Several disease-modifying therapies (DMTs) can help change the disease course of MS. People with MS can also take other medications for symptoms, complications, and relapses.

Multiple sclerosis (MS) causes neurological symptoms that typically worsen over time. People with MS typically experience relapses, during which symptoms worsen or new symptoms appear.

Depending on the type of MS a person has, they may also experience remissions, during which symptoms improve or resolve for a while.

There’s no cure for MS, and the damage it causes cannot be reversed.

Treatment typically involves disease-modifying therapies (DMTs) to help manage the condition, prevent relapses, and slow the accumulation of disability. If relapses occur, other medications can help shorten their severity and length. If you have complications or other symptoms of MS, doctors may also recommend additional medications and therapies to help manage them and improve your quality of life.

Keep reading to learn about the different medications that can help manage MS.

Quick look

The Food and Drug Administration (FDA) has approved the following drugs for the treatment of MS:

  • Oral drugs: cladribine (Mavenclad), dimethyl fumarate (Tecfidera), diroximel fumarate (Vumerity), fingolimod (Gilenya), monomethyl fumarate (Bafiertam), ozanimod (Zeposia), siponimod (Mayzent), teriflunomide (Aubagio), ponesimod (Ponvory)
  • Injections: interferon beta-1a (Avonex, Rebif), interferon beta-1b (Betaseron, Extavia), glatiramer acetate (Copaxone, Glatopa), peginterferon beta-1a (Plegridy), ofatumumab (Kesimpta)
  • Infusions: alemtuzumab (Lemtrada), mitoxantrone hydrochloride, natalizumab (Tysabri), ocrelizumab (Ocrevus)

DMTs may help change the disease course of MS by helping slow MS progression, preventing relapses, and reducing disease activity.

The length of treatment with DMTs can range from a few months to years, depending on how they work to manage your MS.

A doctor or healthcare professional may recommend switching between these medications throughout treatment. This depends on how effectively each drug manages your disease and how well you tolerate the side effects.

If you switch to a different DMT, a doctor will likely monitor you to ensure its effectiveness. This can include scans to see if new lesions have formed and monitor existing ones.

The FDA has approved 12 MS medications administered by injection or infusion.

Interferon beta products

These drugs include:

They help change relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS) in people with active disease. MS is active when a relapse has occurred or new lesions have appeared on an MRI scan.

They also treat clinically isolated syndrome (CIS), a one-off episode of neurological symptoms. CIS can progress to MS and is sometimes categorized as a type of MS.

These drugs are made up of proteins that keep certain white blood cells (WBCs) from entering the brain and spinal cord, where they may damage the myelin that forms a protective coating over nerve fibers. Read more about how MS affects the brain.

Preventing these WBCs from moving into your brain and spinal cord may help slow their damage and reduce the number of relapses you have.

You inject these drugs yourself after a healthcare professional shows you how. The number of injections depends on the drug:

  • Rebif: three times per week
  • Betaseron: every other day
  • Extavia: every other day
  • Avonex: once per week
  • Plegridy: every 2 weeks

Glatiramer acetate (Copaxone)

Glatiramer acetate (Copaxone) is a manufactured substance that resembles a basic protein of natural myelin. It’s thought to work by prompting the WBCs to attack the substance instead of the myelin cells.

You inject this drug yourself once per day or three times per week, depending on your dosage.

People who also receive injections three times per week should ensure at least 48 hours between them.

The FDA has also approved glatopa, a generic form of Copaxone.

Natalizumab (Tysabri)

Natalizumab (Tysabri) is an infused medication that may block damaged T lymphocytes from entering the brain and spinal cord.

A healthcare professional gives you this drug as an intravenous (IV) infusion. The infusion takes about an hour, and you typically get it every 4 weeks.

Note: Natalizumab (Tysabri) has a black box warning stating that using natalizumab (Tysabri) can increase your chance of getting progressive multifocal leukoencephalopathy (PML). PML is a rare brain infection that usually leads to death or severe disability. Currently, there’s no known treatment for PML.

A black box warning is issued by the FDA for the most severe adverse reaction that can occur.

It tends to happen in people with weakened immune systems, and your risk may be higher if you take other medication that weakens your immune system. But, people who take natalizumab (Tysabri) on its own can still develop PML.

Mitoxantrone hydrochloride (Novantrone)

Mitoxantrone hydrochloride is an infused medication originally used to treat cancer. Now, doctors also prescribe it to treat MS. It suppresses the immune system cells thought to target myelin cells. This medication is only available as a generic drug.

It’s used to treat SPMS or worsening RRMS if other drugs haven’t worked. It has a high risk of serious side effects, so it’s only appropriate for people with these more severe forms of MS. You can only receive a limited amount of the drug during your lifetime.

A healthcare professional gives you this drug as a short IV infusion once every 3 months until the maximum lifetime dose is reached. The infusion takes about 5 to 15 minutes.

