Multiple sclerosis (MS) is a condition that damages nerve cells in your central nervous system (CNS). Your CNS is composed of your brain, spinal cord, and optic nerves.

MS causes symptoms that gradually get worse, as well as symptoms that come on suddenly after a period of being controlled. This sudden appearance of symptoms is called a relapse.

There’s no cure for MS, and the damage it causes can’t be reversed. However, there’s medication available that can help manage the condition.

Condition management focuses on medication that can treat relapses as well as modify the disease to reduce damage and disability. It also involves other drugs that treat the symptoms or complications of MS.

FAST FACTS The Food and Drug Administration has approved the following drugs for the treatment of multiple sclerosis (MS):
  • Oral drugs: dimethyl fumarate (Tecfidera); fingolimod (Gilenya); teriflunomide (Aubagio)
  • Injections: interferon beta-1a (Avonex, Rebif); interferon beta-1b (Betaseron, Extavia); glatiramer acetate (Copaxone, Glatopa); peginterferon beta-1a (Plegridy)
  • Infusions: alemtuzumab (Lemtrada);mitoxantrone hydrochloride; natalizumab (Tysabri); ocrelizumab (Ocrevus)

There are several types of disease-modifying therapies (DMTs) that work to help change the course of MS. The length of treatment with these medications can range from a few months to years, depending on how effective the medications are for you.

Your doctor may recommend switching between these drugs throughout the course of your treatment. This will depend on how effectively each drug manages your disease and how you tolerate the side effects.

If you switch to a different DMT, your doctor will take note of whether you develop new lesions.

Interferon beta products

Interferon beta-1a (Avonex, Rebif), peginterferon beta-1a (Plegridy), and interferon beta-1b (Betaseron, Extavia) are injectable drugs.

They help modify relapsing-remitting MS (RRMS) and secondary progressive multiple sclerosis (SPMS) in cases of active disease — that is, a relapse has occurred or new lesions have appeared on an MRI scan.

These drugs are made up of proteins that keep certain white blood cells (WBCs) from entering your brain and spinal cord. These WBCs are thought to damage the myelin, which forms a protective coating over your nerve fibers.

Therefore, preventing these WBCs from moving into your brain and spinal cord can help slow their damage and reduce the number of relapses you have.

You inject these drugs yourself. Your healthcare provider will show you how to do this. The number of injections depends on the drug:

  • Rebif: three times per week
  • Betaseron: every other day
  • Extavia: every other day
  • Avonex: once per week
  • Plegridy: every two weeks

Glatiramer acetate (Copaxone)

Glatiramer acetate (Copaxone) is a manufactured substance that resembles a basic protein of natural myelin. It’s thought to work by prompting the WBCs to attack it instead of the myelin cells.

It’s used to treat RRMS and SPMS in cases of active disease — that is, a relapse has occurred or new lesions have appeared on an MRI scan.

You inject this drug yourself once per day or three times per week, depending on your dosage. Your healthcare provider will show you how.

Glatopa is an approved generic form of Copaxone.

Natalizumab (Tysabri)

Natalizumab (Tysabri) is an antibody that blocks damaged WBCs from moving into your brain and spinal cord.

It’s used to treat RRMS and SPMS in cases of active disease — that is, a relapse has occurred or new lesions have appeared on an MRI scan.

A healthcare provider gives you this drug as an intravenous (IV) infusion. The infusion takes about an hour, and you’ll get it every four weeks.

Mitoxantrone hydrochloride

Mitoxantrone hydrochloride was originally used to treat cancer. Now it’s also prescribed to treat people with MS. It suppresses the immune system cells that are thought to attack myelin cells. This medication is only available as a generic drug.

It’s used to treat secondary progressive MS or worsening relapsing-remitting MS after other drugs haven’t worked. It has a high risk of serious side effects, so it’s only appropriate for people with these more severe forms of MS.

A healthcare provider gives you this drug as a short IV infusion once every three months.

Alemtuzumab (Lemtrada)

Alemtuzumab (Lemtrada) is prescribed for people with relapsing forms of MS who have tried at least two other MS medications without success.

It works by reducing the number of specific WBCs in your body. This action may decrease the inflammation of and damage to nerve cells.

Alemtuzumab is given as a four-hour IV infusion. To start, you receive this drug once per day for five days. Then 12 months after your first treatment, you receive it again for three more days.

Ocrelizumab (Ocrevus)

Ocrelizumab (Ocrevus) is the newest infusion treatment for MS. It was approved by the Food and Drug Administration (FDA) in 2017. It’s the first drug used to treat primary progressive MS (PPMS). It’s also used to treat relapsing forms of MS.

