Medications
Below is a list of the many medications used to treat the various forms of demyelinating disease. There is also information about usage and side effects. Many people with multiple sclerosis and other demyelinating diseases may need to only use one or two of the medications on this list. The medication(s) a person is on varies depending on symptoms, diagnosis, and response to treatment. Tell your doctor if any of the side effects are severe or do not go away.
Azathioprine (Imuran)
Azathioprine is an immunosuppressant designed to weaken the body's immune system so it will not attack the body's joints, which is often the case with transverse myelitis and Devic's Disease
- How it is given: Imuran is a tablet form of azathioprine, taken by mouth usually once or twice a day after meals
- Side effects:
- o upset stomach
- o vomiting
- o diarrhea
- o muscle aches
Beta-interferon (Avonex, Betaseron, and Rebif)
Derived from human cytokines (proteins used by the body to send signals), beta-interferon medications help regulate the immune system. Avonex, Betaseron, and Rebif are all types of beta-interferon medications.
- How it is given: Avonex is an intramuscular injection given (in thick muscles) once a week, Betaseron is a subcutaneous injection (just under the skin) given every other day, and Rebif is a subcutaneous injection (just under the skin) given three times a week.
- Side effects:
Avonex
- § tight muscles
- § dizziness
- § numbness, burning, tingling, or pain in hands or feet
- § joint pain
- § stomach pain
- § eye problems
- § runny nose
- § toothache
- § hair loss
- § bruising, pain, redness, swelling, bleeding, or irritation at the injection spot
Betaseron
- § upset stomach
- § indigestion
- § diarrhea
- § constipation
- § weight gain or weight loss
- § feeling cold or hot much of the time
- § dizziness
- § increased urinary frequency
- § incontinence
- § flushing
- § hair loss
- § joint or muscle weakness or pain
- § leg cramps
- § difficulty falling asleep or staying asleep
- § increased menstrual pain
Rebif
- § dry eyes
- § dry mouth
- § upset stomach
- § vomiting
- § stomach pain
- § tight muscles
- § bruising, pain, redness, swelling or tenderness at the injection spot
Corticosteroids (includes Prednisone, methylprednisone--Solumedrol, and dexamethosone--Decadron)
A treatment designed to reduce the inflammation around the nerves; corticosteroids are often used to treat all demyelinating diseases
- How it is given: it is added to an intravenous fluid that will drip through a needle or a catheter placed in one's vein for at least 1 hour per day
- Side effects:
- o headache
- o dizziness
- o insomnia (inability to sleep)
- o restlessness
- o depression
- o anxiety
- o unusual moods
- o increased sweating
- o increased hair growth
- o reddened face
- o acne
- o thinned skin
- o easy bruising
- o tiny purple skin spots
- o irregular or absent menstrual periods
Glatiramer acetate (Copaxone)
A treatment that works by stopping the body from attacking its own nerve cells, glatiramer acetate is used to reduce episodes of symptoms in patients with relapsing-remitting multiple sclerosis. Copaxone is a type of glatiramer medication.
- How is it given: Copaxone is a subcutaneous injection (just under the skin) given once a day.
- Side effects
- o pain, redness, swelling, itching, or lump at injection spot
- o weakness
- o flushing
- o depression
- o abnormal dreams
- o pain in the back, neck, or any other part of the body
- o severe headache
- o loss of appetite
- o diarrhea
- o upset stomach
- o vomiting
- o weight gain
- o swelling of the hands, feet, ankles, or lower legs
- o purple patches on skin
- o joint pain
- o confusion
- o nervousness
- o crossed eyes
- o difficulty speaking
- o shaking hands that you cannot control
- o sweating
- o ear pain
- o painful or changed menstrual periods
- o vaginal itching and discharge
- o urgent need to urinate or defecate
- o tightness in muscles
- o white patches in the mouth
Intravenous immune globulin (IVIG)
A treatment designed to boost the body's natural response in patients with compromised immune systems, IVIG is sometimes used in addition to high-dose corticosteroids to treat attacks of demyelination
- How it is given: IVIG may be given alone or added to an intravenous fluid that will drip through a needle or catheter placed in one's vein for 2-4 hours, once a day for 2-7 days. Additional dosage may be given every 10-21 days or every 3-4 weeks, if needed.
