Multiple sclerosis (MS) is a condition that damages nerve cells in your central nervous system (CNS).
Your CNS is composed of your brain, spinal cord, and optic nerves.
MS causes symptoms that gradually get worse, as well as symptoms that come on suddenly after a period of being controlled. This sudden appearance of symptoms is called a relapse.
There’s no cure for MS, and the damage it causes can’t be reversed. However, certain medications can help you manage the condition.
Condition management focuses on medication that can treat relapses, as well as modify the disease to reduce damage and disability. It also involves other drugs that treat the symptoms or complications of MS.
Understanding disease-modifying therapies (DMTs)
There are several types of DMTs that work to help change the course of MS. The length of treatment with these medications can range from a few months to years, depending on how effective the medications are for you.
Your doctor may recommend switching between these drugs throughout the course of your treatment. This will depend on how effectively each drug manages your disease and how you tolerate the side effects.
If you switch to a different DMT, your doctor will take note of whether you develop new lesions.
Injections and infusions
The Food and Drug Administration (FDA) has approved 12 MS medications that are administered by injection or infusion.
Interferon beta products
Injectable drugs include:
- interferon beta-1a (Avonex, Rebif)
- peginterferon beta-1a (Plegridy)
- interferon beta-1b (Betaseron, Extavia)
They help modify relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS) in cases of active disease — that is, a relapse has occurred or new lesions have appeared on an MRI scan.
They also treat clinically isolated syndrome (CIS), a one-off episode of neurological symptoms. CIS can progress to MS and is sometimes categorized as a type of MS.
These drugs are made up of proteins that keep certain white blood cells (WBCs) from entering your brain and spinal cord. These WBCs are thought to damage the myelin that forms a protective coating over your nerve fibers.
Therefore, preventing these WBCs from moving into your brain and spinal cord can help slow their damage and reduce the number of relapses you have.
You inject these drugs yourself. Your healthcare provider will show you how to do this. The number of injections depends on the drug:
- Rebif: three times per week
- Betaseron: every other day
- Extavia: every other day
- Avonex: once per week
- Plegridy: every 2 weeks
Glatiramer acetate (Copaxone)
Glatiramer acetate (Copaxone) is a manufactured substance that resembles a basic protein of natural myelin. It’s thought to work by prompting the WBCs to attack the substance instead of the myelin cells.
It’s used to treat RRMS and SPMS in cases of active disease — that is, a relapse has occurred or new lesions have appeared on an MRI scan. It can also treat CIS.
You inject this drug yourself once per day or three times per week, depending on your dosage. Your healthcare provider will show you how.
People who receive injections three times per week should ensure that at least 48 hours elapses between their injections.
The FDA has also approved Glatopa, a generic form of Copaxone.
Natalizumab (Tysabri)
Natalizumab (Tysabri) is an antibody that may block damaged T lymphocytes from moving into your brain and spinal cord.
It’s used to treat RRMS and SPMS in cases of active disease — that is, a relapse has occurred or new lesions have appeared on an MRI scan. It can also treat CIS.
A healthcare provider gives you this drug as an intravenous (IV) infusion. The infusion takes about an hour, and you’ll get it every 4 weeks.
Mitoxantrone hydrochloride
Mitoxantrone hydrochloride was originally used to treat cancer. Now it’s also prescribed to treat people with MS. It suppresses the immune system cells that are thought to attack myelin cells. This medication is only available as a generic drug.
It’s used to treat SPMS or worsening RRMS in instances where other drugs haven’t worked. It has a high risk of serious side effects, so it’s only appropriate for people with these more severe forms of MS.
A healthcare provider gives you this drug as a short IV infusion once every 3 months. The infusion should only take 5 to 15 minutes.
Alemtuzumab (Lemtrada)
Alemtuzumab (Lemtrada) is approved for people with relapsing forms of MS, including RRMS and active SPMS. It’s intended for people who’ve tried at least two other MS medications but found that treatment was unsuccessful or caused intolerable side effects.
It works by reducing the number of specific B and T lymphocytes in your body. This action may decrease the inflammation of and damage to nerve cells.
Alemtuzumab is given as a 4-hour IV infusion. To start, you receive this drug once per day for 5 days. Then 12 months after your first treatment course, you receive it once per day for 3 more days.
Ocrelizumab (Ocrevus)
Ocrelizumab (Ocrevus) is the newest infusion treatment for MS. It was approved by the FDA in 2017.
It’s the first drug used to treat primary progressive MS (PPMS). It’s also used to treat CIS and relapsing forms of MS.
Ocrelizumab appears to work by targeting and ultimately reducing the number of B lymphocytes. B lymphocytes are responsible for damage and repair of the myelin sheath.
