Medications for multiple sclerosis symptoms

 

In multiple sclerosis (MS), inflammation in the brain and spinal cord causes damage to the myelin sheath, a fatty covering around nerve fibers that is essential for nerve communication.

Depending on which specific parts of the nervous system are affected, this neurological damage may cause a range of MS symptoms, including spasticity, difficulty walking, fatigue, and trouble regulating the bladder and bowels. The severity of such symptoms can vary among patients, with the effects ranging from mild to acute.

Treating MS generally involves long-term use of disease-modifying treatments, or DMTs, which are medications that can slow the progression of MS. Other therapies can be used to ease disease relapses when they occur.

In addition, there are many treatments that may be used for managing MS symptoms. These medications do not alter the course of the disease itself, but they can ease individual symptoms to make them less bothersome and easier to cope with in day-to-day life.

Spasticity

Several medications have been approved by the U.S. Food and Drug Administration (FDA) to help manage MS-related spasticity, which refers to an increase in muscle stiffness and involuntary spasms. An estimated 60%–90% of MS patients will experience spasticity at some point.

These therapies broadly work by dampening the signals from nerve cells that tell muscles to contract, thereby reducing abnormal muscle contraction. Approved medications for MS-related spasticity include:

• baclofen (sold as oral tablets, oral solution, and injectable formulations)
• botulinum toxin products, such as Dysport and Botox
• Zanaflex (tizanidine)
• Valium (diazepam)
• Dantrium (dantrolene)

Other approved medicines are sometimes used “off-label” in the management of MS-related spasticity. That means that the medication has not been specifically approved or “labeled” for this indication in the U.S., but has been shown to help patients. These include:

• clonazepam (sold as Klonopin)
• gabapentin (marketed as Neurontin and Gralise, among others)
• carbamazepine (sold as Tegretol and Carbatrol, among others)
• pregabalin (sold as Lyrica and generics)

Fatigue

Fatigue in MS is managed mainly through lifestyle changes, such as getting regular physical exercise, managing stress, and improving sleep. This symptom also is among the most common in MS, affecting about 80% of patients.

No medications are specifically approved by the FDA to treat MS-related fatigue, but several therapies may be used for this purpose. These include:

• amantadine (sold as Gocovri and Osmolex ER)
• modafinil (sold as Provigil)
• fluoxetine (sold as Prozac among others)
• dextroamphetamine plus amphetamine (sold as Adderall and Mydayis)
• methylphenidate (marketed as Ritalin among others)

Gait and mobility issues

Management of gait and mobility issues in MS generally involves supportive interventions like physical therapy and the use of assistive devices. In addition, patients can try treatments that ease spasticity, fatigue, and other symptoms that can make getting around more challenging.

Ampyra (dalfampridine) is the only medication approved by the FDA for the improvement of walking ability in people with MS. It works by blocking the activity of proteins called potassium channels, which are thought to strengthen electrical signals from damaged neurons.

A noninvasive device called the Portable Neuromodulation Stimulator, known as PoNS, also is FDA-approved for use in combination with exercise therapy to improve walking ability in adults with MS. The device delivers mild electrical stimulation to the brain via electrodes placed on the tongue. This is thought to help the brain “rewire itself” in response to new experiences.

Bladder and bowel problems

Bladder dysfunction

Several prescription medications are FDA-approved to treat MS-related bladder problems, such as frequent urination or incontinence. Most of these medicines work by relaxing the muscles around the bladder that regulate urination; some act by regulating kidney function. Treatments that are approved to treat problems associated with an overactive bladder include:

• Botox (onabotulinumtoxinA)
• Detrol (tolterodine)
• Oxytrol (oxybutynin)
• darifenacin (formerly sold as Enablex; currently only available as a generic)
• Myrbetriq (mirabegron)
• Vesicare (solifenacin succinate)

Constipation

Constipation, one of the most common bowel problems in MS, is generally managed with modifications to diet and lifestyle. Such modifications include eating a lot of fiber, drinking plenty of water, and exercising regularly. Over-the-counter stool softeners and laxatives, which work by helping stool matter mix with liquids and/or promoting contractions of the muscles that move stools through the digestive tract, also may help ease constipation in MS. These include:

• docusate-based medication such as Colace and Enemeez
• Dulcolax and other bisacodyl-containing medications
• Fleet Enema (sodium phosphate)
• glycerin based suppositories such as Sani-Supp

Sexual dysfunction

Erectile dysfunction, or not being able to achieve or maintain an erection, is a common MS symptom in men. Several medications are approved in the U.S. to treat this symptom, and generally work by increasing blood flow to the penis. They include:

• sildenafil, sold as Viagra, among others
• tadalafil, marketed as Cialis and Adcirca
• alprostadil, sold as Caverject, among others

Other forms of sexual dysfunction, such as vaginal dryness or reduced genital sensation, are typically managed by making changes or accommodations during sexual intimacy — for example, liberal use of water-based lubricants or experimenting with new toys, positions, or activities.

Nerve pain

MS-related nerve pain can range from uncomfortably cold or hot sensations to a stabbing sensation similar to an electric shock, or a burning or aching sensation. It occurs when there is damage to the parts of the nervous system that are involved in processing physical sensations.

No treatment is approved by the FDA to treat nerve pain, but a number of medications are commonly used off-label to manage pain or other uncomfortable sensations caused by MS. These are mainly antidepressant or anti-seizure medications that broadly work by modulating activity within the nervous system. Medicines that may be used for MS-related pain include:

• carbamazepine (sold as Tegretol, among others)
• gabapentin (marketed as Neurontin and Horizant, among others)
• lamotrigine (sold as Lamictal and several other brand names)
• amitriptyline (formerly sold as Elavil and others; currently only available as a generic)
• duloxetine (marketed as Cymbalta, among others)
• pregabalin (sold as Lyrica and generics)

Mental health

Antidepressants are medicines that modulate the activity of certain signaling molecules in the brain — for example, serotonin, a hormone that regulates mood. Using these medications, along with certain modifications in lifestyle, such as practicing regular exercise and eating healthy, may help ease symptoms of depression in people with MS.

Several FDA-approved antidepressants may be helpful for managing depression in people with MS. These include:

• duloxetine, marketed as Cymbalta, among several other brand names and generics
• fluoxetine, sold as Prozac and other brand names, with generics also available
• sertraline, marketed as Zoloft and generics
• citalopram, sold as Celexa and generics

Nuedexta (dextromethorphan and quinidine) is the only therapy that is FDA-approved to treat pseudobulbar affect, a sudden burst of uncontrollable laughter or crying, caused by MS. Other antidepressants also may be helpful for managing uncontrolled bouts of laughing or crying that are not connected to the person’s emotional state.

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Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.