Multiple Sclerosis Drug Therapy

Our Specialty Pharmacy offers pharmacy services to people with multiple sclerosis who need long-term drug therapy. Our pharmacy staff can provide the medications for your condition after you return home from the clinic. Experienced pharmacy professionals work closely with your Mayo Clinic care team to develop a personalized medication management program at no additional cost. We coordinate all billing and claims on your behalf, relieving you of up-front costs and the headaches of completing insurance forms and filing claims.

About Multiple Sclerosis
The Role of Medications in Treating Multiple Sclerosis
Side Effects, Cautions and Special Requirements
Always Ask Your Pharmacist

About Multiple Sclerosis

Multiple sclerosis (MS) is a chronic, potentially debilitating disease that affects the brain and spinal cord (central nervous system). The illness is believed to be an autoimmune disease; the immune system attacks a part of your body as if it was a foreign substance.

With MS, the body directs antibodies and white blood cells against proteins in the myelin sheath, the insulating layer that surrounds nerves in the brain and spinal cord. This causes inflammation and injury to the sheath and ultimately to the nerves. The result may be multiple areas of scarring (sclerosis). The damage slows or blocks muscle coordination, visual sensation and other nerve signals.

The disease varies in severity, ranging from mild to permanent disability. Treatments can modify the course of the disease and relieve symptoms. An estimated 400,000 Americans have MS. Most people experience their first symptoms between the ages of 20 and 50. The disease is twice as common in women as in men.

The Role of Medications in Treating Multiple Sclerosis

If attacks are mild or infrequent, your doctor may advise a wait-and-see approach, with counseling and observation. However, if the diagnosis is a relapsing form of the disease (the most common), your doctor may recommend treatment with disease-modifying medications as soon as possible. These medications may include:

Beta interferons. Interferon beta-1b (Betaseron) and interferon beta-1a (Avonex, Rebif) are genetically engineered copies of proteins that occur naturally in your body. They help fight viral infection and regulate your immune system. If you use Betaseron, you inject yourself under the skin (subcutaneously) every other day. If you use Rebif, you inject yourself subcutaneously three times a week. Avonex is self-injected into your muscle (intramuscularly) once a week. These medications reduce flare-ups of MS.

Glatiramer (Copaxone). This medication is an alternative to beta interferons if you have relapsing remitting MS. Glatiramer is as effective as beta interferons in curbing MS attacks but shouldn't be used simultaneously. Doctors believe that glatiramer works by blocking your immune system's attack on myelin. You must inject glatiramer subcutaneously once daily. Side effects may include flushing and shortness of breath after injection. Medications to relieve symptoms in progressive MS may include:

Corticosteroids. Doctors most often prescribe oral or intravenous corticosteroids to reduce inflammation in nerve tissue and shorten the duration of flare-ups. Prolonged use of these medications, however, may cause side effects such as osteoporosis and high blood pressure (hypertension).

Muscle relaxants. Tizanidine (Zanaflex) and baclofen (Lioresal) are oral treatments for muscle spasticity. If you have MS, you may experience muscle stiffening or spasms, particularly in your legs, which can be painful and uncontrollable. Baclofen often increases weakness in the legs while tizanidine appears to control muscle spasms without leaving your legs feeling weak, but it can be associated with drowsiness or dry mouth.

Medications to reduce fatigue. These may include antidepressants such as fluoxetine (Prozac), the antiviral drug amantadine (Symmetrel) or modafinil (Provigil), a medication for narcolepsy. All appear to work because of their stimulant properties.

Many medications are used for the muscle stiffness, depression, pain and bladder control problems often associated with MS. Drugs for arthritis and medications that suppress the immune system may also slow MS in some cases.

Side Effects, Cautions and Special Requirements

Beta interferons should never be used in combination with one another. Only one of these medications should be used at a time.

The Food and Drug Administration (FDA) has approved beta interferons only for people with relapsing forms of MS who can still walk. Beta interferons don't reverse damage and haven't been proven to prevent permanent disability. Some people develop antibodies to beta interferons, which can make them less effective. Other people can't tolerate the side effects, which may include symptoms similar to the flu.

Mayo Clinic neurologists generally recommend beta interferons for people who have more than one attack of MS a year and for those who don't recover well from flare-ups. The treatment may also be used for people who have a significant buildup of new lesions, which are caused by myelin loss (as seen on an MRI scan), even in the absence of major new symptoms of disease activity.

Always Ask Your Pharmacist

If you experience problems with your multiple sclerosis treatment, your pharmacist is a reliable source of information about multiple sclerosis management and can help you monitor your condition, maximize the benefits of your medications, limit side effects and identify drug-drug or drug-disease interactions. Your pharmacist will work closely with your doctor to create a safe and appropriate care plan.

Optimal management of multiple sclerosis requires the coordinated care of your health care team. Doctors, nurses and other caregivers must work closely with pharmacists and others to ensure therapy is safe and effective. Incomplete management of multiple sclerosis or another medical condition may lead to complications or limit the success of treatment.