Medications for multiple sclerosis (MS) include a wide variety of drugs to modify the course of the disease, treat relapses, or help manage symptoms.

MS is a condition that affects the nervous system. The course of the condition is different for each individual, as are the symptoms they will experience.

This article discusses the different types of disease-modifying therapies (DMTs) for MS and how they work.

It also provides details on drugs to treat individual symptoms of MS, dosage, and side effects.

A healthcare professional handing a packet of medication for MS.Share on Pinterest
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MS results from damage to the coating of nerve fibers in the brain, spinal cord, and optic nerve.

DMTs are not a cure for MS, but they may help slow the progression of the disease and reduce the number and severity of relapses, according to the Multiple Sclerosis Association of America (MSAA).

In many cases, researchers do not know exactly how a particular DMT works. In general, the drugs may act to calm the immune system and lessen the attack on nerve cells.

Injectable therapies

A person with MS can inject these medications themselves or ask a caregiver to do it for them.

It is important to note that the Food and Drug Administration (FDA) have not approved injectable DMTs for use during pregnancy or lactation.

There are two types of injectable DMTs:

Beta interferon drugs

Beta interferon drugs help regulate the immune cells.

The following information is from the National Multiple Sclerosis Society (NMSS):

DrugAdministrationDose
Avonexinjected into a muscle, or intramuscularly, with a pre-filled syringe or auto-injector30 micrograms (mcg) once per week
Betaseron injected under the skin, or subcutaneously0.25 milligrams (mg) every other day
Extaviainjected under the skin using a syringe or auto-injector0.25 mg every other day
Rebifinjected under the skin using a pre-filled syringe or auto-injector22 mcg or
44 mcg three times per week
Plegridyinjected under the skin or into a muscle125 mcg every 14 days

Common side effects include:

More severe side effects may include:

Glatiramer acetate

These drugs help change the balance of the immune cells and include:

DrugAdministrationDose
Glatopainjected under the skin using a pre-filled syringe20 milligrams per milliliter (mg/ml) per day or 40 mg/ml three times per week
Copaxoneinjected under the skin using a pre-filled syringe20 mg/ml per day or 40 mg/ml three times per week

They cause the following side effects:

More severe side effects include damage to fatty tissue under the skin and liver problems.

Oral therapies

A person with MS can take the following oral therapies:

MedicationBrand nameDoseCommon side effects
teriflunomideAubagioa 7-mg or 14-mg pill once per dayheadache
nausea
diarrhea
abnormal liver tests
thinning hair
monomethyl fumarateBafiertam95 mg twice daily for 1 week, followed by 190 mg twice per daynausea
diarrhea
abdominal pain
flushed skin
dimethyl fumarateTecfidera120 mg twice daily for 1 week, followed by a 240-mg capsule twice per daynausea
diarrhea
abdominal pain
flushed skin
diroximel fumarateVumerity231 mg twice daily for 1 week, followed by 2 231-mg pills twice per daynausea
diarrhea
abdominal pain
flushed skin
cladribineMavenclad2 treatment courses of 4–5 days per yearheadache
respiratory infection
reduced white blood cell count
siponimodMayzent1 mg or 2 mg per dayhigh blood pressure
headache
abnormal liver tests
fingolimodGilenyaa 0.5-mg capsule once per day for those weighing more than 40 kilograms (kg)
0.25 mg for those who weigh 40 kg or less
headache
pain in the back, abdomen, or extremities
diarrhea
cough
flu
sinusitis
abnormal liver tests
ozanimodZeposia0.23 mg for 4 days, followed by 0.46 mg for 5–7 days, followed by 0.92 mg once per dayhigh blood pressure
back pain
upper respiratory infections
abnormal liver tests
blood pressure drop upon standing
frequent, painful urination

Infusion therapies

In addition to oral and self-injected drugs, DMTs include medications that a person receives through an intravenous (IV) infusion.

A healthcare professional administers these through a needle placed into a person’s vein.

According to the National Institute of Neurological Disorders and Stroke (NINDS), because of potentially serious side effects, doctors typically recommend this type of treatment only if other therapies have not worked for a person with MS.

