If you have a type of multiple sclerosis called relapsing-remitting MS and your condition is acting up, your doctor may first treat you with a disease-modifying drug. These medicines slow down the advance of your disease and prevent flare-ups.
The drugs work by curbing the immune system – your body's main defense against germs – so that it doesn't attack the protective coating called myelin that surrounds the nerves.
Multiple Sclerosis Medications
Some drugs come as injections under your skin or into a muscle. The shot might make your skin sore, red, itchy, or dimply. They include:
Beta interferons: These are some of the most common drugs used to treat MS. They make flares less frequent and less severe. They can also cause flu-like symptoms, like aches, fatigue, fever, and chills, but these should fade within a few months. They may make you slightly more likely to get an infection. That’s because they lower the number of white blood cells, which help your immune system fight illnesses. They include:
Glatiramer (Copaxone, Glatopa): This medication stops your immune system from attacking the myelin that surrounds and protects your nerves. Other injectables include Interferon beta-1a (Avonex, Rebif), Interferon beta-1b (Betaseron, Extavia), ofatumumab (Kesimpta), and peginterferon beta-1a (Plegridy).
You can take other medications as a pill:
Cladribine (Mavenclad) is a pill taken once a day for 5 days for a month and once a day again for the second month. You may need another course in a year. It is not for treating relapsing forms of MS, including relapsing-remitting disease and active secondary progressive disease. It can affect your immune system and make you more likely to get other infections, so you will need to be monitored. You could also have hair loss and rashes.
Dimethyl fumarate (Tecfidera) is a tablet you take twice a day. It can lower your immune cells, so the doctor will do regular blood tests to keep an eye on them. The drug's most common side effects are flushing, stomach pain, diarrhea, nausea, and vomiting. An active ingredient similar to the one in Tecfidera is linked to four cases of PML.
Diroximel fumarate (Vumerity) is similar to Tecfidera. You take a tablet twice daily. The drug is used to treat relapsing forms of MS. Its most common side effects are flushing, redness, itching, rash, nausea, vomiting, diarrhea, stomach pain, or indigestion. Vumerity has been shown to be easier on the stomach than Tecfidera.
Fingolimod (Gilenya) is also a once-daily tablet. If you haven’t had chickenpox, you’ll need a vaccine. Common side effects include headache, diarrhea, back pain, cough, and abnormal liver tests. Because the medicine may slow your heart rate, the doctor will watch you closely after your first dose. The drug is also linked to progressive multifocal leukoencephalopathy (PML), a rare brain infection.
Monomethyl fumarate (Bafiertam) is a pill taken twice per day and is similar to dimethyl fumarate. Common side effects include flushing, belly pain, diarrhea, and nausea. Blood counts and liver enzymes should be monitored.
Ofatumumab (Kesimpta) is an injection you give yourself or get from your doctor every four weeks. Ofatumumab is used to prevent immune system cells (lymphocytes) from attacking the nerves in your brain and spinal cord. It helps decrease the number of episodes of disease worsening (relapses) and may prevent or delay disability. This drug may lower your resistance to infections.
Ozanimod (Zeposia) is a pill taken once a day. It starts with a low dose and then builds up over the first week. Common side effects include some dizziness, headaches, respiratory infections and cold symptoms. You shouldn’t take it if you have liver or heart problems.
Ponesimod (Ponvory) is a pill taken daily. It prevents immune system cells (lymphocytes) from attacking the nerves in your brain and spinal cord. It helps decrease the number of episodes of disease worsening (relapses) and prevent or delay disability. This drug may lower your resistance to infections.
Siponimod (Mayzent) is a tablet taken daily after a 5-day buildup to the proper dose. It can affect your immune system and had been linked to clotting in the extremities. The most common side effects are diarrhea, dizziness, swelling in the extremities, high blood pressure, headaches and a slowed heartbeat. You shouldn't take siponimod if you are pregnant.
