Multiple Sclerosis: Drug Therapy

(Lewis, 2006, p 1565)

DRUG SYMPTOMS SIDE EFFECTS/ PATIENT TEACHINGS

RELIEVED PRECAUTIONS

Corticosteroids

ACTH, prednisone, Exacerbations Edema, mental changes Restrict salt intake

methylprednisolone (euphoria), weight gain,
redistribution of body fat, Do NOT abruptly stop therapy
widespread effects of many
metabolic processes. Know drug interactions

Immunomodulators

Beta-interferon Exacerbations Flu-like symptoms, local skin Perform self injection techniques
(Betaseron, Avonex, Rebif) reactions, depression; monitor
CBC, blood chemistries, and Report side effects
liver function tests every 3
months

Glatiramer acetate Local skin reactions; chest Perform self injection techniques
(Copaxone) Exacerbations pain, weakness, no laboratory
monitoring required Report side effects

Immunosuppressants

Mitoxantrone (Novantrone) Exacerbations Nausea, vomiting, diarrhea,
mucositis, alopecia,
hepatotoxicity,
myelosuppression;
cardiovascular disease;
lifetime dose limit because of
cardiotoxicity; monitor CBC
and liver function every month
Received regular monitoring and
follow up
Consult health care provider before
getting immunizations
Be aware that urine may turn a blue
green color initially

Maintain adequate fluid intake

Cholinergics

Bethanechol (Urecholine), Urinary retention Hypotension, diarrhea, Consult with HCP before using other
Neostigmine (Prostigmin) (flaccid bladder) diaphoresis, muscle weakness; drugs, including OTC drugs
history of cardiac dysfunction,
hypotension, allergies, PUD,
asthma

Anticholinergics

Probanthine (Pro-banthine) Urinary Dry mouth, blurred vision, Consult HCP before using other
Oxybutynin (Ditropan) frequency and constipation, HTN, flushing, drugs, especially sleeping aids,
urgency urinary retention (too high of antihistamines
(spastic bladder) dose); contraindicated with
history of glaucoma, prostatic
hyperplasia, cardiac
dysfunction, intestinal
obstruction
 DRUG SYMPTOMS SIDE EFFECTS/
RELIEVED PRECAUTIONS
Muscle Relaxant
Diazepam (Valium) Spasticity Drowsiness, ataxia, fatigue,
contraindicated with history of
narrow angle glaucoma
Baclofen (Lioresal) Spasticity Drowsiness, weakness; used
cautiously with a history of
hypersensitivity and renal
damage; possible exacerbation
of seizures in patients with
seizure disorders
Dantrolene (Dantrium) Spasticity Drowsiness, dizziness,
malaise, fatigue, diarrhea;
used cautiously in patents with
history of respiratory or
cardiac dysfunction; risk of
hepatotoxicity
Tizanidine (Zanaflex) Spasticity Drowsiness, dry mouth,
fatigue, nausea; used
cautiously in patients with
history of hypersensitivity,
liver or renal disease,
hypotension, bradycardia.
PATIENT TEACHINGS
Avoid driving and similar activities
because of CNS depressant effects
Be aware of addictive potential
Avoid long term use
Avoid concomitant use of
barbiturates, MAO inhibitors,
antidepressants
Do NOT abruptly stop therapy
(possibility of hallucinations)
Avoid driving and similar
activities because of sedative effects
Avoid use of other CNS depressants
Take it with food/milk
Avoid driving when drug is used
Avoid use with tranquilizers and
alcohol (possibly causing
photosensitivity)
Obtain baseline liver function tests
Avoid driving when drug is used
Avoid use with tranquilizers an
alcohol (possibility causing
photosensitivity)
Eat small frequent meals to reduce
nausea
Change position slowly when going
from lying or sitting position to
standing