Carl R. Darnall Army Medical Center - Health Library

Medications for Multiple Sclerosis (MS)

Here are the basics about each of the drugs below. Only the most common problems are listed. Ask your doctor if you need to take any special steps. Use each of these drugs as advised by your doctor or the booklet they came with. If you have any questions, call your doctor.

MS drugs can help slow the disease, treat flare ups, and ease problems. They do not cure it.

Over the Counter Medications

Prescription Medications

 

Disease-Modifying Therapies (DMTs)

Immunomodulating Drugs

Common names are:

  • Interferon beta-1a or 1b
  • Glatiramer acetate
  • Fingolimod
  • Teriflunomide
  • Dimethyl fumarate
  • Cladribine
  • Natalizumab
  • Alemtuzumab
  • Daclizumab
  • Rituximab
  • Ocrelizumab

These drugs lower the number of flare-ups and slow the disease. Some may limit harm to the myelin sheath. Others stop the blood cells in lymph nodes from moving to the brain and spine. These drugs can be given as a shot or pill. People taking fingolimod may have a decrease in heart rate. A higher risk of infections and eye problems may also happen. Some drugs may work faster than others. Glatiramer acetate may need to be taken for months before it starts to help.

Some problems are:

  • Fever and chills
  • Headache
  • Feeling tired
  • Diarrhea
  • Back pain
  • Sweating
  • Skin problems
  • Cough
  • Muscle aches or spasms
  • Depression
  • High risk of infection
  • Kidney and liver harm
  • Progressive multifocal leukoencephalopathy (a brain virus that can cause death)—natalizumab
  • Problems after shots, such as flushing, problems breathing, rapid heartbeat, sweating, and anxiety

Immunosuppressive Drugs

Common names are:

  • Azathioprine
  • Mitoxantrone
  • Cyclophosphamide
  • Methotrexate

These drugs limit what the immune system can do to the body. They may be given to try to put off a flare up. These drugs may cause harmful reactions.

Some problems are:

  • Upset belly and vomiting
  • Diarrhea
  • Fever
  • Feeling tired
  • Hair loss
  • High risk of infection
  • Menstrual problems
  • Liver harm
  • Progressive multifocal leukoencephalopathy (a brain virus that may cause death)—azathioprine
  • Problems after shots, such as flushing, breathing problems, rapid heartbeat, sweating, and anxiety
  • Leukoencephalopathy (non-infectious)—methotrexate
  • Kidney injury—methotrexate
  • Bleeding from the bladder—cyclophosphamide
 

Corticosteroids

Common names are:

  • Methylprednisolone
  • Prednisone
  • Betamethasone

These drugs are used to ease nerve tissue inflammation and shorten flare-ups. It is not known how they work. These drugs are often given short term. Do not stop taking them without talking to your doctor. Your doctor will tell you how to lower the dose or days you take them.

Some problems are:

  • High risk of infection
  • Weight gain
  • High blood pressure
  • High blood sugar
  • Mood swings
  • Problems sleeping
  • Bone density loss
  • Gastrointestinal problems

Other drugs may be used if these do not work for you. Immunoglobulin therapy injects antibodies into the blood. Plasmapheresis exchanges plasma in the blood.

 

Antiseizure Medicines

Common names are:

  • Gabapentin
  • Carbamazepine

These drugs are used to control shaking and seizures. They also may be used to treat nerve pain. Gabapentin may be given to treat spasticity and unusual sensations.

Some problems are:

  • Feeling tired
  • Nausea
 

Muscle Relaxers

GABA-B Agonists

A GABA-B agonist is used to control muscle spasticity. It may be taken as a pill or given as a shot into the spine. It often helps only a short time. Do not stop taking this drug without talking to your doctor.

Some problems are:

  • Feeling tired
  • Lightheadedness
  • Weakness

Noradrenergic Alpha-2 Agonists

Common names are:

  • Tizanidine
  • Clonidine

These drugs affect nerve pathways. They are used to treat spasticity. Clonidine may also help with insomnia. Your doctor may order lab tests to check your liver while you take this.

Some problems are:

  • Drowsiness
  • Dry mouth
  • Low blood pressure

Dantrolene

Dantrolene is used to control muscle cramps and spasms in people who can't walk. It can worsen muscle weakness.