Ocrelizumab is given as an IV infusion. To begin, you’ll receive it in two 300-milligram (mg) infusions, separated by 2 weeks. After that, you’ll receive it in 600-mg infusions every 6 months.
You’ll also receive a corticosteroid and an antihistamine on the day of each infusion to reduce the risk of reaction to the medication.
Ofatumumab (Kesimpta)
Ofatumumab (Kesimpta) was approved by the FDA in August 2020 and is the newest treatment for MS.
It’s used to treat RRMS and SPMS in cases of active disease — that is, a relapse has occurred or new lesions have appeared on an MRI scan. It can also treat CIS.
Like ocrelizumab (Ocrevus), it also works by targeting harmful B lymphocytes and reducing their overall number.
Ofatumumab is given as an injection once per week for the first 3 weeks. After a 1-week break, the drug is given as a monthly injection.
Oral medications
The FDA has approved eight oral medications for the treatment of MS.
Fingolimod (Gilenya)
Fingolimod (Gilenya) comes as an oral capsule that you take once per day.
It was the first oral medication approved by the FDA to treat RRMS. It’s also used to treat CIS and active SPMS.
Fingolimod causes the damaging WBCs to remain within your lymph nodes. This reduces the chance that they’ll enter your brain or spinal cord and cause damage.
Teriflunomide (Aubagio)
Teriflunomide (Aubagio) is an oral tablet that you take once per day.
It’s used to treat RRMS and SPMS in cases of active disease — that is, a relapse has occurred or new lesions have appeared on an MRI scan. It can also treat CIS.
Teriflunomide works by blocking an enzyme that’s needed by the damaging WBCs. As a result, teriflunomide helps decrease the number of these cells, which reduces the damage they can inflict.
Dimethyl fumarate (Tecfidera)
Dimethyl fumarate (Tecfidera) is an oral capsule that you take twice per day.
It’s used to treat RRMS and SPMS in cases of active disease — that is, a relapse has occurred or new lesions have appeared on an MRI scan. It can also treat CIS.
The exact mechanism of this drug is unknown.
It appears to work by interfering with the activity of certain immune system cells and chemicals to reduce the risk of MS relapse. It may also have antioxidant properties that help protect against brain and spinal cord damage.
Monomethyl fumarate (Bafiertam)
Monomethyl fumarate (Bafiertam) is an oral capsule that you take twice per day. It’s the newest oral drug on the market, having been approved by the FDA in April 2020.
It’s used to treat RRMS and SPMS in cases of active disease — that is, a relapse has occurred or new lesions have appeared on an MRI scan. It can also treat CIS.
Monomethyl fumarate is a bioequivalent of dimethyl fumarate (Tecfidera). Like dimethyl fumarate, monomethyl fumarate may have antioxidant properties and appears to work by interfering with the activity of certain immune system cells and chemicals.
Cladribine (Mavenclad)
Cladribine (Mavenclad) is a pill that you take for a total of 16 or 20 days over the course of 2 years. You’ll have treatment for 2 weeks per year, with each one lasting 4 or 5 days. There’s a 1-month break in between the 2 weeks of treatment.
It’s approved for people with relapsing forms of MS, including RRMS and active SPMS. It’s intended for people who’ve tried at least one other MS medication but found that treatment was unsuccessful or caused intolerable side effects.
It may work by reducing the number of harmful B and T lymphocytes that you have.
Siponimod (Mayzent)
Siponimod (Mayzent) is an oral tablet that you take once per day.
It’s used to treat RRMS and SPMS in cases of active disease — that is, a relapse has occurred or new lesions have appeared on an MRI scan. It can also treat CIS.
It’s believed to work by blocking certain inflammatory cells from leaving your lymph nodes. This action limits the amount of nerve damage that they can inflict.
Diroximel fumarate (Vumerity)
Diroximel fumarate (Vumerity) is an oral capsule that you take twice per day.
It’s used to treat RRMS and SPMS in cases of active disease — that is, a relapse has occurred or new lesions have appeared on an MRI scan. It can also treat CIS.
Diroximel fumarate has the same active ingredient as dimethyl fumarate (Tecfidera), and it works the same way. This means that it may also have antioxidant properties and interfere with the activity of certain immune system cells and chemicals.
Ozanimod (Zeposia)
Ozanimod (Zeposia) is an oral capsule that you take once per day.
It’s used to treat RRMS and SPMS in cases of active disease — that is, a relapse has occurred or new lesions have appeared on an MRI scan. It can also treat CIS.
It’s believed to work by blocking immune cells from leaving your lymph nodes and entering your CNS.
MS medications for children
Fingolimod (Gilenya) is currently the only DMT that’s approved by the FDA for use in children. It’s safe for use in people ages 10 years old and up.
