The list of multiple sclerosis medications to avoid is not the same for every person, and it can depend on the severity of the condition and other factors. The more effective medications have the potential to cause more severe side effects, so it is always necessary to weigh the benefits versus the risks.

However, people, whose top priority in medication is safety, may wish to avoid medications, such as fingolimod (Gilenya), natalizumab (Tysabri), and alemtuzumab (Lemtrada). Research indicates they can have life threatening side effects.

However, Medical News Today is not advising people to always avoid these drugs. A person should discuss medications with a doctor to examine the benefits versus risk ratio.

In contrast, multiple sclerosis medications with the safest profile are interferon-β preparations, such as Avonex, and glatiramer acetate (Copaxone).

This article discusses which multiple sclerosis medications to avoid and which have the best safety profile. It also examines how to manage symptoms and relapses.

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An older 2017 study explains that although newer multiple sclerosis medications are more effective, they can have more serious side effects.

This ratio may vary with the severity of multiple sclerosis (MS). It also may depend on whether someone is pregnant or what co-occurring conditions they have, such as heart problems. Other factors to consider are an individual’s response to a medication, as well as their preference regarding the level of risks.

The below medications may have life threatening risks:

Fingolimod

Fingolimod (Gilenya) has possible serious effects that include:

  • infections that can cause death
  • progressive multifocal leukoencephalopathy, a rare brain infection that is usually fatal or results in severe disability
  • posterior reversible encephalopathy syndrome, a rare condition involving narrowing and swelling of blood vessels in the brain
  • macular edema, swelling in a part of the eye that may cause blurred vision
  • shortness of breath
  • increased blood pressure
  • types of skin cancer
  • severe worsening of MS after stopping treatment
  • relapses of tumefactive multiple sclerosis, a rare type that results in tumor-like growths in the brain

Read more about Gilenya here.

Natalizumab

Natalizumab (Tysabri) has possible serious side effects that include:

  • progressive multifocal leukoencephalopathy
  • herpes infection that may raise the likelihood of an infection of the brain or an infection of the covering of the spinal cord and brain, called the meninges
  • liver damage
  • weakened immunity and increased risk of infections
  • low blood platelets, the component of the blood that helps clots form and prevents excessive bleeding

Read more about Tysabri here.

Alemtuzumab

Alemtuzumab (Lemtrada) has possible serious side effects that include:

  • serious and sometimes fatal kidney and autoimmune problems, which are conditions where the body attacks healthy tissues and cells
  • serious and life threatening stroke
  • serious and life threatening infusion reactions, which are hypersensitivity responses to the administration of a drug into the bloodstream
  • an increased likelihood of certain cancers
  • overactivity of the immune system, which can be fatal
  • inflammation of the liver
  • reduction in the number of some types of blood cells
  • progressive multifocal leukoencephalopathy
  • a higher risk of serious infections
  • bleeding conditions
  • thyroid conditions
  • blood clotting problems

The above three medications are the most effective. However, they also have the most serious side effects, so they are not necessarily the best option for a person with MS. Interferon-β preparations, such as Avonex and glatiramer acetate (Copaxone), are only moderately effective, but they rarely have life threatening side effects, indicates evidence.

If someone’s definition of “best” means the safest, then the two medications below would fall into this category. It is worth noting that despite having fewer side effects than other options, they may not be the best choice for people with certain co-occurring conditions.

Interferon-β-1a

Interferon-β -1a (Avonex) has possible serious side effects that include:

  • suicidal thoughts, depression, and hallucinations
  • heart problems, including heart failure
  • liver problems, including liver failure and death
  • blood problems
  • autoimmune conditions
  • injury to red blood cells, small blood vessels, and platelets that can sometimes lead to death
  • injection site reactions, including severe skin damage or a skin infection

Glatiramer acetate

Glatiramer acetate (Copaxone) has possible serious side effects that involve liver problems, including liver failure. It may also damage the fatty tissue under the skin and, rarely, cause the death of skin tissue.

Together with multiple sclerosis medications, many symptoms respond well to lifestyle changes, such as increased exercise, which can improve the following:

  • fatigue
  • mood
  • insomnia
  • cognition, or the ability to think
  • mobility
  • muscle stiffness
  • bowel function

Additionally, below are some management approaches for specific symptoms:

  • Walking problems: Strategies involve fall prevention training and the use of mobility aids, such as a walker.
  • Bladder control problems: Strategies entail using absorbent pads, limiting caffeine intake, and doing pelvic floor exercises.
  • Bowel dysfunction: Strategies include eating a high fiber diet, drinking an adequate amount of fluids, and undergoing bowel training.
  • Cognitive dysfunction: Strategies involve compensatory methods, which are tools and procedures that aim to improve cognitive function through substitutions.
  • Slurred speech: Strategies entail speech and language therapy, which may include using alternative communication devices.
  • Swallowing difficulties: Strategies include diet modification and exercise programs to strengthen the muscles that ease swallowing.
  • Tiredness: This includes assistive devices and techniques for energy conservation and work simplification.
  • Mood changes: Antidepressants are a common strategy.
  • Sensory symptoms: Strategies to address tingling or pain include topical application of capsaicin acid cream or meditation.
  • Sexual dysfunction: In addition to medications, strategies involve prosthetic devices for males and lubrication and increased stimulation for females.
  • Spasticity: Strategies entail balance training and stretching.
  • Tremors: Strategies include coordination and balance exercises, as well as special writing and eating utensils.
  • Vertigo: Strategies to address the sensation of whirling or spinning involve vestibular rehabilitation, which aims to improve inner ear functions.
  • Visual impairment: Adaptive equipment or environmental modifications can help with functional difficulties due to vision loss.

Doctors define relapse as any new or sudden worsening neurological symptom that is due to multiple sclerosis. It must last longer than 24 hours and appear at least 30 days following the onset of the previous relapse.

Aside from medications, rehabilitation can help people optimize or regain function after a relapse. This includes:

  • physical therapy, which can provide an exercise program to increase strength and gait
  • occupational therapy for training in energy conservation and the use of adaptive equipment
  • speech and language pathology to help with speech and swallowing problems
  • nursing to help with bowel and bladder management

Multiple sclerosis medications to avoid depend on various factors, including the severity of the condition and any co-occurring conditions, such as heart trouble.

However, if a person’s MS is mild, and they wish to avoid medications with more serious side effects, they should avoid fingolimod (Gilenya), natalizumab (Tysabri), and alemtuzumab (Lemtrada).

There are many ways to manage symptoms. These include measures such as avoiding caffeine to alleviate bladder problems and using energy conservation techniques to reduce tiredness.

Rehabilitation programs can help manage relapses.