Medications for Multiple Sclerosis

Although there is currently no cure for multiple sclerosis, there are several medications that can help improve the quality of life for MS patients. Medications can help ease symptoms, keep the disease from progressing, and reduce the frequency of a relapse. Medications for multiple sclerosis include pills, injections, or infusions.

Finding the right medication to treat your MS may take time. It may also take time to see improvements. Once you have established a treatment plan with your healthcare providers, continue to follow it until your providers tell you to stop. Make sure you communicate any side effects you experience. Remember that each person’s body may respond to medication differently.

Disease-modifying Drugs

Disease-modifying drugs (DMDs) are a group of drugs that modify or influence the underlying disease course. They are also known as immunomodulatory drugs. DMDs target some aspect of the inflammatory process of MS. This reduces the frequency and severity of relapses. DMDs also help prevent new brain lesions. The FDA has approved 17 disease-modifying agents for MS as of 2019.

DMDs cannot reverse or halt MS. But they can slow disease progression. This means less damage will accumulate over time, resulting in fewer relapses and symptoms. It is best to start DMD treatment as early as possible. Most medications in this class are for people who have relapsing-remitting MS. However, there are DMDs available for people with progressive MS.

Beta Interferons

Beta interferons are some of the most common DMDs used to treat MS. You can take beta interferons if you have:

  • Relapsing MS and have had a recent relapse, or if an MRI shows new brain lesions
  • Secondary progressive MS and have significant relapses
  • A clinically isolated syndrome and a brain scan shows you are likely to develop MS

Interferons are proteins that are part of the body’s natural defenses. They tell the immune system that there are germs or cancer cells in the body. This triggers immune cells to fight off the invaders. Beta interferons are manmade versions of these proteins. They help reduce the inflammation that damages nerves in MS.

The mechanism of action for beta interferons isn’t exactly clear. Researchers believe they promote the growth of new neurons. Neurons are cells that send information between different parts of the brain. They also send information between the brain and the rest of the nervous system.

Types of Beta Inteferons

There are four types of beta interferons on the market in the U.S.:

  • Interferon Beta-1A—Injected into the muscle once a week.
  • Interferon Beta-1A (albumin)—Injected under the skin three times per week.
  • Interferon Beta-1B—Injected just under the skin every other day.
  • Peginterferon Beta-1A—Injected just under the skin every two weeks.

Beta interferons reduce relapse rate by 30%. Long-term use has been shown to increase survival rates. Although they are considered the first-line medication for MS, beta interferons don’t work for all patients. Thirty to 50% of patients are non-responsive to beta interferon therapies. This can be attributed to genetic, pharmacologic, or pathogenic factors.

Beta interferons do have some side effects. Some people may have flu-like symptoms such as headaches, muscle aches, and fever. They may also have a reaction at the injection site. Most of these side effects are mild or moderate in severity.

Glatiramer Acetate

Indian woman getting injectionGlatiramer acetate is approved for relapsing-remitting MS. Glatiramer acetate is a synthetic protein that stimulates myelin basic protein, the second most abundant protein in myelin.

Glatiramer acetate works in treating MS by blocking T-cells that damage myelin. It is an immunomodulator that helps support immune system function. It is injected under the skin either once a day or three days every week depending on the dose. It is available in either 40 mg/mL for three-times-a-week injection and 20 mg/mL for once-daily injection.

A doctor will give you the first dose of glatiramer acetate. After that, you can inject it yourself or have a friend or relative help you. You can inject it into specific spots in the arms, thighs, hips, and lower stomach. To keep your skin healthy, do not inject it into the same spot twice in a row.

You may have a reaction immediately after injecting glatiramer acetate, such as flushing, chest pain, pounding heartbeat, or trouble breathing. These reactions usually go away on their own without treatment. If they become severe or last longer than a few minutes, call your doctor.

Dimethyl Fumarate

Dimethyl fumarate is a type of medication specifically formulated to treat adults with various forms of multiple sclerosis. It belongs to a class of medications called Nrf2 activators. It decreases inflammation and prevents nerve damage that may cause MS symptoms. Dimethyl fumarate is a delayed-release capsule and is usually taken twice a day around the same time.