Infusion therapies include:

  • Natalizumab (Tysabri): A healthcare professional will administer this once per month. Experts associate the use of the drug with an increased chance of progressive multifocal leukoencephalopathy, a potentially fatal brain infection.
  • Ocrelizumab (Ocrevus): A healthcare professional will administer this every 6 months. The FDA have approved the therapy for primary progressive and relapsing forms of MS. The drug may increase the risk of infections and cancer.
  • Alemtuzumab (Lemtrada): A healthcare professional will administer this for 5 days in a row, followed by 3 days 1 year later. Therapy with this drug may increase the risk of autoimmune conditions.
  • Mitoxantrone (Novantrone): A healthcare professional will administer this four times per year. Side effects may include heart damage and certain blood cancers.

Most people with MS initially have relapses, which are a worsening of symptoms or the appearance of new symptoms for several days up to a few months. The symptoms then subside.

Learn more about MS exacerbations here.

If a relapse is severe enough, a healthcare professional may recommend treatment with an IV infusion of certain medications for several days.

Medications for relapses include corticosteroids, a type of steroid that helps decrease inflammation in the central nervous system.

These include:

Side effects of corticosteroid treatment may include:

An alternative to corticosteroids is Acthar gel. A person takes this drug through an injection under the skin or into a muscle once per day for several weeks.

Acthar contains a form of adrenocorticotropin, which tells the body to make more steroids.

Side effects of Acthar gel are similar to those of corticosteroids.

MS can cause a person to experience symptoms such as an overactive bladder, urinary incontinence, or constipation.

Bladder conditions

According to MSAA, MS can cause a muscle in the bladder wall, called the detrusor muscle, to contract. This reduces the amount of urine the bladder can hold, producing symptoms such as a frequent need to urinate.

MS can also interfere with nerve signals to the urinary sphincter. As a result, a person may have trouble emptying their bladder completely.

Darifenacin (Enablex) is a drug that relaxes the bladder muscles to help relieve an overactive bladder.

The recommended starting dose of Enablex extended-release tablets is 7.5 mg per day, which a person may increase to 15 mg per day.

Side effects include:

Other drugs that may help relieve an overactive bladder in MS include:

  • tolterodine (Detrol)
  • oxybutynin (Ditropan)
  • solifenacin succinate (Vesicare)

Another option is tamsulosin (Flomax). This drug may relax the muscles in the prostate and bladder to improve the flow of urine. The dose is typically 0.4 mg per day.

Healthcare professionals predominantly prescribe Flomax for males with MS.

Common side effects include:

Bowel dysfunction

MS may disrupt the nerve signals to muscles that help empty the bowels.

Almost 70% of people with MS experience bowel problems, which in most cases is constipation, according to MSAA.

Drinking more fluids, eating more fiber, and exercising regularly often helps. In addition, a person can try over-the-counter medications that may relieve constipation. These include:

People with MS may feel a wide range of emotions after receiving a diagnosis. Additionally, damage to nerve fibers in the brain may also cause emotional changes, according to the NMSS.

Emotional changes

About 10% of people with MS will experience pseudobulbar affect (PBA), in which an individual has bouts of uncontrolled laughter or crying that are not related to how they are feeling.

Nuedexta is a form of medication to treat PBA. A person typically starts by taking 1 capsule per day for 7 days, followed by 1 capsule every 12 hours.

Possible side effects include:

Depression

Depression is common in people with MS.

NINDS note that treatment often includes cognitive behavioral therapy and selective serotonin reuptake inhibitor antidepressants.

The latter include:

Among possible side effects are:

MS can cause movement and coordination difficulties.

Tremors

There are no specific medications for tremor. However, there are medications that can have secondary effects that may help reduce tremors.

