If you have multiple sclerosis (MS), your doctor may prescribe steroids to treat episodes of disease activity. These episodes of new or returning symptoms are known as:
- flare-ups
- relapses
- exacerbations
- attacks
Steroids are intended to shorten the flare-up so you can get back on track sooner. It’s not necessary to treat all MS flare-ups with steroids, though.
These medications are generally reserved for severe flare-ups that interfere with your ability to function. Some symptoms of severe flare-ups include:
- severe weakness
- balance issues
- visual 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 known as glucocorticoids. They belong to a larger class of steroids called corticosteroids.
Glucocorticoid drugs imitate the effect of glucocorticoid hormones, which your body produces naturally.
Glucocorticoid drugs work by closing the impaired blood-brain barrier, which helps stop inflammatory cells from migrating into the central nervous system. This helps suppress inflammation and ease symptoms of MS.
High-dose steroids are usually administered intravenously once a day for 3 to 5 days. The administration of the steroids 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 1 or 2 weeks. During this time, the dose is slowly decreased. In some cases, oral steroids are taken for as long as 6 weeks.
There’s no standard dosage or regimen for steroid treatment for MS. Your doctor will consider the severity of your symptoms and likely want to start with the lowest possible dose.
Methylprednisolone may be administered as:
- an oral treatment (Medrol)
- an injection into the muscles, joints, soft tissues, or skin (Depo-Medrol, Solu-Medrol)
- an IV infusion (Solu-Medrol)
Solu-Medrol, the only form that can be administered intravenously, is quite potent and often used for severe flare-ups.
Depo-Medrol has a slower onset and longer duration of action, so it may not be as useful for acute flare-ups.
Typical dosing for Solu-Medrol ranges from 500 to 1,000 milligrams (mg) a day. If you have a small body mass, a dose on the lower end of the scale may be more tolerable.
Solu-Medrol is administered in an infusion center or hospital. It’s the most commonly prescribed steroid for people with MS who are admitted into infusion centers or inpatient facilities.
Each infusion lasts about 1 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 3 to 7 days. Treatment typically lasts for 5 days.
Prednisone is an oral medication that’s available as a generic drug and under the brand names Prednisone Intensol and Rayos.
This medication can be used in place of IV steroids, especially if you’re having a mild to moderate flare-up.
Prednisone is also used to help you taper off steroids after receiving IV steroids.
Tapering guidance is often specific to each person. However, a typical tapering regimen for an adult might require you to reduce your prednisone doses
Children who take prednisone may have their doses reduced by 10 to 20 percent every 3 to 7 days until they’ve reached 8 to 10 mg per square meter of body surface area (mg/m2).
Prednisolone is available as an oral tablet or an oral syrup. The tablet is only available as a generic drug, while the oral syrup is available as a generic drug and under the brand name Prelone.
A 2021 study concluded that tapering oral prednisolone for 20 days after taking IV methylprednisolone had little effect on the health of people with MS. Oral prednisolone even increased the risk of side effects such as increased appetite and weight gain.
If your doctor prescribes oral tablets, then your treatment regimen will typically begin with 200 mg of prednisolone each day for 1 week. Afterward, you’ll take 80 mg every other day for 1 month.
Dexamethasone can be administered orally or via injection. The generic form of the drug is the only form that the Food and Drug Administration (FDA) has approved for the treatment of MS.
Taking a daily dose of 30 mg for 1 week has been shown to be effective in treating MS flare-ups. This may be followed by 4 to 12 mg every other day for as long as 1 month.
Your doctor will determine the right starting dose for you.
Betamethasone is an injectable drug that’s available as a generic drug and as the brand-name drug Celestone Soluspan. Betamethasone is also available in other forms, but those forms are rarely used to help treat MS.
As with dexamethasone, the standard starting dosage for people with MS is 30 mg daily for 1 week. Afterward, the recommended dosage is 12 mg every other day for a month.
It’s important to note that corticosteroids aren’t expected to provide long-term benefits or change the course of MS.
However, there’s
Just as MS varies so much from one person to another, so does steroid treatment. It’s not possible to predict how well it’ll help you recover or how long it’ll take.
Several small studies, including a
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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 these drugs do have side effects. Some you’ll feel immediately. Others may be the result of repeated or long-term treatments.
Short-term effects
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:
- acne
- facial flushing
- allergic reaction
- depression
- swelling of the hands and feet from fluid and sodium retention
- headache
- increased appetite
- increased blood glucose
- increased blood pressure
- insomnia
- lowered resistance to infection
- metallic taste in mouth
- muscle weakness
- stomach irritation or ulcers
Long-term effects
Long-term steroid treatment can potentially lead to additional side effects such as:
- cataracts
- worsening glaucoma
- diabetes
- osteoporosis
- weight gain
In pregnancy
According to a 2020 literature review, people in their first trimester of pregnancy should avoid using corticosteroids to help treat their MS. This is because corticosteroid usage increases the risk of miscarriage.
The researchers also recommended that corticosteroids only be used in situations where flare-ups are having a substantial effect on your daily activities.
Dexamethasone and betamethasone shouldn’t be used during pregnancy at all.
Prednisone, like all corticosteroids, can affect your production of the hormone cortisol, especially if you take it for more than a few weeks at a time.
However, if you suddenly stop taking corticosteroids, or if you taper off too fast, you might experience withdrawal symptoms. It’s important to carefully follow your doctor’s instructions regarding tapering off corticosteroids.
Symptoms that indicate you’re tapering off too quickly may include:
- body aches
- muscle and joint pain
- fatigue
- lightheadedness
- weakness
- confusion
- drowsiness
- headache
- loss of appetite
- weight loss
- peeling skin
- nausea
- upset stomach and vomiting
Corticosteroids are used to treat severe symptoms and shorten the length of an MS flare-up. They don’t treat the disease itself.
Except in the case of vision loss, treatment for MS flare-ups isn’t urgent. However, 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 flare-ups affect your ability to carry out your daily tasks
- how each type of steroid is administered and whether you’re able to follow the treatment regimen
- the potential side effects and how they may affect your ability to function
- any potential serious complications, including how steroids may affect any other health conditions such as diabetes or mental health disorders
- any possible interactions with other medications
- which steroid treatments are covered by your medical insurance
- what alternative treatments are available for the specific symptoms of your flare-ups
It’s a good idea to have this discussion the next time you visit a neurologist. That way, you’ll be prepared to decide in the event of a flare-up.