What are the Medications for Multiple Sclerosis?

Medically Reviewed By Philip Ngo, PharmD
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There are various different medications for multiple sclerosis (MS). Some focus on slowing down the progression of the condition while others help you manage your symptoms. If you have MS, your doctor may prescribe oral or injectable medications. Some medications are also available via infusion therapy.

This article explains more about the types of MS medications. It also looks at possible side effects of MS medication, when to contact a doctor, and more.

Disease-modifying therapies

A woman is taking medication.
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Disease-modifying therapies (DMTs) are drugs that can help slow down the progression of MS. They can also help reduce the frequency and severity of relapses in the case of relapsing-remitting MS.

There are three types of DMTs approved by the Food and Drug Administration for treating MS:

  • oral
  • injectable
  • infusion

Oral treatments

Oral treatments are tablets that you can take by swallowing them with water.

It is important to be aware of the possible side effects of any medication you are taking, and to contact your doctor if you have concerns about your prescription.

Medication (brand name)DosageCommon side effectsSome possible serious side effects
Cladribine (Mavenclad)

Two treatment courses, once a year for 2 years

Dosage depends on the person’s weight

headache, low white blood cell count, respiratory infectionblood transfusion complications, increased risk of cancer, liver problems, serious infection
Dimethyl fumarate (Tecfidera)120 milligrams (mg) increased to 240 mg twice dailyflushing, gastrointestinal problemsdecreased white blood cell count, liver problems, progressive multifocal
leukoencephalopathy (PML), shingles
Diroximel fumarate (Vumerity)231 mg daily, increased to 2 231 mg capsules dailyflushing, gastrointestinal problemsdecreased white blood cell count, liver problems, PML, shingles
Fingolimod (Gilenya)

0.5 mg daily for adults/children weighing >40 kg

0.25 mg daily for children
weighing ≤40 kg

abdominal pain, abnormal
liver tests, cough, diarrhea, headache, flu, back pain, sinusitis, abdominal pain
infection, PML, shortness of breath, skin cancer, vision problems
Monomethyl fumarate (Bafiertam)95 mg twice daily for 7 days, then 190 mg twice dailyabdominal pain, diarrhea, flushing, nauseadecreases in white blood cell count, liver problems, PML, shingles
Ozanimod (Zeposia)0.23 mg daily, then increased up to 0.92 mg dailyback pain, elevated liver enzymes, high blood pressure, orthostatic hypotension, upper respiratory tract infectionbreathing problems, slow heart rate, vision problems
Ponesimod (Ponvory)2 mg to 20 mg daily, increased in incrementsabnormal liver tests, high blood pressure, upper respiratory tract infectioninfection, slow heart rate, skin cancer, vision problems
Siponimod (Mayzent)1 mg or 2 mg dailyabnormal liver tests, headache, high blood pressureinfection, liver problems, shortness of breath, skin cancer, slow heart rate
Teriflunomide (Aubagio)7 mg or 14 mg dailyabnormal liver tests, diarrhea, hair thinning, headache, nausealiver problems, skin reactions, decrease in white blood cell count

Injectable treatments

Injectable drugs can be a first-line treatment for MS, particularly relapsing-remitting MS. You may require the injection daily, every other day, or once a week.

Medication (brand name)DosageCommon side effectsSome possible serious side effects
Interferon beta-1a (Avonex)30 mcg once a weekheadache, flu-like symptoms, pain at injection siteblood problems, depression or suicidal thoughts, heart problems, liver problems, small blood vessel injury
Interferon beta-1a (Rebif)22 mcg or 44 mcg three times a weekflu-like symptoms, reaction at injection sitedepression or suicidal thoughts, liver problems, low blood cell counts, seizure
Interferon beta-1b (Betaseron, Extavia)0.25 mg every other dayheadache, flu-like symptoms, increased liver enzymes, insomnia, low white blood cell count, pain at injection sitedepression or suicidal thoughts, heart problems, injection site injury, liver problems, lupus erythematosus, small blood vessel injury
Glatiramer acetate (Copaxone, Glatopa)20 mg daily or 40 mg 3 times a weekflushing, shortness of breath, rash, reaction at injection siteliver problems, damage to fatty tissue and skin tissue
Ofatumumab (Kesimpta)20 mg weekly for three weeks, then once monthlyheadache, reaction at injection site, upper respiratory tract infectiondecrease in some antibodies, HBV reactivation, infection
Pegylated
interferon beta-1a (Plegridy)
63 mcg on day 1, 94 mcg on day 15, then 125 mcg every 14 daysflu-like symptoms, reaction at injection siteautoimmune disease, blood problems, depression or suicidal thoughts, heart problems, liver problems