These include:

  • hydroxyzine (Atarax, Vistaril), an antihistamine that can help reduce stress-induced tremors
  • clonazepam (Klonopin) or buspirone (Buspar), which are antianxiety medications that have a sedative effect
  • propranolol (Inderal), a beta-blocker
  • ondansetron (Zofran), a type of antinausea medication
  • primidone (Mysoline), an anti-epileptic medication
  • acetazolamide (Diamox), a diuretic
  • onabotulinumtoxinA (Botox), a neurotoxin
  • isoniazid (Laniazid), an antibiotic

Spasticity

Spasticity occurs when a person has muscle stiffness or spasms. It is a common symptom of MS.

The FDA have approved a muscle relaxant called baclofen (Lioresal) for treating spasticity in MS.

The maximum dose is 20 mg four times per day.

Common side effects include drowsiness, dizziness, and weakness.

Many people with MS experience difficulty walking and maintaining their balance. Physical therapy and use of a cane or walker may help.

In addition, doctors may prescribe dalfampridine (Ampyra) to help people with MS walk faster. The drug blocks the flow of potassium across the surface of nerve cells, and this may improve their ability to send signals to other cells.

The maximum dose is two 10-mg tablets each day.

Side effects include:

  • urinary tract infection
  • trouble sleeping
  • dizziness
  • headache
  • nausea

Medications known as nonsteroidal anti-inflammatory drugs, such as ibuprofen, may help reduce aches and pains.

People with MS may also experience neuropathic pain that results from irritation of or damage to the nerves. According to the NMSS, the damaged nerves may produce stabbing, burning, or squeezing sensations.

A doctor might prescribe certain drugs off-label for treating neuropathic pain. These include medications that the FDA have approved for treating seizures or depression.

Some of them are FDA-approved for treating certain types of nerve pain:

DrugBrand nameTypeSide effects
duloxetineCymbaltaantidepressantnausea
diarrhea
constipation
dizziness
insomnia
fatigue
gabapentinNeurontinanti-seizuredizziness
drowsiness
peripheral edema, or swelling
carbamazepineTegretolanti-seizuredizziness
drowsiness
difficulty walking
nausea
vomiting

A person should consult a healthcare professional about the suitable dosages to treat MS-related pain.

People with MS often experience physical or mental fatigue. Mild to moderate exercise each day may prove effective.

Medications to help reduce fatigue include:

A person should speak with a healthcare professional about the dosages to help treat MS-related fatigue.

Damage to the myelin, a fatty substance that covers the nerve fibers, can lead to a variety of visual and eyesight problems.

Typically, these will resolve without treatment. However, severe symptoms may warrant the use of IV steroid medications.

Learn more about how MS affects the eyes here.

People with MS can use hydroxyzine (Vistaril) to treat itching or burning sensations. Hydroxyzine is an antihistamine.

The typical dosage for MS-related itching is 25 mg for adults up to four times per day, as needed.

Examples of the side effects include headache, drowsiness, skin rash, and dry mouth.

A person with MS can take meclizine (Antivert) to treat dizziness.

It is advisable for a person to take 25–100 mg daily, in divided doses.

Side effects may include a severe allergic reaction known as anaphylaxis, drowsiness, dry mouth, headache, fatigue, vomiting, or blurred vision.

MS can lead to:

  • libido loss
  • difficulty reaching an orgasm
  • reduced sensation in the penis or vaginal and clitoral area
  • vaginal dryness
  • difficulty achieving and maintaining an erection

If a person is having difficulty maintaining an erection, there are oral and injectable medications available.

Learn more about the treatment options for erectile dysfunction here.

A person experiencing vaginal dryness can use water-soluble personal lubricants. It is important to note that petroleum jelly is not a suitable personal lubricant, as it can lead to an infection.

Learn more about the treatment options for vaginal dryness here.

The cost of DMTs can be high. A person’s health insurance may cover some of the costs of a DMT treatment.

Learn more about Medicare and MS drugs here.

Additionally, manufacturers of DMTs offer patient assistance programs.

A person can also ask the doctor’s office for a reduced rate or payment plan to help with the costs of DMTs.

According to the NMSS, the best way for people with MS to manage the disease is to adopt a healthy lifestyle, treat the symptoms, and use DMTs.

Medications can play an important role in helping individuals with MS improve their quality of life.

People with MS should work closely with their doctor to determine the most appropriate treatment.