The exact mechanism of action is not known. Dimethyl fumarate may suppress the body’s inflammatory response. It may also have antioxidant properties that are protective against brain and spinal cord damage.

Common side effects of dimethyl fumarate include:

  • Flushing
  • Redness
  • Itching
  • Rash
  • Nausea or vomiting
  • Indigestion
  • Stomach pain
  • Diarrhea


Natalizumab aims to prevent episodes of symptoms and slow the worsening of disability in adults with MS. It belongs to a class of medications called monoclonal antibodies. Natalizumab stops certain cells of the immune system from reaching the brain and spinal cord. It is available as a concentrated solution and a doctor or nurse injects it  slowly into a vein once every four weeks.

Side effects of natalizumab may include:

  • Headache
  • Extreme tiredness
  • Drowsiness
  • Joint pain or swelling
  • Back pain
  • Pain in arms or legs
  • Muscle cramps

Although disease-modifying medications for multiple sclerosis are safe and effective, prognosis at the individual level will vary. Following your treatment plan is important for effectiveness. You should not stop treatment without speaking to your doctor first, even if you start to feel better.

Relapse Management Therapies

MS relapses or exacerbations are when new symptoms occur or when old symptoms worsen. Relapses can be mild, moderate, or sever. No two relapses are alike. An attack must last at least 24 hours and be separated by at least 30 days. Infection or another cause cannot cause the relapse.

Medication isn’t needed to treat all relapses. Some such as mild sensory changes can go away on their own. Relapse management drugs can reduce the frequency and duration of severe exacerbations. These drugs work to actively suppress inflammation in the central nervous system.


Some of the most common medications for multiple sclerosis relapse management are intravenous or oral corticosteroids. They are given in three- or five-day courses. These include dexamethasone, methylprednisolone, and prednisone. Corticosteroids are powerful and should only be taken on a short-term basis. They should be used to treat moderate or severe relapses that cause painful or disabling symptoms.

Studies have shown that there is no difference in effectiveness between oral and intravenous corticosteroid administration. The benefit of taking oral corticosteroids is that it doesn’t require hospitalization. However, symptom relief is typically faster with IV administration.

Like all medications, corticosteroids carry side effects. Some are more adverse than others. Short-term side effects of corticosteroids include:

  • Allergic reaction
  • Insomnia
  • Mood changes
  • Fluid retention
  • Stomachache
  • Increased appetite

Long-term side effects can include:

  • Weight gain
  • High blood pressure
  • Diabetes
  • Cataracts
  • Hardening of the arteries (atherosclerosis)


If corticosteroids don’t work to manage your relapse, your doctor may prescribe a repository corticotropin gel called HP Acthar gel. The gel is a highly-purified injectable preparation of adrenocorticotropic hormone (ACTH). ACTH stimulates the adrenal cortex gland to secrete cortisol, corticosterone, and aldosterone. Cortisol helps regulate the body’s immune and stress response. Corticosterone regulates energy, immune reactions, and stress responses. Aldosterone affects the body’s ability to regulate blood pressure.

HP Acthar gel provides extended release of ACTH after injection. It is a short-term medication that treats acute MS exacerbations. It stimulates the outer layer of cells of the adrenal gland to promote the production of natural hormones that reduce inflammation. The gel is slowly absorbed into the bloodstream after it is injected. When the gel reaches the adrenal gland, it stimulates the production of steroid hormones.

Side effects of repository corticotropin can include:

  • Nausea
  • Lightheadedness
  • Trouble breathing
  • Hives
  • Swelling of the face, lips, tongue, or throat

Relapse management therapies do not affect the long-term course of MS. They work best if you take them as soon as possible after the start of your relapse.

Symptom Management Therapies

Symptom management therapies focus on easing MS-related symptoms such as spasticity, pain, and mobility impairment. Treatment varies based on symptoms.

Mood Changes

Moodiness, irritability, fear, and depression are common mood changes that can occur with MS. Antidepressants such as citalopram or duloxetine hydrocholoride can help. These belong to a group of medications known as selective serotonin reuptake inhibitors (SSRIs). These medications increase the level of serotonin in the brain. Serotonin is the key hormone that stabilizes mood and feelings of well-being.