Infusion treatments

Infusion treatments involve receiving the drugs via a catheter or small needle under your skin. A pump helps to control the dosage of the medication and the length of infusion time.

Medication (brand name)DosageCommon side effectsSome possible serious side effects
Alemtuzumab (Lemtrada)12 mg for 5 days, then 12 mg for 3 days a year laterdiarrhea, headache, fatigue, infection, itching, rash, nausea, reaction at infusion site, vomitingautoimmune problems, kidney problems, increased risk of some cancers, liver inflammation
Mitoxantrone (Novantrone)12 mg/m² every 3 monthsback pain, changes in menstrual cycle, diarrhea, hair loss, headache, nausea, upper respiratory infection, urinary tract infectioncardiotoxicity, secondary acute myeloid leukemia
Natalizumab (Tysabri)300 mg every 28 daysdiarrhea, fatigue, gastroenteritis, headache, joint pain, lower respiratory tract infection, rash, urinary tract infection, vaginitisincreased risk of infection, liver damage, low blood platelet counts, PML, weakened immune system
Ocrelizumab (Ocrevus)600 mg every 6 monthsincreased risk of respiratory tract
infections and herpes infections, reaction at infusion site
increased risk of cancer, infection, weakened immune system

Medications for relapse

Medications for relapse focus on reducing both the frequency and severity of relapse in people with relapsing-remitting MS.

Doctors will typically prescribe corticosteroids for relapse. One of the main types of corticosteroids for MS relapse is methylprednisolone.

You will receive methylprednisolone intravenously, usually over the course of 5 days, when you experience a relapse.

Learn about relapsing-remitting MS.

Medications for symptoms of multiple sclerosis

The medications your doctor prescribes will depend on which symptoms you experience. Medication can help you to manage symptoms such as:

Vision problems

For many people, changes in vision are some of the first symptoms of MS.

Corticosteroids may help to alleviate vision problems. However, it is important to note that there are no specific guidelines on dosage or duration of treatment when taking corticosteroids for vision problems such as optic neuritis.

Find out about how MS affects your vision.

Pain and itchiness

There are various medications that your doctor may prescribe for pain and itchiness associated with MS.

For trigeminal neuralgia, which is a brief but sharp pain in the face, your doctor may prescribe:

  • carbamazepine
  • oxcarbazepine
  • misoprostol
  • gabapentin
  • baclofen
  • pregabalin
  • phenytoin

The same medications may also be suitable for treating muscle spasms. Your doctor may recommend that you take one or more medications for pain relief.

Fatigue

Medications your doctor may recommend for fatigue include:

  • amantadine
  • armodafinil (Nuvigil)
  • dextroamphetamine (Dexedrine)
  • methylphenidate (Ritalin)
  • modafinil (Provigil)

Your doctor will also be able to advise on ways you can conserve energy and make sure you are getting enough sleep and exercise.

Learn about MS-related fatigue.

Vertigo

For mild vertigo, your doctor may recommend antihistamines, including:

  • dimenhydrinate (Dramamine)
  • diphenhydramine (Benadryl)
  • meclizine (Antivert)

You will usually take between 25–50 mg every 8 hours. Your doctor will be able to advise on the strength and frequency of the dosage that they recommend for you.

Your doctor may also recommend benzodiazepines. They can help to decrease activity in the part of the nervous system that controls the inner ear.

