Some medications for MS can be taken at home, while others must be given in a clinical setting. Each type has benefits and potential side effects.

There are a variety of treatments for MS designed to:

  • change how the disease progresses
  • manage relapses
  • help with symptoms
  • improve your overall quality of life

Medications for MS, also called disease-modifying therapies (DMTs), fall into three categories:

With so many options, it can be hard to decide which treatment to try first. A doctor can help you weigh the pros and cons of each and determine how they may affect your lifestyle.

Here’s more information on each type of medication to help you make an informed decision.

Many MS medications are given by injection, which you can do yourself. A healthcare professional can provide training to teach you the proper way to safely inject yourself.

The Food and Drug Administration (FDA) approved the following self-injectable medications for MS treatment:

  • glatiramer acetate (Copaxone, Glatopa), which is available in either a 20- or 40-mg dose
  • interferon beta-1a (Avonex, Rebif)
  • interferon beta-1b (Betaseron, Extavia)
  • ofatumumab (Kesimpta)
  • peginterferon beta-1a (Plegridy)

Depending on the medication, you’ll either inject the drug subcutaneously (beneath the skin) or intramuscularly (directly into the muscle). Injections may involve a needle or an injection pen.

The frequency of injections ranges from daily (for some people taking Copaxone or Glatopa) to once per month (for people who’ve taken Kesimpta for at least 3 weeks).

Who should take them?

If you’re comfortable self-injecting and prefer not to take oral medications daily, injectable treatments might be a good choice for you.

Side effects and safety

The side effects of most injectable medications can be unpleasant but are usually short-lived and manageable.

Side effects can include:

  • pain
  • swelling
  • skin reactions at the injection site
  • flu-like symptoms
  • liver test abnormalities

If you experience side effects, a doctor may recommend the following strategies that can help, according to the Multiple Sclerosis Association of America (MSAA).

  • rotating the injection sites
  • taking your injectables at night or on weekends to avoid symptoms during the work week
  • decreasing the needle size
  • switching to an auto-injectable
  • icing the injection site beforehand to reduce pain and swelling
  • taking an over-the-counter (OTC) pain reliever, such as acetaminophen (Tylenol) to help alleviate flu-like symptoms

Daclizumab (Zinbryta) is an injectable medication that had previously been used to treat MS. Its manufacturers voluntarily removed it from the global market in 2018 due to safety concerns, including reports of severe liver damage and anaphylaxis.

Infusion medications are given intravenously (through a needle) in a clinical setting. You cannot take them at home, so you must be able to get to infusion appointments.

The FDA-approved infusion medications for MS include:

  • alemtuzumab (Lemtrada)
  • mitoxantrone (Novantrone)
  • natalizumab (Tysabri)
  • ocrelizumab (Ocrevus)

The schedules for infusion medications vary:

  • Lemtrada is given in two courses. You receive daily infusions for 5 days. One year later, you receive your second set of infusions, consisting of daily infusions for 3 days.
  • Novantrone is given once every 3 months.
  • Tysabri is given once every 4 weeks.
  • The first two doses of Ocrevus are given 2 weeks apart. Later infusions are given every 6 months.

Who should take them?

If you want a healthcare professional to help you administer your medication or do not want to take pills every day, infusion medications might be a good choice for you.

Side effects and safety

Common side effects include:

  • nausea
  • headache
  • abdominal discomfort
  • fever
  • flushing
  • rash at the infusion site

In rare cases, these medications may cause serious side effects such as infection and heart damage. You can also ask a doctor about taking certain medications before your infusion sessions, such as antihistamines, fever-reducers (antipyretics), and anti-nausea drugs (antiemetics), to help prevent or alleviate side effects.

If you have asthma, a doctor will ask you to bring your rescue inhaler with you to your infusion appointment. If you are of childbearing age, you may also be counseled on using birth control to help prevent potential birth irregularities that infusion medications may cause.

A doctor will help you weigh the risks of taking these drugs with the potential benefits.

If you prefer, you may be able to take your MS medication in pill form.

One 2015 study that evaluated preferences for various MS medication receiving routes reported a strong preference for daily oral medications due to ease of use. However, there are also potential risks and side effects, which you can discuss with a doctor.