However, doctors may prescribe other DMTs off label.
Medications for MS relapses
While many relapses go away on their own, more severe relapses require treatment.
Inflammation causes MS relapses, and it’s typically treated with corticosteroids. These drugs can reduce inflammation and help make MS attacks less severe. Corticosteroids used to treat MS include:
- dexamethasone (Dexamethasone Intensol)
- methylprednisolone (Medrol)
- prednisone (Prednisone Intensol, Rayos)
If corticosteroids don’t work, your doctor may prescribe corticotropin (H.P. Acthar Gel).
Corticotropin is an injection, and it’s also known as ACTH gel. It works by prompting the adrenal cortex to secrete the hormones cortisol, corticosterone, and aldosterone. The secretion of these hormones helps to reduce inflammation.
Medications to treat MS symptoms and complications
Other drugs can be used to treat specific MS symptoms or complications from MS-related damage.
For walking problems
Dalfampridine (Ampyra) is an oral tablet taken twice per day to help improve walking.
Dalfampridine works by blocking potassium channels, which form tiny pores in your nerve cells. This action may help damaged nerve cells to better send messages.
Improved nerve impulse conduction aids in leg muscle control and strength.
For muscle stiffness or spasms
A doctor will often give muscle relaxants to people with MS who have painful muscle stiffness or muscle spasms. Drugs commonly used to treat these symptoms include:
- baclofen (Lioresal)
- cyclobenzaprine (Amrix)
- dantrolene (Dantrium)
- diazepam (Valium)
- onabotulinumtoxinA (Botox)
- tizanidine (Zanaflex)
For fatigue
Ongoing fatigue is a common problem for people with MS. For this symptom, your doctor may prescribe a drug such as modafinil (Provigil).
They may also prescribe an off-label drug, such as amantadine (Gocovri) and fluoxetine (Prozac).
For dysesthesia
Dysesthesia means “bad sensation.” It’s a type of pain that can feel like ongoing burning or itching. It may also feel like wetness, electric shock, or pins and needles.
To treat dysesthesia, your doctor may prescribe:
- amitriptyline
- clonazepam (Klonopin)
- gabapentin (Neurontin)
- nortriptyline (Pamelor)
- phenytoin (Dilantin)
For depression
According to a 2014 articleTrusted Source published in Nature Reviews Neurology, some research has shown that people with MS are more likely to be clinically depressed than the general population.
Drugs used to treat depression in people with MS include:
- bupropion (Wellbutrin SR, Wellbutrin XL)
- duloxetine (Cymbalta)
- fluoxetine (Prozac)
- paroxetine (Paxil)
- sertraline (Zoloft)
- venlafaxine (Effexor)
For constipation
Constipation is another common complication of MS. Your doctor may recommend treating it with one of the following over-the-counter drugs:
- bisacodyl (Dulcolax)
- docusate (Colace)
- magnesium hydroxide (Phillips’ Milk of Magnesia)
- psyllium (Metamucil)
For bladder dysfunction
Bladder dysfunction is also a common complication of MS. Symptoms may include frequent urination, incontinence, or hesitancy in starting urination. You may also experience frequent nocturia (nighttime urination).
Drugs to treat these symptoms include:
- darifenacin (Enablex)
- oxybutynin (Ditropan XL)
- prazosin (Minipress)
- solifenacin (VESIcare)
- tamsulosin (Flomax)
- tolterodine (Detrol)
For sexual dysfunction
Both men and women with MS tend to have higher rates of sexual dysfunction than the general population, according to an international cross-sectional studyTrusted Source from 2016.
Oral medications that may be prescribed to help treat erectile dysfunction (ED) include:
- sildenafil (Viagra)
- tadalafil (Cialis)
- vardenafil (Levitra)
- avanafil (Stendra)
Older drugs that must be injected directly into the penis are also available. These drugs aren’t used as much now that oral drugs are available.
They include alprostadil (Caverject). A drug that may be used off label for this purpose is the blood pressure medication papaverine.
People with a vagina or clitoris may experience problems such as reduced feeling or vaginal dryness.
There are no drugs currently available to treat these problems. However, for vaginal dryness, you can use water-soluble personal lubricants available over the counter.
Talk with your doctor
Many different types of drugs are available to help you manage MS. The type of drugs that may be best for you depend on the type of MS you have and the symptoms you experience.
You may not be able to access all of these medications. Ask your doctor to confirm which drugs are currently on the market in your area and which ones might be most appropriate for you. Speaking with your doctor is especially important if you’re pregnant or planning to become pregnant.
Work with your doctor to create a plan to manage your MS symptoms and help prevent further damage from the disease. Sticking to your treatment plan can help you feel better and slow the progression of your condition.