Alemtuzumab (Lemtrada)

Alemtuzumab (Lemtrada) is approved for people with relapsing forms of MS, including RRMS and active SPMS. It’s intended for people who’ve tried at least two other MS medications but found that treatment was unsuccessful or caused intolerable side effects.

It works by lowering the number of specific B and T lymphocytes in your body. This action may decrease inflammation and damage to your nerve cells.

Alemtuzumab is given as a 4-hour IV infusion. To start, you receive this drug once daily for 5 days. Then, 12 months after your first treatment course, you receive it once daily for 3 more days.

Ocrelizumab (Ocrevus)

Ocrelizumab (Ocrevus) is the newest infusion treatment for MS. It was approved by the FDA in 2017.

It’s the first drug used to treat primary progressive MS (PPMS). It’s also used to treat CIS and relapsing forms of MS.

Ocrelizumab appears to work by targeting and ultimately lowering your number of B lymphocytes. B lymphocytes are responsible for the damage and repair of your myelin sheaths.

Ocrelizumab is given as an IV infusion. To begin, you’ll receive it in two 300-mg infusions separated by 2 weeks. After that, you’ll receive 600-mg infusions every 6 months.

You’ll also receive a corticosteroid and an antihistamine on the day of each infusion to lower your risk of a reaction to the medication.

Ofatumumab (Kesimpta)

Ofatumumab (Kesimpta) was approved by the FDA in August 2020 and is the newest treatment for MS.

Like ocrelizumab (Ocrevus), it targets harmful B lymphocytes and lowers their overall number.

You receive Ofatumumab as a weekly injection for the first 3 weeks. After a 1-week break, this changes to a monthly injection.

The FDA has approved eight oral medications for treating MS.

Fingolimod (Gilenya)

Fingolimod (Gilenya) is an oral capsule that you take once daily.

It was the first oral medication approved by the FDA to treat RRMS. Doctors also prescribe it to treat CIS and active SPMS.

Fingolimod causes the damaging WBCs to remain within your lymph nodes, which are nodes throughout your body that store white blood cells. This lowers the chance of these WBCs entering your brain or spinal cord and causing damage.

Teriflunomide (Aubagio)

Teriflunomide (Aubagio) is an oral tablet you take once daily.

Teriflunomide works by blocking an enzyme needed by the damaging WBCs. As a result, teriflunomide helps decrease the number of these cells, which lowers the damage they can inflict.

Dimethyl fumarate (Tecfidera)

Dimethyl fumarate (Tecfidera) is an oral capsule you take twice daily.

The exact mechanism of this drug is unknown.

It appears to work by interfering with the activity of certain immune system cells and chemicals to lower your risk of an MS relapse. It may also have antioxidant properties that help protect against brain and spinal cord damage.

Diroximel fumarate (Vumerity)

Diroximel fumarate (Vumerity) is an oral capsule you take twice daily.

Diroximel fumarate has the same active ingredient as dimethyl fumarate (Tecfidera) and works similarly. This means that it may also have antioxidant properties and interfere with the activity of certain immune system cells and chemicals.

Monomethyl fumarate (Bafiertam)

Monomethyl fumarate (Bafiertam) is an oral capsule you take twice daily. The FDA approved it in April 2020.

Monomethyl fumarate is a bioequivalent of dimethyl fumarate (Tecfidera). Like dimethyl fumarate, monomethyl fumarate may have antioxidant properties and appears to work by interfering with the activity of certain immune system cells and chemicals.

Cladribine (Mavenclad)

Cladribine (Mavenclad) is a pill that you take for a total of 16 or 20 days over the course of 2 years. You’ll have treatment for 2 weeks per year, with each session lasting 4 or 5 days. There’s a 1-month break between the 2 weeks of treatment.

It’s approved for people with relapsing forms of MS, including RRMS and active SPMS. It’s intended for people who’ve tried at least one other MS medication but found that treatment was unsuccessful or caused intolerable side effects.

It may work by lowering the number of harmful B and T lymphocytes.

Siponimod (Mayzent)

Siponimod (Mayzent) is an oral tablet you take once daily.

It’s believed to work by blocking certain inflammatory cells from leaving your lymph nodes. This action limits the amount of nerve damage that they can inflict.

Ozanimod (Zeposia)

Ozanimod (Zeposia) is an oral capsule you take once daily.

It’s believed to work by blocking immune cells from leaving your lymph nodes and entering your CNS.

Ponesimod (Ponvory)

Ponesimod (Ponvory) is an oral tablet you take one daily.

It’s believed to work by reducing the action of the immune cells that cause nerve damage.

Fingolimod (Gilenya) is currently the only DMT approved by the FDA for use in children. It’s safe for use in people ages 10 years old and up.

But doctors may prescribe other DMTs off label.

