Overview

Establishing and following a treatment plan with your healthcare provider is the best strategy for managing your MS. Medications are used in multiple sclerosis (MS) to modify the disease course, treat relapses — also called attacks or exacerbations — and manage symptoms. Along with the other essential components of comprehensive MS care, these medications help you manage your MS and enhance your quality of life.

Modifying the disease course

The following US Food and Drug Administration (FDA) approved disease modifying therapies for MS have been found through clinical trials to reduce the number of relapses, delay progression of disability, and limit new disease activity (as seen on MRI).

• Injectable medications
  • Avonex® (interferon beta-1a)
  • Betaseron® (interferon beta-1b)
  • Copaxone® (glatiramer acetate)
  • Extavia® (interferon beta-1b)
  • Glatiramer Acetate Injection (glatiramer acetate -generic equivalent of Copaxone 20 mg and 40 mg doses)
  • Glatopa® (glatiramer acetate – generic equivalent of Copaxone 20mg and 40mg doses)
  • Kesimpta® (ofatumumab)
  • Plegridy® (peginterferon beta-1a)
  • Rebif® (interferon beta-1a)
• Oral medications
  • Aubagio® (teriflunomide)
  • Bafiertam^™ (monomethyl fumarate)
  • Dimethyl Fumarate (dimethyl fumarate – generic equivalent of Tecfidera)
  • Gilenya® (fingolimod)
  • Mavenclad® (cladribine)
  • Mayzent® (siponimod)
  • Ponvory™ (ponesimod)
  • Tecfidera® (dimethyl fumarate)
  • Vumerity® (diroximel fumarate)
  • Zeposia® (ozanimod)
• Infused medications
  • Lemtrada® (alemtuzumab)
  • Novantrone® (mitoxantrone)
  • Ocrevus® (ocrelizumab)
  • Tysabri® (natalizumab)

Under certain circumstances, some healthcare providers may use medications to treat MS that have FDA approval for other diseases – read more about “off-label” use. For help with DMT costs, read about pharmaceutical companies’ patient assistance programs.

MS disease modifying therapies and progressive multifocal leukoencephalopathy (PML)

Progressive multifocal leukoencephalopathy (PML) is a rare, progressive white matter brain disease that targets cells that make myelin and usually leads to severe disability or death. PML is caused by the reactivation of the JC (John Cunningham) virus, a common virus to which most people have been exposed. The JC virus causes no symptoms and is usually managed by the immune system without any treatment.

Testing positive for the JC virus does not mean you will develop PML, though it could put you at higher risk if you take medications that weaken your immune system. PML has occurred very rarely in people using some MS disease modifying therapies. A warning is included in the prescribing information and medication guide for those therapies. One medication, Tysabri, tests for JC virus before starting treatment and while on treatment to help identify people who are at a higher risk for PML. Talk to your healthcare provider about the testing required while taking Tysabri.

Symptoms of PML are diverse and can be similar to MS symptoms, including clumsiness, weakness and visual, speech and personality changes. Individuals should be alert to any new or worsening symptoms and report them promptly to their MS healthcare provider. Learn more about PML from the National Institute of Neurological Disorders and Stroke.

Managing relapses

MS relapses are caused by inflammation in the central nervous system that damages the myelin coating around nerve fibers. This damage slows or disrupts the transmission of nerve impulses and causes the symptoms of MS. Read more about managing relapses here.

Managing symptoms

Below are common symptoms of MS and some of the medications used to treat those symptoms.

Bladder Problems

Dysfunction

• Botox (onabotulinumtoxin A)
• DDAVP Nasal Spray (desmopressin)
• Detrol (tolterodine)
• Ditropan (oxybutynin), Ditropan XL
• Enablex (darifenacin)
• Flomax (tamsulosin)
• Prazosin
• Myrbetriq (mirabegron)
• Oxytrol (oxybutynin)
• Tofranil (imipramine)
• Vesicare (solifenacin succinate)

Infection

• Bactrim; Septra (sulfamethoxazole)
• Cipro (ciprofloxacin)
• Levaquin (levofloxacin)
• Macrodantim (nitrofurantoin)
• Hiprex (methenamine)
• Pyridium (phenazopyridine)

Bowel Dysfunction

• Colace (docusate)
• Dulcolax (bisacodyl)
• Enemeez (docusate stool softener laxative)
• Fleet Enema (sodium phosphate)
• Mineral Oil
• Metamucil (psyllium hydrophilic musilloid)
• Phillips Milk of Magnesia (magnesium hydroxide)
• Sani-Supp suppository (gylcerin)

Depression

• Celexa (citalopram)
• Cymbalta (duloxetine hydrochloride)
• Effexor (velafaxine)
• Paxil (paroxetine)
• Prozac (fluoxetine)
• Wellbutrin (bupropion)
• Zoloft (sertraline)

Dizziness and Vertigo

• Antivert (meclizine)

Emotional Changes

• Nuedexta (dextromethorphan + quinidine)

Fatigue

• Adderall (dextroamphetamine and amphetamine)
• Amantadine
• Provigil (modafinil)
• Prozac (fluoxetine)
• Ritalin (methylphenidate)

Itching

• Vistaril (hydroxyzine)

Pain

• Cymbalta (duloxetine)
• Effexor (venlafaxine)
• Elavil (amitriptyline)
• Lamictal (lamotrigine)
• Lyrica (pregabalin)
• Neurontin (gabapentin)
• Pamelor; Aventyl (nortriptyline)
• Tegetrol (carbamazepine)
• Trileptal (oxcarbazepine)

Sexual Problems

• Cialis (tadalafil)
• Levitra (vardenafil)
• MUSE (alprostadil)
• Prostin VR (alprostadil)
• Stendra (avanafil)
• Viagra (sildenafil)

Spasticity

• Baclofen
• Botox (onabotulinumtoxin A)
• Dantrium (dantrolene)
• Klonopin (clonazepam)
• Valium (diazepam)
• Zanaflex (tizanidine)

Tremors

• Laniazid – Nydrazid (isoniazid)
• Klonopin (clonazepam)

Walking (Gait) Difficulties

• Ampyra (dalfampridine)

Additional resources

Learn more about treatment options by watching these videos.  Additional videos on specific treatments are available on the treatment’s web page.

• Disease Modifying Therapies for MS (.pdf)
• The American Academy of Neurology (AAN) guideline for starting, switching and stopping DMTs for adults with clinically isolated syndrome, relapsing-remitting MS and progressive forms of MS.
• What You Need to Know About Interferon Beta (Avonex®, Betaseron®, Extavia®, Rebif®)
• What You Need To Know About Glatiramer Acetate (Copaxone®, Glatopa™)
• What You Need to Know About Natalizumab (Tysabri®)
• Guideline: Disease Modifying Therapies for Multiple Sclerosis – American Academy of Neurology

Medications | National Multiple Sclerosis Society (nationalmssociety.org)