About 10% of patients may experience pseudobulbar affect (PBA), a condition that causes inappropriate involuntary laughing or crying. The combination of dextromethorphan hydrobromide and quinidine sulfate can help treat PBA. Dextromethorphan belongs to a class of medications known as central nervous system agents. The way it works in the brain to treat PBA is unknown. Quinidine is an antiarrhythmic that prevents and treats abnormal heartbeat. It increases the effect of dextromethorphan.

Side effects of this combination can include:

  • Diarrhea
  • Vomiting
  • Gas
  • Stomach pain
  • Cough
  • Muscle spasms


Spasticity is abnormal muscle tightness caused by prolonged muscle contraction. Tizanidine treats the increased muscle tone associated with spasticity in MS. Additionally, it helps relieve spasms, cramping, and muscle tightness. It’s a skeletal muscle relaxant that slows activity in the brain and nervous system to allow muscles to relax.

Side effects of tizanidine can include:

  • Dizziness
  • Drowsiness
  • Dry mouth
  • Back pain
  • Sweating
  • Depression
  • Vomiting
  • Diarrhea

Walking or Gait Difficulties

Spasticity, loss of balance, fatigue, or weakness can cause walking difficulties in MS. Dalfampridine is an oral medication for multiple sclerosis that blocks potassium channels on the surface of nerve fibers. Blocking these channels may improve the conduction of nerve signals along the nerve fibers whose myelin coating has been damaged by MS.

Dalfampridine side effects can include:

  • Trouble falling asleep or staying asleep
  • Dizziness
  • Headache
  • Nausea
  • Constipation
  • Weakness
  • Burning, tingling, or itching of the skin

Dizziness and Vertigo

Dizziness and vertigo are common with MS. Lesions in the brain stem, the area of the brain that controls balance, can cause vertigo. Vertigo is the feeling that you or your surroundings are spinning.

Meclizine prevents nausea, dizziness, and vomiting caused by motion sickness by blocking signals to the brain. It is an antihistamine that reduces the effects of the natural chemical histamine in the body. Side effects of meclizine can include drowsiness or fatigue and dry mouth.


Woman with itchy skin

The itching MS causes is a form of dysesthesias or “abnormal sensation.” It differs from a regular itch because the nerves are affected, not the skin, which means it doesn’t go away with scratching.

Hydroxyzine is an antihistamine that relieves or prevents the symptoms of allergies. As a medication for multiple sclerosis, it relieves sensory symptoms like itching. It blocks the action of histamine, a substance in the body that causes allergy symptoms. Hydroxyzine decreases histamine activity in the brain.

Hydroxyzine side effects can include:

  • Dry mouth
  • Dizziness
  • Headache
  • Confusion, especially in older adults
  • Constipation, especially in older adults


About 80% of MS patients will experience fatigue, although the cause of MS fatigue is currently unknown.

The combination of dextroamphetamine and amphetamine is a central nervous stimulant that treats ADHD or narcolepsy. It can be used off-label in MS for fatigue or to improve mental alertness for those experiencing brain fog. It works by changing the amounts of certain natural substances in the brain.

Side effects of this combination can include:

  • Diarrhea
  • Vomiting
  • Gas
  • Weakness
  • Muscle spasm
  • Cloudy or strong-smelling urine
  • Frequent, painful, or difficult urination

Methylphenidate is another central nervous system stimulant. It is used off-label in MS for fatigue or to improve mental alertness. It is believed to block dopamine and norepinephrine reuptake by neurons.

Methylphenidate side effects can include:

  • Nervousness
  • Irritability
  • Trouble falling asleep or staying asleep
  • Dizziness
  • Nausea or vomiting
  • Loss of appetite
  • Weight loss
  • Headache

These medications can be habit forming. Do not take a larger dose or take them more often than prescribed by your doctor. Misuse can cause addiction or overdose.

Managing MS

Medications for multiple sclerosis can help improve your quality of life. They can also slow the progression of the disease. But they are just one way to treat and manage the condition. You and your doctor may decide to combine the use of medication with other strategies, such as lifestyle changes, to manage your MS.

If you’re living with MS, you might be curious about what medications can help manage your condition and how others have responded to them. At PatientsLikeMe, there are over 75,000 members who are living with MS. Join them today to learn about how they manage their condition.

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