Off-label drug use

Off-label is when a medication approved by the FDA for one purpose is used for a different purpose that hasn’t been approved. But a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs but not how doctors use the drugs to treat people. A doctor can prescribe a drug however they think is best for your care. Learn more about off-label drug use.

While relapses may go away on their own, more severe relapses can require treatment.

MS relapses are caused by CNS inflammation, and depending on the severity, they’re typically treated with IV or oral corticosteroids. These drugs can lower inflammation and help make MS attacks less severe. Corticosteroids used to treat MS include:

  • dexamethasone (Dexamethasone Intensol)
  • methylprednisolone (Medrol)
  • prednisone (Prednisone Intensol, Rayos)

If corticosteroids don’t work, a doctor may prescribe corticotropin (H.P. Acthar Gel).

Corticotropin is an injection, and it’s also known as adrenocorticotropic hormone gel. It works by prompting your adrenal cortex to secrete the hormones cortisol, corticosterone, and aldosterone. The secretion of these hormones helps to lower inflammation.

Other drugs can be used to treat specific MS symptoms or complications from MS-related damage.

For walking problems

Dalfampridine (Ampyra) is an oral tablet taken twice daily to help improve your walking.

Dalfampridine blocks potassium channels, which form tiny pores in your nerve cells. This action may help your damaged nerve cells to better send messages.

Improved nerve impulse conduction aids in your leg muscle control and strength.

For muscle stiffness or spasms

A doctor may give muscle relaxants to people with MS who have painful muscle stiffness or muscle spasms. Drugs commonly used to treat these symptoms include:

  • baclofen (Ozobax)
  • cyclobenzaprine (Amrix)
  • dantrolene (Dantrium)
  • diazepam (Valium)
  • onabotulinumtoxinA (Botox)
  • tizanidine (Zanaflex)

For fatigue

Ongoing fatigue is a common problem for people with MS. For this symptom, a doctor may prescribe a drug such as modafinil (Provigil).

They may also prescribe an off-label drug, such as amantadine (Gocovri) and fluoxetine (Prozac). Doctors may also prescribe amphetamines off-label to treat fatigue.

For dysesthesia

Dysesthesia is a type of pain that can feel like ongoing burning or itching. It may also feel like wetness, an electric shock, or pins and needles.

To treat dysesthesia, a doctor may prescribe:

  • amitriptyline
  • clonazepam (Klonopin)
  • gabapentin (Neurontin)
  • nortriptyline (Pamelor)
  • phenytoin (Dilantin)

For depression

According to 2021 research, some research has shown that people with MS are more likely to experience clinical depression than the general population.

Drugs used to treat depression in people with MS include:

  • bupropion (Wellbutrin SR, Wellbutrin XL)
  • duloxetine (Cymbalta)
  • fluoxetine (Prozac)
  • paroxetine (Paxil)
  • sertraline (Zoloft)
  • venlafaxine (Effexor XR)

For constipation

Constipation is another common complication of MS. A doctor may recommend treating it with one of the following over-the-counter drugs:

  • bisacodyl (Dulcolax)
  • docusate (Colace)
  • magnesium hydroxide (Phillips’ Milk of Magnesia)
  • psyllium (Metamucil)

For bladder dysfunction

Bladder dysfunction is also a common complication of MS. Symptoms may include:

Drugs to treat these symptoms include:

  • darifenacin (Enablex)
  • oxybutynin (Ditropan XL)
  • prazosin (Minipress)
  • solifenacin (VESIcare)
  • tamsulosin (Flomax)
  • tolterodine (Detrol)

For sexual dysfunction

An estimated 50% and 90% of males and 40% and 80% of females with MS experience sexual dysfunction, according to a 2022 systemic review.

Oral medications prescribed to help treat erectile dysfunction include:

  • sildenafil (Viagra)
  • tadalafil (Cialis)
  • vardenafil (Levitra)
  • avanafil (Stendra)

Older drugs that must be injected directly into the penis are also available. These drugs aren’t used as much now that oral medications are available.

They include alprostadil (Caverject). The blood pressure medication papaverine may also be used off-label for this purpose.

People with a vagina or clitoris may experience problems such as reduced feeling or vaginal dryness.

There are no drugs currently available to treat these issues. But for vaginal dryness, you can use water-soluble personal lubricants that are available over the counter.

Many different types of drugs are available to help you manage MS. The medications that may be best for you can depend on the type of MS you have and the symptoms you experience.

You may not be able to access all of these medications. Ask a doctor to confirm which drugs are currently on the market in your area and which might be most appropriate. Speaking with a doctor is especially important if you’re pregnant or planning to become pregnant.

Your doctor may recommend medications along with other types of treatment, such as physical therapy, to help improve your quality of life with MS.

Work with a doctor to create a plan to manage your MS symptoms and help prevent further damage from the disease. Sticking to your treatment plan can help you feel better and slow the progression of MS.

It’s best to stay in contact with a doctor while taking medication for MS.