Ocrelizumab appears to work by targeting the B lymphocytes that are responsible for damage and repair of the myelin sheath.

Ocrelizumab is given as an IV infusion. To begin, you’ll receive it in two 300-milligram (mg) infusions, separated by two weeks. After that, you’ll receive it in 600 mg infusions every six months.

You’ll also receive a steroid and an antihistamine on the day of each infusion to reduce the risk of reaction to the medication.

Fingolimod (Gilenya)

Fingolimod (Gilenya) comes as an oral capsule that you take once per day.

It’s the first oral medication approved by the FDA for RRMS.

Fingolimod causes the damaging WBCs to remain within your lymph nodes. This reduces the chance that they’ll enter your brain or spinal cord and cause damage.

Teriflunomide (Aubagio)

Teriflunomide (Aubagio) is an oral tablet that you take once per day.

It’s used to treat RRMS and SPMS in cases of active disease — that is, a relapse has occurred or new lesions have appeared on an MRI scan.

Teriflunomide works by blocking an enzyme that the damaging WBCs need. As a result, this drug helps decrease the number of these cells, which reduces the damage they can inflict.

Dimethyl fumarate (Tecfidera)

Dimethyl fumarate (Tecfidera) is an oral capsule that you take twice per day.

It’s used to treat RRMS and SPMS in cases of active disease — that is, a relapse has occurred or new lesions have appeared on an MRI scan.

This drug appears to work by interfering with the activity of certain immune system cells and chemicals to reduce the risk of MS relapse.

While many relapses go away on their own, more severe relapses require treatment.

Inflammation causes MS relapses, and it’s typically treated with corticosteroids. These drugs can reduce inflammation and help make MS attacks less severe. Corticosteroids used to treat MS include:

If corticosteroids don’t work, your doctor may prescribe corticotropin (H.P. Acthar Gel).

Corticotropin is an injection, and it’s also known as ACTH gel. It works by prompting the adrenal cortex to secrete the hormones cortisol, corticosterone, and aldosterone. The secretion of these hormones helps to reduce inflammation.

Other drugs can be used to treat specific MS symptoms or complications from MS-related damage.

For walking problems

Dalfampridine (Ampyra) is an oral tablet taken twice per day to help improve walking.

Dalfampridine works by blocking the tiny pores in nerve cells called potassium channels. This action may help damaged nerve cells to better send messages. Improved nerve impulse conduction aids in leg muscle control and strength.

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:

For fatigue

Ongoing fatigue is a common problem for people with MS. For this symptom, your doctor may prescribe a drug such as modafinil (Provigil).

They may also prescribe a drug off-label. “Off-label” means that a drug that’s been approved to treat one condition is being used to treat a different condition. These drugs include amantadine (Gocovri) and fluoxetine (Prozac).

OFF-LABEL DRUG USE Off-label drug use means that a drug that’s been approved by the FDA for one purpose is used for a different purpose that hasn’t been approved. However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients. So your doctor can prescribe a drug however they think is best for your care. Learn more about off-label drug use.

For dysesthesia

Dysesthesia means “bad sensation.” It’s a type of pain that can feel like ongoing burning or itching. It may also feel like wetness, electric shock, or pins and needles. To treat dysesthesia, your doctor may prescribe:

For depression

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:

For constipation

Constipation is another common complication of MS. Your doctor may recommend treating it with one of the following over-the-counter drugs:

  • bisacodyl (Dulcolax)
  • docusate (Colace)
  • magnesium hydroxide (Phillips’ Milk of Magnesia)
  • psyllium (Metamucil)

For bladder dysfunction

Bladder dysfunction is also a common complication of MS. Symptoms may include frequent urination, incontinence, or hesitancy in starting urination. You may also experience frequent nocturia (nighttime urination). Drugs to treat these symptoms include:

For sexual dysfunction

Both men and women with MS tend to have higher rates of sexual dysfunction than the general population.

Oral medications that may be prescribed to help treat erectile dysfunction (ED) 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). A drug that may be used off-label for this purpose is the blood pressure medication papaverine.

Women may experience problems such as reduced feeling in the vagina or clitoris, or vaginal dryness. There are no drugs currently available to treat these problems. However, for vaginal dryness, women can use water-soluble personal lubricants that are available over the counter.

Many different types of drugs are available to help you manage MS. The type of drugs that may be best for you depends on the type of MS you have and the symptoms you experience.

You may not be able to access all of these medications. Ask your doctor to confirm which drugs are currently on the market and which ones might be most appropriate for you.

Work with your doctor to create a plan to manage your MS symptoms and to help prevent further damage from the disease. Sticking to your treatment plan can help you feel better and slow the progression of your condition.