If you have multiple sclerosis (MS), your doctor may prescribe corticosteroids to treat episodes of disease activity called exacerbations. These episodes of new or returning symptoms are also known as attacks, flare-ups, or relapses.
Steroids are intended to shorten the attack so you can get back on track sooner.
It’s not necessary to treat all MS relapses with steroids, though. These medications are generally reserved for severe relapses that interfere with your ability to function. Some examples of this are severe weakness, balance issues, or vision disturbances.
Steroid treatments are potent and can cause side effects that vary from person to person. Intravenous (IV) steroid treatments can be expensive and inconvenient.
The pros and cons of steroids for MS must be weighed on an individual basis and may change during the course of the disease.
Continue reading to learn more about steroids for MS and their potential benefits and side effects.
The type of steroids used for MS are called glucocorticoids. These medications imitate the effect of hormones your body produces naturally.
High-dose steroids are usually administered intravenously once a day for three to five days. This must be done in a clinic or hospital, usually on an outpatient basis. If you have serious health concerns, hospitalization may be required.
IV treatment is sometimes followed by a course of oral steroids for one or two weeks, during which the dose is slowly decreased. In some cases, oral steroids are taken for as long as six weeks.
There’s no standard dosage or regimen for steroid treatment for MS. Your doctor will consider the severity of your symptoms and will likely want to start with the lowest possible dose.
The following are some of the steroids used to treat MS relapses.
Typical dosing ranges from 500 to 1000 milligrams a day. If you have a small body mass, a dose on the lower end of the scale may be more tolerable.
Solumedrol is administered intravenously in an infusion center or hospital. Each infusion lasts about an hour, but this can vary. During the infusion, you might notice a metallic taste in your mouth, but it’s temporary.
Depending on how you respond, you may need a daily infusion for anywhere from three to seven days.
Oral prednisone is available under brand names such as Deltasone, Intensol, Rayos, and Sterapred. This medication can be used in place of IV steroids, especially if you’re having a mild to moderate relapse.
Prednisone is also used to help you taper off after receiving IV steroids, usually for one or two weeks. For example, you might take 60 milligrams a day for four days, 40 milligrams a day for four days, and then 20 milligrams a day for four days.
Decadron is a brand name for oral dexamethasone. Taking a daily dose of 30 milligrams (mg) for a week has been shown to be effective in treating MS relapses.
This may be followed by 4–12 mg every other day for as long as a month. Your doctor will determine the right starting dose for you.
It’s important to note that corticosteroids are not expected to provide long-term benefits or change the course of MS.
There is evidence that they can help you recover from relapses faster. It may take a few days to feel your MS symptoms improve.
But just as MS varies so much from one person to another, so does steroid treatment. It’s not possible to predict how well it will help you recover or how long it will take.
Several small studies have suggested that comparable doses of oral corticosteroids can be used in place of high-dose IV methylprednisolone.
A 2017 meta-analysis concluded that oral methylprednisolone is not inferior to IV methylprednisolone, and they’re equally well tolerated and safe.
Since oral steroids are more convenient and less expensive, they may be a good alternative to IV treatments, especially if infusions are a problem for you.
Ask your doctor if oral steroids are a good choice in your case.
Occasional use of high-dose corticosteroids is usually well-tolerated. But they do have side effects. Some you’ll feel immediately. Others may be the result of repeated or long-term treatments.
While taking steroids, you may experience a temporary surge of energy that can make it difficult to sleep or even to sit still and rest. They can also cause mood and behavior changes. You might feel overly optimistic or impulsive while on steroids.
Together, these side effects may make you want to tackle large projects or take on more responsibilities than you should.
These symptoms are generally temporary and start to improve as you taper off the medication.
Other potential side effects include:
- facial flushing
- allergic reaction
- swelling of the hands and feet (from fluid and sodium retention)
- increased appetite
- increased blood glucose
- increased blood pressure
- lowered resistance to infection
- metallic taste in mouth
- muscle weakness
- stomach irritation or ulcers
Long-term steroid treatment can potentially lead to additional side effects such as:
It’s important to carefully follow your doctor’s instructions regarding tapering off steroids. If you stop taking them suddenly, or if you taper off too fast, you might experience withdrawal symptoms.
Prednisone can affect your cortisol production, especially if you take it for more than a few weeks at a time. Signs that you’re tapering off too quickly may include:
- body aches
- joint pain
- loss of appetite
Abruptly stopping Decadron can lead to:
- loss of appetite
- weight loss
- muscle and joint pain
- peeling skin
- upset stomach and vomiting
Corticosteroids are used to treat severe symptoms and shorten the length of an MS relapse. They do not treat the disease itself.
Except in the case of vision loss, treatment for MS relapses is not urgent. But it should be started as soon as possible.
Decisions about the benefits and side effects of these medications must be made on an individual basis. Things to discuss with a doctor include:
- the severity of your symptoms and how your relapse affects your ability to carry out your daily tasks
- how each type of steroid is administered and whether you’re able to comply with the regimen
- the potential side effects and how they may affect your ability to function
- any potential serious complications, including how steroids may affect your other conditions such as diabetes or mental health issues
- any possible interactions with other medications
- which steroid treatments are covered by your medical insurance
- what alternative treatments are available for specific symptoms of your relapse
It’s a good idea to have this discussion next time you visit a neurologist. That way, you’ll be prepared to decide in the event of a relapse.