- Side effects:
- o backache
- o headache
- o joint or muscle pain
- o general feeling of discomfort
- o leg cramps
- o rash
- o pain at the injection site
Mitoxantrone (Novantrone)
Mitoxantrone suppresses the activity of T cells, B cells, and macrophages that are thought to lead the attack on MS patients' myelin. Novantrone in a type of mitoxantrone medication.
- How it is given: Novantrone is given by a short 5 to 15 minute IV infusion (injected very slowly) once every three months over a two to three year period.
***NOTE: We do not yet prescribe Novantrone to MS patients under the age of 18.*** - Side effects:
- o nausea
- o hair loss
- o bladder infections
- o changes in menstrual cycle
- o mouth sores
- o diarrhea
- o constipation
- o changes in cardiac rhythm
Mycophenolate (Cell-Cept)
Mycophenolate is an immunosuppressant designed to weaken the body's immune system so it will not damage other parts of the body
- How it is given: CellCept is a capsule or tablet form of mycophenolate, taken by mouth usually once or twice a day with food
- Side effects:
- o diarrhea
- o constipation
- o stomach pain
- o upset stomach
- o vomiting
- o difficulty falling asleep or staying asleep
- o pain, especially in the back, muscles, or joints
Natalizumab (Tysabri)
Used to prevent episodes of symptoms and slow the worsening of disability in patients with relapsing forms of multiple sclerosis, natalizumab stops certain cells of the immune system from reaching the brain and spinal cord and causing damage. Tysabri is a type of natalizumab medication.
- How it is given: Tysabri is usually infused (injected very slowly) through the patient's vein for an hour once every 4 weeks in a registered infusion center by a doctor or nurse.
***NOTE: We do not yet prescribe Tysabri to MS patients under the age of 18.*** - Side effects:
- o headache
- o extreme tiredness
- o joint pain or swelling
- o pain in arms or legs
- o swelling of the arms, hands, feet, ankles, or lower legs
- o muscle cramps
- o stomach pain
- o diarrhea
- o weight gain or loss
- o depression
- o night sweats
- o painful, irregular, or missed menstrual period
- o vaginal swelling, redness, burning, or itching
- o white vaginal discharge
- o stuffed or runny nose or other cold symptoms
- o frequent or painful urination
- o sudden need to urinate right away
- o difficulty controlling urination
- o tooth pain
- o cold sores
Plasmapheresis (also called Plasma Exchange, PLEX, and TPE)
Used in extreme cases of demyelination, when high-dose steroids are ineffective, plasmapheresis has shown to help remove the antibodies that are responsible for demyelination
- How it is given: the patient's blood is circulated and filtrated, then replaced, with all it's red and white bloods cells, back into the body
- Side effects:
- o occasional infections
- o blood clotting problems
Prednisone
As a low-dose type of corticosteroids, prednisone is often used to gradually ease a patient off of high-dose steroids.
- How is it given: prednisone can be taken by mouth, as a pill, a liquid, or a concentrated solution, with food one to four times a day or once every other day
- Side effects:
- o headache
- o dizziness
- o difficulty falling asleep or staying asleep
- o inappropriate happiness
- o extreme changes in mood
- o changes in personality
- o bulging eyes
- o acne
- o thin, fragile skin
- o red or purple blotches or lines under the skin
- o slowed healing of cuts and bruises
- o increased hair growth
- o changes in the way fat is spread around the body
- o extreme tiredness
- o weak muscles
- o irregular or absent menstrual periods
- o heartburn
- o increased sweating
Rituximab (Ritoxan)
Rituximab temporarily depletes the number of B-cells, cells of the immune system which cause inflammation during demyelination
- How it is given: Rituxan is an intravenous form of rituximab that is injected into a patient's veins usually once weekly for four weeks or twice two weeks apart
- Side effects:
- o flu-like symptoms (fever, rigor, chills)
- o nausea
- o hives
- o fatigue
- o headache
- o itching
- o difficulty breathing
- o sensation of swelling of the tongue of throat
- o runny nose
- o vomiting
- o decreased blood pressure
- o flushing
Infusion Medications
o These medications are used less frequently in pediatric MS patients
Oral Medications
-Oral medications are being researched in adult MS patients. The outlook is very hopeful for the future, and many clinical trials are taking place. We are hopeful that an oral medication will be available at the most within the next 5-10 years. For more information on the clinical trials and the oral medications being researched, please visit the Clinical Trials page of the National MS Society website by clicking on the following link: Clinical Trials