The FDA-approved oral MS medications include:

  • cladribine (Mavenclad)
  • dimethyl fumarate (Tecfidera)
  • dimethyl fumarate (generic)
  • diroximel fumarate (Vumerity)
  • fingolimod (Gilenya)
  • monomethyl fumarate (Bafiertam)
  • ozanimod (Zeposia)
  • ponesimod (Ponvory)
  • siponimod (Mayzent)
  • teriflunomide (Aubagio)

Aubagio, Gilenya, Mayzent, Ponvory, and Zeposia are taken once per day. Tecfidera and Bafiertam are taken twice daily.

In your first week on Vumerity, you’ll take one pill twice daily. Afterward, you’ll take two pills twice per day.

Mavenclad is a short-course therapy. Over the course of 2 years, you’ll have either 16 or 20 treatment days. On your treatment days, your dose will consist of either one or two pills. Your weight will determine whether your dose contains one or two pills.

Who should take them?

Oral medications can be easy to take and may be a good option if you do not like needles.

Taking your medication as prescribed is important for it to be effective, so you’ll need to follow an organized schedule if you take daily oral doses.

Setting reminders for yourself can help you stick to a schedule and take each dose on time.

Side effects and safety

Side effects of oral medications may include:

  • headache
  • upset stomach
  • liver test abnormalities

A doctor may prescribe a lower dose of your MS medication and then gradually increase it to reduce the risk of side effects, according to the MSAA.

To treat an upset stomach, a doctor may recommend an OTC medication such as Pepto-Bismol. The MSAA suggests it may be helpful to take your DMT with food.

The previously mentioned study on MS treatment preferences also notes that oral medications may not be as effective as other DMTs. However, study participants still overwhelmingly preferred this method due to its ease of use and the reduced risk of immediate side effects compared with other methods.

Your MS treatment plan should consider ease of use, along with other potential benefits versus possible risks of treatment. There’s no one-size-fits-all MS medication.

Before starting any new oral therapy for MS, a doctor may run certain blood tests to ensure a new medication is safe for you to take. For example, before prescribing Tysabri infusions, a doctor must test you for possible reactivation of the John Cunningham (JC) virus.

The JC virus is relatively common, with most people being exposed to it at some point in their lifetime. It causes no symptoms. But when you have MS, the reactivation of this virus may lead to a rare — but potentially fatal — infection called progressive multifocal leukoencephalopathy (PML), which targets white matter in your brain.

Receiving a positive JC virus test does not mean you’ll automatically develop PML. However, it does mean that taking certain DMTs could increase your risk for the condition. Symptoms of PML are similar to those of MS, and may include:

  • weakness
  • clumsiness
  • visual changes
  • speech changes
  • changes in your personality

According to the National Multiple Sclerosis Society and the American Academy of Neurology, no matter what type of MS treatment you and a doctor decide on, it’s also important to keep up with your recommended vaccine schedule, which includes the following vaccines:

  • COVID-19
  • influenza (the flu)
  • hepatitis B
  • shingles
  • pneumococcal disease
  • monkeypox
  • smallpox
  • human papillomavirus (HPV)
  • varicella (chickenpox)

However, there are a few important considerations that might interfere with the types of vaccines you take, as well as the timing of them. Talk with a doctor about the following exceptions:

  • Live vaccines are not recommended for people with MS while they’re taking DMTs.
  • People with MS should avoid any vaccines if they’re currently experiencing symptoms of relapse.
  • If a person has MS, they may need to avoid taking vaccines before starting certain DMTs or follow a waiting period before starting their medication. Otherwise, this may interfere with the vaccine’s effectiveness.

DMTs are available in different forms, such as self-injectable, infusion, and oral treatments. Each form has side effects as well as benefits.

A doctor can help you choose a medication that’s right for you based on your symptoms, preferences, and lifestyle. They can also advise you on how to lessen potential side effects associated with treatment.

While it can take 6 to 12 months for a DMT to take full effect, it’s important to tell a doctor if you’re experiencing any side effects or worsening MS symptoms.