Managing Multiple MS Medications
-Reviewed by Walter Truax, M.D.

By Madeline Vann, MPH Medically reviewed by Cynthia Haines, MD Click here to read original story on EveryDayHealth.com Multiple sclerosis is a complicated disease that can progress in vastly different ways in different people. For most people, however, the general approach in MS treatment is to first prescribe one of three Food and Drug Administration (FDA)-approved beta interferon drugs or glatiramer acetate (Copaxone) soon after a multiple sclerosis diagnosis is made to try to prevent relapses and progression of symptoms. These drugs, along with two others approved by the FDA in the United States, are known as disease-modifying MS medications, meaning they are directed at changing the course of the disease. Monotherapy for Treating Multiple Sclerosis Using a single disease-modifying MS treatment at a time is called monotherapy. And even if you are prescribed monotherapy for your multiple sclerosis, you may still have to take more than one medication as part of your overall MS treatment. Many times a doctor will prescribe additional medications to treat such common MS symptoms as fatigue or pain. Over the course of their treatment, some patients may see some worsening of their multiple sclerosis while taking monotherapy disease-modifying medications. If this is the case for you, you will want to talk to your doctor about either switching to another medication, or maybe trying one of the more powerful FDA-approved drugs such as natalizumab (Tysabri), or trying a combination of MS medications. "What neurologists typically do for someone who has [MS] disease activity while on one of those [disease-modifying] drugs is to stop the drug and go to something stronger like Tysabri, or start adding drugs that are not FDA-approved. But there is evidence that [the combination] works," says John Richert, MD, executive vice president of research and clinical programs at the National Multiple Sclerosis Society. Examples of drugs that could be combined with MS medications as part of MS treatment are steroids, taken on a monthly basis for acute symptoms, or methotrexate, a medication used to treat rheumatoid arthritis that eases pain and reduces inflammation. Managing Multiple MS Medications While "we usually use only one [disease-modifying MS medication] at a time, sometimes other drugs like steroids or some anticancer drugs like methotrexate are used in combination with these medications," says neurologist Walter Truax, MD, medical director of the Stroke Rehabilitation Unit at West Jefferson Medical Center in New Orleans. Dr. Truax notes that "this usually does not [present] a problem [for MS patients]." Still, some issues can arise when taking multiple drugs. Most prominently, these include managing side effects, dealing with the difficulties of juggling several MS medications, and facing what can be a very high financial cost of MS treatment. The following tips can make managing your MS medication regimen easier: Don't go it alone. Any side effects or difficulties managing your combination of medications should be discussed with your treating physician, advises Truax. For more on the side effects associated with MS medications Talk money up front. One of the obstacles inherent in combining MS medications, especially the frontline beta interferon drugs or glatiramer acetate therapies, is cost. "With disease-modifying therapies — the ones that are approved by the FDA — the issue is that they are so expensive that it is difficult to afford more than one disease-modifying agent at a time," says Dr. Richert. "More and more, if somebody has disease activity while on one of the frontline drugs, they usually get switched to the stronger drugs." Consider other options. Combining drugs may be a better option for patients who do not want to take on the risks associated with the more aggressive disease-modifying medications. Such medications might include Tysabri or mitoxantrone (Novantrone). This can be a good solution for those who have insurance that only covers MS medications, or even for those paying out of pocket and trying to keep costs down. Richert notes that there is currently a National Institutes of Health-funded study comparing the effectiveness of two frontline treatments separately and in combination. The results of that study, which are still three years away, could move insurance companies toward being willing to support combination therapy. "If [MS medications] are safe and continue to be safe in combination, there will be good evidence to support the use of combined therapy," says Richert. Last Updated: 12/12/2008 This section created and produced exclusively by the editorial staff of EverydayHealth.com. © 2008 EverydayHealth.com; all rights reserved. Last date this page was modified 01/05/09.