Symptom Management
This third section for the treatment of multiple sclerosis (MS) refers to managing symptoms. A number of treatments are available to reduce the effects of most MS symptoms, such as fatigue, spasticity and spasms, tremor, vertigo and dizziness, depression, pain, bowel and bladder problems, sexual dysfunction, and cognitive changes. Many of the drugs mentioned (in the listing to follow) are not specifically approved for MS by the FDA (United States Food & Drug Administration); however, doctors may prescribe these drugs "off-label" for some of their patients, if appropriate.
For example, Lyrica® (pregabalin) is a newer 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, along with a few medical procedures, which may be prescribed or recommended by physicians for the treatment of MS symptoms. As noted earlier, many of these drugs are not FDA-approved specifically for the treatment of MS symptoms, so they are prescribed "off label."
While this list includes many of the medications and procedures 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.
In addition to medications and medical procedures, other 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 speech) 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 compiled by Dr. Jack Burks, MSAA’s chief medical officer.
Treatments for Managing the Symptoms of Multiple Sclerosis
FATIGUE
- Provigil® (modafinil)
- Symmetrel® (amantidine)
- SSRI antidepressants (Prozac®, Paxil®, Zoloft®)
- Ritalin® (methylphenidate)
- Energizing" tricyclic antidepressants (Vivactil®, Pamelor®)
- Cylert® (pemoline)
SPASTICITY
- Lioresal® (baclofen)
- Zanaflex® (tizantidine)
- Klonopin® (clonazepam)
- Dantrium® (sodium dantrolene)
- Flexeril (cyclobenzaprine HCl)
- Valium® (diazepam)
- Intrathecal baclofen pump
- Botox®/Myobloc® (botulinium toxin)
For Intermittent Spasms(often at night):
- Neurontin® (gabapentin)
- Tegretol® (carbamazepine)
- Eldepryl® (selegiline)
- Sinemet® (L-dopa)
TREMOR
- Inderal® (propranolol)
- Buspar® (buspirone)
- Klonopin® (clonazepam)
- Atarax®, Vistaril® (hydroxyzine)
- Desyrel® (trazodone)
- Diamox® (acetazolamide)
- Mysoline® (pimidone)
- Isoniazid (INH) & pyridoxine
- Brain stimulation surgery
VERTIGO or DIZZINESS
- Antivert® (meclizine)
- Benadryl® (diphenhydramine)
- Dramamine® (dimenhydrinate)
- Scopolamine patch
- Benzodiazepines
- Klonopin® (clonazepam)
- Ativan® (lorazepam)
- Xanax® (alprazolam)
- Serax® (oxazepam)
- Valium® (diazepam)
DEPRESSION
Selective Serotonin Reuptake Inhibitors (SSRI):
- Paxil® (paroxetine)
- Prozac® (fluoxetine)
- Zoloft® (sertraline)
- Lexapro® (escitalopram)
- Celexa® (citalopram)
Tricyclic Antidepressants:
- Elavil® (amitriptyline)
- Pamelor® (nortriptyline)
- Tofranil® (imipramine)
- Norpramin® (desipramine)
Other Medications for Depression:
- Desyrel® (trazodone)
- Serzone® (nefazodone)
- Welbutrin® (bupropion HCl)
- Effexor® (venlafaxine)
PAIN
- Neurontin® (gabapentin)
- Lyrica® (pregabalin)
- Tegretol® (carbamazepine)
- Zanaflex® (tizanidine)
- Lioresal® (baclofen)
- Dilantin® (phenytoin)
- Cytotec® (misoprostol)
- Depakote® (valproate)
- Zostrix® (Capsaicin; topical analgesic for dysesthesia, which are uncomfortable sensations such as pins and needles feelings)
BOWEL PROBLEMS
Bulk Forming Agents
- Metamucil®
- FiberCon®
- Fiberall®
- Perdiem Plain® fiber
- Citrucel®
Stool Softeners
- Colace®
- Surfac®
- Chronulac® syrup
Oral Laxatives
- PeriColace®
- Milk of Magnesia®
Suppositories (rectal stimulants)
- Glycerin suppositories
- Ducolax® suppositories
- Therevac enemas
BLADDER PROBLEMS
Anti-spasticity Treatments
- Detrol® (tolterodine tartrate)
- Ditropan® (oxybutynin)
- Ditropan XL® (oxybutynin chloride)
- Zanaflex® (tizanidine)
- Crystospaz®, Levbid®, Levsinex® (hyoscyamine)
- Urispas® (flavoxate hydrochloride)
- Tofranil® (imipramine)
- ProBanthine® (propantheline bromide)
- Intrathecal baclofen pump
Alpha Blockers
- Hytrin® (terazosin)
- Dibenzyline® (phenoxybenzamine)
Antibiotic Bladder Agents
- Macrodantin® (nitrofurantoin)
- Cipro® (ciprofloxacin)
- Septra® (trimethoprim and sulfamethoxazole)
Other Bladder Drugs
- Pyridium® (phenazopyridine HCl)
- Urecholine® (bethanechol)
- DDAVP (desmopressin)
SEXUAL DYSFUNCTION
- Viagra® (sildenafil citrate)
- Cialis® (tadalafil)
- Levitra® (vardenafil HCI)
- MUSE® (prostaglandin)
COGNITIVE CHANGES
- Aricept® (donepezil HCl)
- Possibly other Alzheimer's drugs
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.
For more detailed information on managing specific symptoms, please refer to the “Symptom Awareness” columns from the different issues of MSAA’s quarterly publication, The Motivator.
