta-1a (Plegridy)

Depending on the medication, you’ll either inject the drug beneath the skin (subcutaneously) or directly into the muscle (intramuscularly). Injections may involve a needle or an injection pen.

The frequency of injections ranges from daily (for some people taking Copaxone or Glatopa) to once per month (for people who have taken Kesimpta for at least 3 weeks).

Who should take them?

If you’re comfortable self-injecting and prefer not to take oral medications daily, injectable treatments might be a good choice for you.

Side effects and safety

The side effects of the injection can be unpleasant, but they’re usually short-lived and manageable.

Side effects can include:

  • pain, swelling, or other skin reactions at the injection site
  • flu-like symptoms
  • liver test abnormalities

According to the Multiple Sclerosis Association of America (MSAA), the following strategies can help prevent or alleviate unpleasant injection side effects:

  • rotating the injection sites
  • taking your injectables at night or on weekends to avoid symptoms during the workweek
  • decreasing the needle size
  • switching to an auto-injectable
  • icing the injection site beforehand to reduce pain and swelling
  • taking an over-the-counter (OTC) pain reliever, such as acetaminophen (Tylenol) to help alleviate flu-like symptoms

Daclizumab (Zinbryta) was removed from the global market in 2018 due to safety concerns, including reports of severe liver damage and anaphylaxis.

With infusion medications, a healthcare professional administers them through a needle (intravenously) in a clinical setting. You can’t take them at home, so you must be able to get to infusion appointments.

The FDA-approved infusion medications for MS include:

  • alemtuzumab (Lemtrada)
  • mitoxantrone (Novantrone)
  • natalizumab (Tysabri)
  • ocrelizumab (Ocrevus)
  • ublituximab (Briumvi)

The schedule for infusion medications varies:

  • Lemtrada is given in two courses. You receive daily infusions for 5 days. One year later, you receive your second set of daily infusions for 3 days.
  • Novantrone is given once every 3 months.
  • Tysabri is given once every 4 weeks.
  • The first two doses of Ocrevus and Briumvi are given 2 weeks apart. Later infusions are given every 6 months.

Who should take them?

If you want a healthcare professional to help you administer your medication or you don’t want to take pills every day, infusion medications might be a good choice for you.

Side effects and safety

  • nausea
  • headache
  • abdominal discomfort
  • fever
  • flushing
  • rash at the infusion site

In rare cases, these medications may cause serious side effects such as infection and heart damage.

Taking certain medications before your infusion sessions — such as antihistamines, fever reducers (antipyretics), and anti-nausea drugs (antiemetics) — may help prevent or alleviate side effects.

If you have asthma, your healthcare professional will ask you to bring your rescue inhaler with you to your infusion appointment.

If you can become pregnant, you may also be counseled on using birth control to help prevent potential birth irregularities that infusion medications may cause.

If you prefer, you may be able to take your MS medication in pill form.

One 2015 study that evaluated preferences for various MS medication receiving routes reported a strong preference for daily oral medications due to ease of use.

The FDA-approved oral MS medications include:

  • cladribine (Mavenclad)
  • dimethyl fumarate (Tecfidera)
  • dimethyl fumarate (generic)
  • diroximel fumarate (Vumerity)
  • fingolimod (Gilenya, Tascenso ODT)
  • monomethyl fumarate (Bafiertam)
  • ozanimod (Zeposia)
  • ponesimod (Ponvory)
  • siponimod (Mayzent)
  • teriflunomide (Aubagio)

Aubagio, Gilenya, Mayzent, Ponvory, and Zeposia are taken once per day. Tecfidera and Bafiertam are taken twice daily.

In your first week on Vumerity, you’ll take one pill twice daily. Afterward, you’ll take two pills twice per day.

Mavenclad is a short-course therapy. Over 2 years, you’ll have either 16 or 20 treatment days. On your treatment days, your dose will consist of one or two pills, depending on your weight.

Who should take them?

Oral medications can be easy to take and may be a good option if you don’t like needles.

Taking your medication as prescribed is important for it to be effective, so you’ll need to follow an organized schedule if you take daily oral doses.

Setting reminders for yourself can help you stick to a schedule and take each dose on time.

Side effects and safety

Side effects of oral medications may include:

  • headache
  • upset stomach
  • liver test abnormalities

Your healthcare professional may prescribe a lower dose of your MS medication and then gradually increase it to reduce the risk of side effects, according to the MSAA.

To treat an upset stomach, your healthcare professional may recommend an OTC medication such as Pepto-Bismol. The MSAA suggests it may be helpful to take your oral medication with food.

However, participants of the 2015 study mentioned above still overwhelmingly preferred this method due to its ease of use and the reduced risk of immediate side effects compared with other methods.

Your healthcare professional will run certain blood tests to make sure a new medication is safe to incorporate into your routine.

For example, before prescribing Tysabri infusions, your healthcare professional must test you for possible reactivation of the John Cunningham (JC) virus.

The JC virus is relatively common, with most people being exposed to it at some point in their lifetime. It doesn’t cause symptoms.

But when you have MS, the reactivation of this virus may lead to a rare — but potentially fatal — infection called progressive multifocal leukoencephalopathy (PML), which targets white matter in your brain.

Receiving a positive JC virus test doesn’t mean you’ll automatically develop PML. However, it does mean that taking certain DMTs could increase your risk of developing the condition.

Symptoms of PML are similar to those of MS and may include:

  • weakness
  • loss of coordination
  • visual changes
  • speech changes
  • changes in your personality

According to the National Multiple Sclerosis Society and the American Academy of Neurology, it’s important to keep up with your recommended vaccine schedule.

This typically includes the following vaccines:

  • COVID-19
  • influenza
  • hepatitis B
  • shingles
  • pneumococcal disease
  • monkeypox
  • smallpox
  • human papillomavirus (HPV)
  • chickenpox (varicella)

Certain factors can affect your overall vaccination plan:

  • Live vaccines aren’t recommended while taking DMTs.
  • A waiting period between the time of vaccination and the start of DMTs may be required for maximum efficacy.
  • Vaccines shouldn’t be administered while experiencing symptoms of relapse.

Your healthcare professional can provide additional guidance on what vaccines and vaccination schedules make the most sense for you.

DMTs are available in different forms, such as self-injectable, infusion, and oral treatments. Each form has side effects as well as benefits.

Your healthcare professional can help you choose the right medication based on your symptoms, preferences, and lifestyle. They can also advise you on how to lessen potential side effects associated with treatment.

While it can take 6–12 months for a DMT to take full effect, it’s important to seek medical attention if you experience unexpected side effects or worsening MS symptoms.