Some problems are:

  • Diarrhea
  • Nausea
  • Lack of hunger

Benzodiazepines

Common names are:

  • Diazepam
  • Clonazepam

These drugs relax the muscles. They are used to control nighttime muscle spasms and spasticity in people who can't take other drugs. Clonazepam can also help control shaking.

Some problems are:

  • Feeling tired
  • Lightheadedness

Botulinum Toxin

Botulinum toxin is made from a type of bacteria. It is given as a shot into certain muscle groups that cause painful contractions. The shot blocks the signal from the nerves to the muscles. It helps for a short time.

Some problems are:

  • Nausea
  • Feeling tired
  • Flu-like symptoms
  • Headache
 

Bladder Control Medicines

Anticholinergic Drugs

Common names are:

  • Oxybutynin
  • Propantheline

These drugs control urinary urgency, frequency, and incontinence. They increase bladder capacity and ease urinary urgency.

Some problems are:

Desmopressin

This drug helps ease frequent urination during the night. It makes urine more concentrated. It can lower sodium levels, so blood tests may be done while you are on it. This is a nasal spray used at bedtime.

Some problems are:

  • Headache
  • Nasal congestion
 

Medicines Used to Treat Fatigue

Amantadine

Amantadine is an antiviral drug used to treat fatigue.

Some problems are:

  • Nausea
  • Dizziness
  • Problems sleeping

Modafinil

Modafinil is used to treat fatigue. It is a wakefulness agent. You may have headaches with this drug.

 

Antidepressants

Common names are:

  • Amitriptyline
  • Trazodone
  • Fluoxetine

Antidepressants treat depression. Some drugs are also given to people to help ease pain.

Do not stop taking these drugs without talking to your doctor. Do not take these drugs if you have taken a MAO inhibitor in recent weeks.

Some problems are:

  • Blurred eyesight
  • Dry mouth
  • Weight loss or weight gain
  • Lightheadedness when standing up
 

Other Medications Used to Treat MS

Dalfampridine

This drug helps nerves send their signals better. It has helped people with MS walk better.

Some problems are:

Over the Counter Medications

 

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Common names are:

  • Naproxen sodium
  • Ibuprofen
  • Aspirin

These drugs work to ease inflammation and pain. Some problems are:

  • Gastrointestinal bleeding
  • Stomach upset
 

Pain Relievers

Common brand name: Acetaminophen

Acetaminophen eases minor pain. It does not stop future headaches or treat the cause of the headache. It can cause liver problems if taken with alcohol. Do not drink alcohol when you take it. Do not take more than the dose you should. It is unlikely to cause problems.

Special Considerations

If you are taking medicines:

  • Take your medicine as advised. Do not change the amount or schedule.
  • Ask what side effects could happen. Tell your doctor if you have any.
  • Talk to your doctor before you stop taking any prescription medicine.
  • Do not share your prescription medicine.
  • Medicines can be harmful when mixed. Talk to your doctor or pharmacist if you are taking more than one, including over-the-counter products and supplements.
  • Plan ahead for refills.

When to Call Your Doctor

Call your doctor if your symptoms get worse or you have new ones.

REFERENCES:

Disease-modifying therapies for multiple sclerosis. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T905968/Disease-modifying-therapies-for-multiple-sclerosis. Updated August 10, 2018. Accessed September 26, 2018.

Goodin DS, Frohman EM, et al. Disease modifying therapies in multiple sclerosis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the MS Council for Clinical Practice Guidelines. Neurology. 2002 Jan 22;58(2):169-178.

Multiple sclerosis (MS). EBSCO DynaMed Plus website. Available at:https://www.dynamed.com/topics/dmp~AN~T116285/Multiple-sclerosis-MS. Updated July 23, 2018. Accessed September 26, 2018.

NINDS multiple sclerosis information page. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/Disorders/All-Disorders/Multiple-Sclerosis-Information-Page. Accessed September 27, 2018.

Plasmapheresis. Johns Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/transplant/programs/kidney/incompatible/plasmapheresis.html. Accessed September 26, 2018.

Treatment of specific impairments in multiple sclerosis. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T905969/Treatment-of-specific-impairments-in-multiple-sclerosis. Updated April 20, 2018. Accessed September 26, 2018.

2/18/2011 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T113820/Antidepressant-medication-overview: Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry. 2010;71(10):1259-1272.

Last reviewed September 2018 by EBSCO Medical Review Board Rimas Lukas, MD  Last Updated 9/26/2018