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Medications for Multiple Sclerosis (MS)

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by Wood D
 
The information provided here is meant to give you a general idea about each of the medicines listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medicines as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
With multiple sclerosis (MS), medicines are given to suppress or modulate the immune system and control symptoms. Medicines only help in managing the condition, and some slow the disease process. They do not cure MS.

Prescription Medications

  Corticosteroids
Common names include:
  • Methylprednisolone (Solu-Medrol)
  • Prednisone (Cordrol, Deltasone)
  • Betamethasone (Celestone)
Corticosteroids are used to reduce nerve tissue inflammation and shorten MS flare-ups. How these drugs work is not fully understood. These drugs are usually given short term. Do not suddenly stop taking these medicines. Carefully follow your doctor’s instructions for tapering the dose or alternating the days you use them.
Possible side effects include:
For people who do not respond well to corticosteroids, other therapies may be used. For example, immunoglobulin therapy involves injecting antibodies into the blood. So far, though, the study results are inconsistent. Another treatment is plasmapheresis . This involves exchanging plasma in the blood. The results have been inconsistent with this type of treatment too.
  Immunomodulating Drugs
Glatiramer Acetate
Common brand name: Copaxone
Glatiramer acetate helps prevent MS relapses, possibly by blocking the immune system from attacking myelin. The drug is given by an injection. It may take months for this drug to show any benefits.
Possible side effects include:
  • Swelling and skin tenderness
  • Systemic reactions after injections, such as flushing, shortness of breath, palpitations, sweating, and anxiety
Fingolimod
Common brand name: Gilenya
Fingolimod is the first oral medicine to treat MS symptoms. The medicine affects blood cells in the lymph nodes, blocking these cells from moving to the brain and spinal cord. This can reduce relapses and slow the progression of MS.
When starting fingolimod, patients may have a decrease in heart rate. Increased risk of infections and serious eye problems are also possible side effects.
More common side effects include:
  • Headache
  • Influenza
  • Diarrhea
  • Back pain
  • Cough
Other Immunosuppressive Drugs
Common names include:
  • Azathioprine (Imuran)
  • Cyclophosphamide (Cytoxan)
  • Mitoxantrone (Novantrone)
  • Methotrexate (Folex, Rheumatrex)
  • Natalizumab (Tysabri)
  • Cladribine (2-CdA, Leustatin)
These immunosuppressive drugs may be given to try to prevent a relapse or progression of MS. These drugs may produce serious side effects. Some of these are prescribed by doctors who specialize in treating MS, but the medicines may not be approved by the Food and Drug Administration (FDA) for treating MS.
Possible side effects include:
  • Nausea and vomiting
  • Diarrhea
  • Increased risk of infection
  • Kidney and liver damage
  • Progressive multifocal leukoencephalopathy (a potentially fatal viral infection of the brain)—Natalizumab
  Muscle Relaxers
GABA-B Agonists
Common name: Baclofen (Lioresal)
A GABA-B agonist is used to control muscle spasticity. This drug may be taken by mouth or injected into the spinal canal. The benefits are usually short lived. Do not stop taking this medicine without consulting your doctor.
Possible side effects include:
  • Drowsiness
  • Dizziness
  • Weakness
Noradrenergic Alpha-2 Agonists
Common names include:
  • Tizanidine (Zanaflex)
  • Clonidine (Catapres)
Possible side effects include:
  • Drowsiness
  • Dry mouth
  • Low blood pressure
Dantrolene
Common brand name: Dantrium
Dantrolene is used to control muscle cramps and spasms in patients who cannot walk. It tends to worsen muscle weakness. It is given at bedtime and may be increased to include doses during the day.
Possible side effects include:
  • Diarrhea
  • Nausea
  • Loss of appetite
Benzodiazepines
Common names include:
  • Diazepam (Valium)
  • Clonazepam (Klonopin)
Benzodiazepines relax the muscles and are used to control nighttime muscle spasms and spasticity in patients who cannot tolerate other drugs used to treat this symptom. Clonazepam can also help control tremors.
Possible side effects include:
  • Drowsiness
  • Dizziness
Botulinum Toxin
Common brand name: Botox
Botulinum toxin is made from a type of bacteria. Given as an injection, botox is injected into certain muscle groups that are causing painful contractions. The injection works by temporarily blocking the signal from the nerves to the muscles.
Side effects may include:
  • Nausea
  • Fatigue
  • Flu-like symptoms
  • Headache
  Bladder Control Medicines
Desmopressin
Common brand name: Stimate
Desmopressin helps relieve frequent urination during the night that has not responded to other treatment. It produces more concentrated urine. It can decrease sodium levels, so blood tests may be ordered. This drug is a nasal spray used at bedtime.
Possible side effects include:
  • Headache
  • Nasal congestion
 

References


Ampyra. Ampyra website. Available at: http://www.ampyra.com/consumer/ . Accessed August 31, 2012.


Botulinum toxin injections—medical. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated December 2011. Accessed August 31, 2012.


Conn HF, Rakel R. Conn’s Current Therapy. 54th ed. Philadelphia, PA: WB Saunders Company; 2002.


Immunoglobulin therapy. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated November 2011. Accessed August 31, 2012.


Multiple sclerosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated August 10, 2012. Accessed August 31, 2012.


Multiple Sclerosis Society. News item. Multiple Sclerosis Society website. Available at: http://www.nationalmssociety.org/news/news-detail/index.aspx?nid=2568 . Accessed August 31, 2012.


Multiple Sclerosis. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/multiple%5Fsclerosis/multiple%5Fsclerosis.htm . Accessed August 31, 2012.


About MS. National Multiple Sclerosis Society website. Available at: http://nationalmssociety.org/about-multiple-sclerosis/what-we-know-about-ms/treatments/index.aspx . Accessed August 31, 2012.


Nissen D. Mosby’s Drug Consult. St. Louis, MO: Mosby Inc; 2002.


Noble J, Green H. Textbook of Primary Care Medicine . 3rd ed. St. Louis, MO: Mosby, Inc; 2001.


Plasmapheresis. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated November 2011. Accessed August 31, 2012.


9/24/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : US Food and Drug Administration. FDA approves first oral drug to reduce MS relapses. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm226755.htm . Published September 22, 2010. Accessed September 24, 2010.


2/18/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry. 2010;71(10):1259-1272.

 

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