Multiple Sclerosis Health Center

Medicines for multiple sclerosis (MS) may be used:

• During a relapse, to make the attack shorter and less severe.
• Over a long period of time, to alter the natural course of the disease (disease-modifying therapy).
• To control specific symptoms as they occur.

Controlling a relapse

Medicines can shorten a sudden relapse and help you recover more quickly. Temporary treatment with medicines called corticosteroids is the most common treatment used to control a relapse. These medicines have not been shown to affect the long-term course of the disease or to prevent disability.

Altering the course of MS using disease-modifying treatment

Strong evidence suggests that MS is caused by the immune system causing inflammation and attacking the myelin, which is the coating surrounding the nerve and nerve fibers. Medicines that change the activity of the immune system can reduce the number and severity of attacks that damage the protective myelin.

Interferon beta (such as Betaseron), glatiramer (Copaxone), mitoxantrone (Novantrone), natalizumab (Tysabri), and fingolimod (Gilenya) are the only medicines that have been approved for this purpose. For people with relapsing-remitting MS, these medicines can reduce the number and severity of relapses and can result in fewer brain lesions. They may also delay disability in some people. Some of these medicines may delay disease progression in some people who have secondary progressive MS.

Currently, there is no effective disease-modifying treatment for primary progressive MS.

Some people have only one episode of a neurological symptom such as optic neuritis. Yet MRI tests suggest these people have MS. This is known as a clinically isolated syndrome. Many of these people go on to develop MS over time. In some cases, doctors will prescribe medicine (either interferon beta or glatiramer) for people who have had a clinically isolated syndrome. These medicines, when taken early or even before you have been diagnosed with MS, may keep the disease from getting worse or extend your time without disease.⁶

Relieving symptoms

Treating specific symptoms can be effective, even if it does not stop the progression of the disease. Symptoms that can often be controlled or relieved with medicine include:

• Fatigue. Medicines to reduce fatigue or help you sleep better may include amantadine (Symmetrel) or fluoxetine (Prozac).
• Muscle stiffness (spasticity) and tremors. Medicines that may reduce muscle spasms or stiffness include baclofen (Lioresal), tizanidine (Zanaflex), dantrolene (Dantrium), gabapentin (Neurontin), diazepam (Valium), or clonazepam (Klonopin). Sometimes a combination of these medicines works best to reduce your muscle symptoms.
• Urinary problems and constipation. Medicines used to reduce frequent urination may include propantheline, oxybutynin (Ditropan), or tolterodine (Detrol). Medicines sometimes used to relieve constipation include bulk agents such as psyllium (Metamucil) or daily use of laxatives.
• Pain and abnormal sensations. Depending on the severity of the pain, both prescription and nonprescription medicines may be tried. Over-the-counter medicines may include acetaminophen, ibuprofen, or naproxen sodium. Prescription medicines commonly used to reduce pain associated with MS include baclofen (Lioresal), carbamazepine (Tegretol), and gabapentin (Neurontin).
• Depression. Antidepressant medicines may be used to reduce depression that often occurs as a result of having MS. Antidepressants often tried include tricyclic antidepressants (such as amitriptyline, desipramine (Norpramin), or imipramine (Tofranil)) or selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) or sertraline (Zoloft).
• Sexual difficulties. Medicines used to relieve sexual difficulties that can be associated with MS include sildenafil (Viagra) for both men and women. Yohimbine and clomipramine may also be given to improve erectile dysfunction.
• Walking problems. Dalfampridine (Ampyra) is a medicine that can be used to help with walking problems caused by MS.