Corticosteroids for multiple sclerosis

Examples

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Generic Name

dexamethasone

Brand Name	Generic Name
Solu-Medrol	methylprednisolone

Brand Name	Generic Name
Solu-Medrol	prednisone

How It Works

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Methylprednisolone, prednisone, and dexamethasone are corticosteroids. These medications shorten multiple sclerosis (MS) attacks by reducing inflammation on the brain and spinal cord.

A high dosage of methylprednisolone may be given through a vein (intravenous, or IV) daily for 3 to 5 days during an MS attack. Prednisone or methylprednisolone may then be given by mouth for several days after the IV treatment.

Why It Is Used

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Corticosteroids may be used to treat sudden, severe (acute) MS attacks and acute optic neuritis.

How Well It Works

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Treatment with corticosteroids may reduce the symptoms of MS attacks and help you recover more quickly.¹ There is no convincing evidence that corticosteroids can reduce the progression of MS.

For people who have attacks of optic neuritis, IV methylprednisolone seems to be the best treatment.

Treatment with oral prednisone alone may increase the risk of another attack of optic neuritis.²

Side Effects

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Corticosteroids cause few side effects when used over a short period of time. People with MS who use a short course of corticosteroids to treat severe symptom attacks may have:

• Sleep problems.
• Anxiety and agitation.
• Depression.

These problems will usually go away once you stop taking the medication.

When corticosteroids are used in high doses or for longer periods of time, they can have more serious side effects, including:

• Weight gain and swelling in the face.
• High blood pressure.
• Blood sugar problems and diabetes.
• Weakening and thinning of bones (osteoporosis).
• Cataracts.
• Bleeding in the stomach and intestines.
• Lowered resistance to infection.
• Death of bone tissue caused by a restricted blood supply to the bones. This is most common in the bones of the shoulders and hips.
• Severe agitation, paranoia, and psychosis (if corticosteroids are used in very high doses).

The side effects that may occur with prolonged corticosteroid use can be a problem for people who have frequent MS attacks and need repeated treatment with corticosteroids.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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The safety of corticosteroids during pregnancy and breast-feeding is not well known. Talk to your doctor if you are planning a pregnancy, if you are pregnant, or if you are breast-feeding.

Intravenous (IV) corticosteroids may work faster and have fewer side effects than oral steroids alone. Treatment with IV methylprednisolone may be followed by treatment with oral prednisone or oral methylprednisolone. Toward the end of the treatment, increasingly lower doses are used so that the body can recover its own ability to produce natural corticosteroid hormones.

Corticosteroid treatment does not work for everyone. In some people who have severe or frequent attacks, corticosteroids are effective at first, but become less helpful after repeated use.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Nicholas R, Chataway J (2006). Multiple sclerosis, search date January 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

2. Ropper AH, Brown RH (2005). Multiple sclerosis and allied demyelinative diseases. In Adams and Victor's Principles of Neurology, 8th ed., pp. 771–796. New York: McGraw-Hill.

Credits

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Author	Monica Rhodes
Editor	Kathleen M. Ariss, MS
Associate Editor	Denele Ivins
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer	Colin Chalk, MD, CM, FRCPC - Neurology
Last Updated	February 28, 2008