Teriflunomide (Aubagio) is a tablet you take once a day. The most common side effects include diarrhea, abnormal liver tests, nausea, and hair loss. It does carry a "black box" warning, the FDA's most serious warning, because it can lead to liver problems and birth defects. If you take it, your doctor will likely do regular tests to check how well your liver is working. Don’t take it if you're pregnant.
Other medications are given by IV in a doctor’s office or a hospital. But you only have to go once every few months:
Alemtuzumab (Lemtrada) and mitoxantrone (Novantrone) are chemotherapy drugs designed to treat cancer. They’re an option if you don’t respond to other mediations. They curb your immune system and prevent it from attacking nerve coverings. Novantrone has an FDA "black box" warning because it can lead to heart damage and a type of leukemia.
Natalizumab (Tysabri) and ocrelizumab (Ocrevus) are options if other drugs don't work for you. Natalizumab prevents immune cells from getting to your brain and spinal cord, where they can damage nerves. Ocrelizumab attacks certain B cells and stops your immune system from attacking your body. The drugs are linked to PML, so your doctor will do blood tests to check for it.
Medication for MS Flares
If you’re taking other medication, mild flares will eventually go away on their own. If they aren’t bothering you, you don't need to treat them.
Steroids: If a flare gets in the way of your life, your doctor may give you high-dose steroids through a vein (IV) or by mouth to ease your symptoms quickly. These drugs will calm the flare, but they won't slow the course of your disease. The most common ones are:
- Methylprednisolone (Solu-Medrol)
- Prednisone (Deltasone)
- ACTH (H.P. Acthar Gel)
Medication for MS Symptoms
Your doctor may recommend treatments for:
Muscle stiffness and spasms:
- Muscle relaxants like baclofen (Lioresal) and tizanidine (Zanaflex)
- Sedatives like clonazepam (Klonopin) and diazepam (Valium)
Fatigue:
- Amantadine (Symmetrel)
- Armodafinil (Nuvigil)
- Modafinil (Provigil)
Depression:
- Antidepressants, such as bupropion (Wellbutrin), fluoxetine (Prozac), and sertraline (Zoloft)
Bladder problems:
- Oxybutynin (Ditropan) or tolterodine (Detrol)
They may also suggest:
Physical therapy: A trained health care professional can teach you exercises that help you stay active. You might also learn how to use a cane, walker, or other assistive device to get around more easily.
Lifestyle Changes You Can Make
Medications aren’t the only answer. Taking good care of yourself will help you live better with MS. Every day, make sure you:
Get plenty of rest: Keep a regular sleep schedule and make sure your bedroom is cool, dark, and screen-free.
Eat healthy food: There is no “MS diet.” Choose foods low in saturated fats and high in fiber. The U.S. Department of Agriculture’s MyPlate website is a good starting point.
Get some exercise: Even a walk around the block can help. Exercise builds bones and strengthens muscles. It keeps depression at bay and helps you sleep better.
Manage your stress: It may make your symptoms worse. Whether you meditate, read, journal, or chat with friends, find something that helps you control the ups and downs.
Stay cool: A rise in body temperature can make your symptoms worse. Stay in the AC if you can. Wear loose, breathable clothes outside.
Are There Alternative Treatments?
Many products claim to help with MS symptoms. Be wary of those that don’t have scientific studies behind them or make claims that seem too good to be true. Talk to your doctor about anything you’re tempted to take. Some supplements can change the way your medicines work.
Current research suggests these treatments are worth a try:
Vitamin D: Low levels of vitamin D in your blood can boost your chances of having MS. Studies are underway to see if vitamin D supplements can help. You should get your doctor to check your levels and discuss if you need to take a supplement.
Acupuncture: This traditional Chinese treatment holds that energy called chi flows along your body in lines called meridians. When your chi is out of whack, illness or pain results. An acupuncturist slides thin needles into points along the meridians to change your energy flow. Studies show it can help MS symptoms like fatigue, pain, mood, spasticity, numbness, tingling, and bladder problems.