Symptom Management

A number of effective treatments are available to reduce the effects of most MS symptoms. Several drugs mentioned (in the listing to follow) are not specifically approved for MS by the United States Food & Drug Administration (FDA); however, doctors may prescribe these drugs "off-label" for some of their patients, if appropriate.

For example, Lyrica® (pregabalin) is a drug approved for seizures, fibromyalgia, and pain in diabetes and shingles. While it is not specifically approved for MS at this time, it is being prescribed by some doctors for certain types of pain and other MS symptoms. This drug is chemically related to Neurontin® (gabapentin), so neurologists may recommend Lyrica instead of Neurontin for certain patients.

To follow is a list of medications that may be prescribed or recommended by physicians for the treatment of MS symptoms. While this list includes many of the medications commonly prescribed for the individual symptoms noted, other drugs not appearing on the list may also be prescribed by a physician, depending on the specific circumstances and the doctor's preferences. Additionally, not all symptoms are included on this list; only those that may be treated with prescribed medications.

In addition to medications, other medical procedures and strategies may be used to help treat some of the symptoms of MS. For instance, moderate exercise and yoga, as approved by one's physician, can help to reduce fatigue. Various types of counseling can be an important component in treating depression, often in conjunction with a prescribed medication. Cognitive evaluation and intervention can assist individuals with memory and processing issues, while several types of therapies (including physical, occupational, and spee®ch) can help with a host of movement, strength, coordination, and other symptoms that can affect one's quality of life and daily functioning. Individuals experiencing these types of symptoms should discuss treatment options with their physician.

One's doctor is the best source of information on treatments for a patient's individual situation. Patients who have questions about a drug or other symptom-management treatment should consult their physician. The drugs listed were originally compiled by Dr. Jack Burks, MSAA’s chief medical officer.

Symptom-Management Medications for Multiple Sclerosis

Please note that not all symptoms are included in this list – only those with specific drug treatments available. For a full listing of symptoms associated with MS, please visit the Symptoms section of this website.

Anxiety

• Valium® (diazepam)
• Serax® (oxazepam)
• Ativan® (lorazepam)
• Klonopin® (clonazepam)
• Xanax® (alprazolam)

Bladder Dysfunction

Anti-spasticity Treatments:

• Detrol® and Detrol LA® (tolterodine tartrate)
• Ditropan® (oxybutynin)
• Ditropan XL® (oxybutynin chloride)
• Vesicare® (solifenacin)
• Enablex® (darifenacin)
• Levsinex® (hyoscyamine)
• Flomax® (tamsulosin) and Other Antihistamines

Alpha Blockers:

• Hytrin® (terazosin)
• Minipress® (prozosin)

Antibiotic Bladder Agents (please note that a culture is needed to determine the proper antibiotic):

• Bactrim® (sulfamethoxazole and trimethoprim)
• Septra® (sulfamethoxazole and trimethoprim)
• Cipro® (ciprofloxacin)

Other Bladder Drugs:

• DDAVP (desmopressin)
• Botox® (onabotulinumtoxinA) injection

Bowel Problems

Stool Softeners:

• Colace®
• Surfak®
• Chronulac® syrup

Bulk Forming Agents:

• Metamucil®
• FiberCon®
• Citrucel®
• Fiberall®

Oral Laxatives:

• Miralax®
• Pericolace®
• Milk of Magnesia®
• Mineral Oil

Suppositories/Rectal Stimulants:

• Glycerin Suppositories
• Ducolax® (bisacodyl) Suppositories
• Enemeez® Mini Enema (docusate)
• Fleet® (sodium phosphate) Enema

Overall Management:

• Metamucil®
• Imodium® and Related Medications

Cognitive Changes

• Aricept® (donepezil HCl)
• Possibly other Alzheimer's drugs

Depression

Selective Serotonin Reuptake Inhibitors (SSRI):

• Paxil® (paroxetine)
• Prozac® (fluoxetine)
• Zoloft® (sertraline)
• Lexapro® (escitalopram)
• Celexa® (citalopram)

Selective Serotonin and Norepinephrine Reuptake Inhibitors (SRNI):

• Cymbalta® (duloxetine hydrochloride)
• Serzone® (nefazodone)
• Wellbutrin® (bupropion)
• Remeron® (mirtazapine)

Tricyclic Antidepressants:

• Elavil® (amitriptyline)
• Pamelor® (nortriptyline)
• Tofranil® (imipramine)

Dizziness/Vertigo

• Antivert® (meclizine)
• Benadryl® (diphenhydramine)
• Dramamine® (dimenhydrinate)
• Scopolamine Transdermal Patch
• Benzodiazepines
• Klonopin® (clonazepam)
• Serax® (oxazepam)
• Valium® (diazepam)

Fatigue

• Provigil® (modafinil)
• Nuvigil® (armodafinil)
• Symmetrel® (amantidine)
• Ritalin® (methylphenidate)
• Dexedrine® (dextroamphetamine)
• SSRI antidepressants (Prozac®, Paxil®, Zoloft®)

Mobility and Walking Issues

• Ampyra® (dalfampridine)

Numbness

Please note that medications are usually not prescribed for this symptom unless it becomes painful.

• Niacin (one of the B complex vitamins)
• Neurontin® (gabapentin)
• Lyrica® (pregabalin)
• Dilantin® (phenytoin)
• Tegretol® (carbamazepine)
• Elavil® (amitriptyline)
• Pamelor® (nortriptyline)
• Tofranil® (imipramine)

Pain

• Neurontin® (gabapentin)
• Tegretol® (carbamazepine)
• Keppra® (levetiracetam)
• Anti-Anxiety Agents (such as Cymbalta®, Valium®, and Klonopin®)
• Tricyclic Antidepressants (such as Elavil® and Pamelor®)
• Dilantin® (phenytoin)
• Lyrica® (pregabalin)

Pseudobulbar Affect (PBA)

PBA is associated with certain neurological conditions, including MS, and is characterized by uncontrolled, inappropriate, and/or exaggerated episodes of crying, laughing, or other emotional display.

• Nuedexta® (dextromethorphan hydrobromide and quinidine sulfate)

Sexual Dysfunction

• Viagra® (sildenafil citrate)
• Cialis® (tadalafil)
• Levitra® (vardenafil HCI)

Spasticity (stiffness)

• Baclofen (formerly available as Lioresal®)
• Zanaflex® tablets and capsules (tizantidine hydrochloride)
• Valium® (diazepam)
• Klonopin® (clonazepam)
• Dantrium® (dantrolene sodium)
• Neurontin® (gabapentin)
• Tegretol® (carbamazepine)
• Keppra® (levetiracetam)
• Dopaminergic agonists (such as Requip® and Miripex® largely used for “restless legs syndrome, which can be secondary to spasticity)
• Intrathecal baclofen pump
• Botox® and Myobloc® (botulinum toxin) injection

For Intermittent Spasms (only at night):

• Neurontin® (gabapentin)
• Tegretol® (carbamazepine)

Tremor

• Atarax®, Vistaril® (hydroxyzine)
• Klonopin® (clonazepam)
• Buspar® (buspirone)
• Neurontin® (gabapentin)
• Inderal® (propranolol)
• Zofran® (ondansetron)
• Keppra® (levetiracetam)
• Mysoline® (pimidone)
• Laniazide®, Nydrazid® (isoniazid)
• Brain stimulation surgery

Weakness

• Ampyra® (dalfampridine)

Please note that MSAA does not endorse or recommend any specific drug or treatment. Individuals are advised to consult with a physician about the potential benefits and risks of the different treatment therapies.