Multiple sclerosis is an autoimmune disorder in which the body’s immune system attacks the myelin covering of your nerves. Eventually, this causes damage to the nerves themselves. There’s no cure for MS, but treatment can help manage the symptoms and slow the progression of the disease.

Disease-modifying therapies (DMTs) are designed to slow the long-term progression of the disease, reduce relapses, and prevent new damage from occurring. DMTs can be taken orally or by injection. Injections can be either self-injected at home or given as intravenous infusions in a clinical setting.

Both oral and injectable medications have benefits and potential side effects, and many come with specific warnings from the U.S. Food and Drug Administration (FDA).

There are many factors to consider when deciding between oral and injectable treatments. For example, oral medications are taken daily, while most injectable medications are taken less frequently. Your doctor can help you compare the risks versus the benefits and decide on the best option for you.

Your preference is important in the selection of a treatment plan. The medication’s effectiveness, side effects, and frequency of dose all are things to consider. The route that the drug is administered is also important. Here are some things you need to know.

Self-injectable medications

Self-injectable medications are the largest category of DMTs with the most options to choose from. They’re used for the long-term treatment of relapsing and relapsing-remitting MS.

A medical professional will train you in the injection process so that you can administer your own dose safely. Most of these medications can cause redness, swelling, and pain at the injection site, in addition to other side effects.

Avonex (interferon beta-1a)

  • Benefit: immune system modulator, antiviral properties
  • Dose frequency and method: weekly, intramuscular injection
  • Common side effects can include: headache, flu-like symptoms
  • Warnings include: liver enzymes and blood cell count may need to be monitored

Betaseron (interferon beta-1b)

  • Benefit: immune system modulator, antiviral properties
  • Dose frequency and method: every other day, subcutaneous injection
  • Common side effects can include: flu-like symptoms, low white blood cell count
  • Warnings include: liver enzymes and blood cell count may need to be monitored

Copaxone (glatiramer acetate)

  • Benefit: immune system modulator, blocks attack on myelin
  • Dose frequency and method: daily or three times per week, subcutaneous injection
  • Common side effects can include: flushing, shortness of breath, rash, chest pain
  • Warnings include: injection sites can become permanently indented because fatty tissue is destroyed, so careful rotation of injection sites is recommended

Extavia (interferon beta-1b)

  • Benefit: immune system modulator, antiviral properties
  • Dose frequency and method: every second day, subcutaneous injection
  • Common side effects can include: flu symptoms, headache
  • Warnings include: liver enzymes and blood cell count may need to be monitored

Glatopa (glatiramer acetate)

  • Benefit: immune system modulator, blocks attack on myelin
  • Dose frequency and method: daily, subcutaneous injection
  • Common side effects can include: redness, swelling, or pain at the injection site
  • Warnings include: injection sites can become permanently indented because fatty tissue is destroyed, so careful rotation of injection sites is recommended

Plegridy (pegylated interferon beta-1a)

  • Benefit: immune system modulator, antiviral properties
  • Dose frequency and method: every two weeks, subcutaneous injection
  • Common side effects can include: flu-like symptoms
  • Warnings include: liver enzymes may need to be monitored

Rebif (interferon beta-1a)

  • Benefit: immune system modulator, antiviral properties
  • Dose frequency and method: three times per week, subcutaneous injection
  • Common side effects can include: flu-like symptoms
  • Warnings include: liver enzymes may need to be monitored

Zinbryta (daclizumab)

  • Benefit: binds to T cell receptor that activates in response to MS
  • Dose frequency and method: monthly, subcutaneous injection
  • Common side effects can include: cold, flu, upper respiratory tract infection, throat pain, depression
  • Warnings include: can cause severe liver injury — this drug should be used only by people who haven’t been helped by at least two other medications

Intravenous infusion medications

Another type of injectable option for treating MS is intravenous infusion. Instead of entering your system intramuscularly or subcutaneously, infusions go directly into a vein. The infusions must be given in a clinical setting by a trained professional. The doses aren’t given as often.

Intravenous infusions treat relapsing MS. They can result in increased risk of infections in addition to other side effects.

Lemtrada (alemtuzumab)

  • Benefit: suppresses myelin-damaging immune cells
  • Dose frequency: daily for five days; one year later, daily for three days
  • Common side effects can include: nausea, vomiting, diarrhea, headache, rash, itching
  • Warnings include: can cause a bleeding disorder (idiopathic thrombocytopenic purpura) and cancer

Novantrone (mitoxantrone)

  • Benefit: immune system modulator and suppressor
  • Dose frequency: once every three months (limit of two to three years)
  • Common side effects can include: hair loss, nausea, amenorrhea
  • Warnings include: can cause heart damage and leukemia

Tysabri (natalizumab)

  • Benefit: inhibits adhesion molecules
  • Dose frequency: every four weeks
  • Common side effects can include: headache, joint pain, fatigue, depression, abdominal discomfort
  • Warnings include: can increase risk of progressive multifocal leukoencephalopathy (PML), a brain infection that is potentially fatal

Ocrevus (ocrelizumab)

  • Benefit: targets white cells that damage nerves
  • Dose frequency: first two doses are two weeks apart followed by doses every six months
  • Common side effects can include: flu-like symptoms, infection
  • Warnings include: can cause cancer, and in rare instances life-threatening infusion reactions

Oral medications

If you’re not comfortable with needles, there are oral options for treating MS. Taken daily or twice daily, oral medications are the easiest to self-administer but require that you maintain a regular dosing schedule.

Aubagio (teriflunomide)

  • Benefit: immunomodulator, inhibits nerve degeneration
  • Dose frequency: daily
  • Common side effects can include: headaches, liver changes, nausea, hair loss, reduced white blood cells
  • Warnings include: can cause severe liver injury and birth defects

Gilenya (fingolimod)

  • Benefit: blocks T cells from leaving lymph nodes
  • Dose frequency: daily
  • Common side effects can include: flu-like symptoms, elevated liver enzymes

Tecfidera (dimethyl fumarate)

  • Warnings include: can cause changes in blood pressure, liver function, and heart function
  • Benefit: anti-inflammatory, protects nerves and myelin from damage
  • Dose frequency: twice daily
  • Common side effects can include: gastrointestinal changes, reduced white blood cell count, elevated liver enzymes
  • Warnings include: can cause severe allergic reactions, including anaphylaxis

The takeaway

The goal of MS treatment is to manage symptoms, control relapses, and slow the long-term progression of the disease. Injectable MS treatments come in two forms: self-injectables and intravenous infusions. Most injectables don’t have to be taken as often as oral medications, which are taken daily.

All MS treatments have benefits, side effects, and risks. The most important thing is that whatever treatment that you’re on, you take it as prescribed. If the side effects are enough to cause you to want to skip treatments, talk to your doctor. Your doctor can help you choose the best option for you.