Twelve disease-modifying medications are FDA-approved to treat relapsing forms of multiple sclerosis (MS). Specifically, these drugs help prevent relapses and slow progression of the disease.
The newest disease-modifying medications are called “immunomodulators” because they affect the functioning of your immune system.
“All these therapies highlight the increased choices and options for patients living with MS, and the ability of physicians to select a therapy based on individual characteristics,” says Ari Green, MD, assistant clinical director of the UCSF Multiple Sclerosis Center and director of the UCSF Neurodiagnostics Center in San Francisco.
But all drugs can have adverse side effects, and those associated with MS medications range from mild (such as flu-like symptoms or irritation at an injection site) to serious (such as progressive multifocal leukoencephalopathy [PML], a viral disease in the brain).
One of the challenges of MS treatment is balancing risk and benefit, says Dr. Green. Stronger medications might be more effective at slowing progression of the disease, but they may also be associated with more risks.
Discussing Medication Side Effects With Your Doctor
"A doctor has to have a frank and open discussion to find out what is tolerable for patients," says Green. "Some side effects go away as the body gets used to MS medications, but others, such as irritation where the injection takes place, do not."
Because people experience side effects differently, each individual has to decide which side effects he or she can live with, he adds.
In some cases, what are thought to be drug side effects may actually be MS symptoms. Fatigue and headache, for example, may be either.
Keeping a detailed log of your symptoms can help your doctor determine whether you are experiencing a symptom of multiple sclerosis or a medication side effect.
Make a note of when your symptom began, how long it lasted, what might have triggered it, and whether anything you did eased the symptom.
“The more patients are engaged in keeping track of things, the more they can be positively and appropriately engaged in directing their own care,” says Green. This information can also help your provider select appropriate therapies in the future.
Managing MS Medication Side Effects
Some simple steps can often help you manage the most common side effects of MS medications:
Infection risk Some of the immunomodulatory medications increase your risk of common infections, so it’s important to practice prevention strategies such as washing your hands frequently and limiting your contact with people who are ill.
Flu-like symptoms Fever, chills, achiness, and feeling generally under the weather are not uncommon following interferon beta injections, leading some users to stop the medication. Interferon beta medications include Betaseron, Extavia, Avonex, Rebif, and Plegridy.
According to nurses with expertise in MS care, the following steps can help to manage these side effects:
Taking medications before sleep
Warming injectable medicines up to body temperature before injecting
You can also take a small dose of Advil, Motrin, or Nuprin (ibuprofen) an hour before and an hour after your injection. Tylenol (acetaminophen), Aleve (naproxen), or Benadryl (diphenhydramine) may also help ease these side effects, Green says.
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Injection-site irritation Applying ice to your injection sites before injections, and a warm compress afterward, can help ease any irritation.
Some people may also benefit from some retraining on the finer points of giving themselves injections, notes Green. This is especially true because most people learn how to give self-injections right after their diagnosis — a period when they’re undoubtedly absorbing lots of information about the disease.
If you’re having trouble injecting your MS medication, speak to your healthcare provider about working with an MS nurse for training in self-injections.
Heart health The medication Gilenya (fingolimod) is known to slow some users’ heart rate within the first six hours after the first dose. Because of this, your doctor may advise you to have your first dose in a clinical setting, where your pulse and blood pressure can be monitored.
Distinguishing Side Effects From Symptoms
The immediate side effects of MS medications may be more apparent once you experience them. Immediate side effects, such as flu-like symptoms and chills, are easy to discern, says Green. Even the muscle aches and pains that can occur immediately after taking disease-modifying MS medications differ from the pain associated with multiple sclerosis.
The one rare medication side effect that might be hard to distinguish from an MS symptom is PML, which has been related to use of the drug Tysabri (natalizumab). PML, however, will progress much more quickly than multiple sclerosis — a good reason to stay on top of your medical checkups.
Ongoing Medication Monitoring
Most of the medications prescribed for MS require regular blood tests to keep track of the treatment’s effect on your body, including your liver.
The drug Lemtrada (alemtuzumab) requires blood and urine monitoring before, during, and for four years after treatment is given to watch for serious autoimmune conditions associated with the drug.
In addition to monitoring for side effects, you and your doctor should monitor for positive effects of drugs as well. Green says that a change in therapy is needed if you are having more than one MS relapse a year, if multiple new brain lesions are seen on your MRI, or if your symptoms are progressing despite treatment. Switching medications is a decision you and your doctor should make together.02-Oct-2016 1:35 AM