Side effects of antihistamines and benzodiazepines can include:

A scopolamine transdermal patch can also help to reduce vertigo. It is typically used for motion sickness and related vertigo.

Your doctor will advise on which medications for vertigo they recommend.

Spasticity

Medications for spasticity can help to alleviate nerve pain and reduce muscle spasms.

First-line medications for spasticity are tizanidine and baclofen. These are types of muscle relaxants.

Other medications your doctor may prescribe include gabapentin for nerve pain and benzodiazepines to reduce muscle spasms.

According to the UK’s Multiple Sclerosis Trust, around 45% of people experience side effects with baclofen. Common side effects of baclofen and tizanidine are similar, and can include:

  • difficulties sleeping
  • dizziness
  • drowsiness
  • dry mouth
  • weakness

Learn more about managing MS spasticity.

Mobility problems

Treatments for mobility problems focus on helping you to move around more easily. Your doctor may recommend a mobility aid such as a cane or a walker, as well as exercise training programs with a physiotherapist.

Your doctor may also prescribe dalfampridine to help to improve walking. You will usually need to take a 10 mg tablet twice a day.

Some common side effects of dalfampridine include:

Learn more about managing mobility problems with MS.

Bowel dysfunction

Constipation is the most common type of bowel dysfunction in people with MS. Medications your doctor may recommend for constipation include:

  • docusate (Colace 100 mg, Surfak 240 mg)
  • docusate and casanthranol (Peri-Colace)
  • polyethylene glycol 3350 (MiraLAX)
  • Phillips’ Milk of Magnesia

Your doctor may also recommend a glycerin or bisacodyl suppository.

Bladder problems

Some people with MS experience bladder problems such as an overactive bladder or urinary tract dysfunction.

The first-line treatments for bladder dysfunction are anticholinergic medications. Examples include:

  • darefenasi (Enablex)
  • fesoterodine (Toviaz)
  • imipramine (Tofranil)
  • oxybutynin (Ditropan, Ditropan X)
  • solifenacin succinate (Vesicare)
  • tolterodine (Detrol, Detrol LA)
  • trospium chloride (Sanctura)

Anticholinergic medications may cause a dry mouth, which in turn may cause dental problems. It is important to maintain good oral hygiene and contact your doctor and dentist if you have any concerns.

Learn more about managing bowel and bladder problems with MS.

Depression

Your doctor may prescribe antidepressants for depression. Possible antidepressants include:

  • bupropion
  • duloxetine
  • fluvoxamine
  • fluoxetine
  • paroxetine
  • sertraline
  • venlafaxine

It is important to contact your doctor if you experience depression or other changes in mood. They may also refer you to a mental health specialist to help you to manage your symptoms.

Learn more about treatments for symptoms of MS.

What are the medications for multiple sclerosis in children?

Some DMTs are suitable for children with MS. First-line treatments for children include:

  • interferon beta-1a
  • interferon beta-1b
  • glatiramer acetate

In cases where the condition does not respond to first-line treatments, the child’s doctor may recommend other DMTs. However, research into other DMTs for children is not as extensive as it is for adults with MS.

The child’s doctor will be able to provide more information about which DMTs they recommend in cases of pediatric MS.

When should I see a doctor?

It is important to contact your doctor if you have concerns about MS. Learning more about the symptoms of MS can help you to be aware of the early warning signs of the condition.

You should also contact your doctor if you have concerns about your current MS treatment or if you wish to discuss other treatment options. They will be able to advise on which medications they recommend for you.

Our Multiple Sclerosis Appointment Guide can help you prepare for your appointment.

Learn more

Summary

Medications for MS include DMTs, corticosteroids for relapse, and medications to alleviate symptoms. The medications your doctor recommends will depend on the type of MS you have and which symptoms you develop.

It is important to contact your doctor if you have any questions or concerns about any medication you currently take for MS. You should also contact your doctor if you develop new symptoms or if you wish to discuss alternative treatment options. They will be able to advise on which medications they recommend for you.

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Medical Reviewer: Philip Ngo, PharmD
Last Review Date: 2022 Oct 27
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