Medications That Can Exacerbate MS Symptoms
Many medications prescribed for co-existing conditions or even for MS symptom management can unintentionally worsen MS symptoms or create undesirable side effects. It is crucial for patients and healthcare providers to review all medications regularly to mitigate risks.
Anticholinergics
Often used to manage bladder dysfunction, a common issue in MS, anticholinergic medications can have unwanted side effects that negatively impact a patient's quality of life. For example, drugs like oxybutynin and tolterodine can cause or worsen cognitive issues such as memory problems and confusion. Given that many people with MS already experience cognitive difficulties, adding an anticholinergic medication can make these challenges significantly harder to manage.
Antidepressants
Depression is common in MS, and antidepressants are frequently prescribed. However, certain types, particularly tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), can present risks. For instance, some antidepressants may contribute to bone loss, increasing the risk of fractures in people with already low bone density. Some can also worsen sexual dysfunction, another common MS symptom. TCAs and other classes, like bupropion, can also increase the risk of seizures, particularly at higher doses.
Muscle Relaxants
Used to treat spasticity, muscle relaxants such as baclofen and tizanidine can cause fatigue and weakness, which can compound existing MS symptoms. For a person with MS who already experiences fatigue or muscle weakness, this can be particularly debilitating. These drugs can also impair balance and coordination, increasing the risk of falls.
Antihistamines
Certain over-the-counter and prescription antihistamines, like diphenhydramine (Benadryl), are known for their sedating effects. For a person with MS, this can intensify fatigue and balance problems. Furthermore, some antihistamines can cause cognitive impairment, including poor memory and concentration, which can worsen existing cognitive issues associated with MS. Recent research has even suggested a specific antihistamine, clemastine, may worsen disease progression in some cases, though further research is needed.
TNF-alpha Blockers
These medications, such as Humira, are typically used for other autoimmune conditions like rheumatoid arthritis. They are generally contraindicated in people with MS because evidence suggests they can increase the risk of MS relapses and other central nervous system demyelinating diseases.
The Complexities of Polypharmacy and Drug Interactions
For many living with MS, managing the disease means taking a combination of medications for symptoms, co-existing conditions, and disease modification. This practice, known as polypharmacy, dramatically increases the risk of drug interactions and unwanted side effects.
One study found that 53% of surveyed MS patients were taking five or more medications, with a higher likelihood of severe drug-drug interactions occurring in this group. For instance, certain MS disease-modifying therapies (DMTs) can interact with other drugs. The interaction between citalopram and fingolimod is one example that has been flagged as potentially severe. Other DMTs, such as S1P modulators (ozanimod, siponimod), teriflunomide, and cladribine, also have documented interaction profiles that require careful monitoring.
Important Considerations and When to Consult Your Doctor
- Risk of Stopping Treatment: Discontinuing certain DMTs can lead to a severe worsening of MS, sometimes referred to as 'rebound activity'. Stopping medications like fingolimod or natalizumab requires careful supervision and often a planned transition to another therapy.
- Pseudo-Exacerbations: Sometimes, a temporary worsening of symptoms can occur due to factors like infection, stress, or heat. This is not a true relapse, but certain medications, like high-dose steroids, can be involved in managing these temporary symptom flares. Your doctor can help determine the cause of any worsening symptoms.
- Regular Medication Reviews: Due to the dynamic nature of MS and the potential for polypharmacy, regular reviews of your entire medication list with your healthcare team—including your neurologist and pharmacist—is vital. Make sure to inform them of all medications, including over-the-counter drugs and supplements, as these can also cause interactions.
Potential Medication Side Effects to Monitor
| Medication Category | Examples | Potential Side Effects Worsening MS Symptoms |
|---|---|---|
| Anticholinergics | Oxybutynin, Tolterodine | Memory loss, cognitive issues, confusion |
| Antidepressants (TCAs/SSRIs) | Amitriptyline, Citalopram | Increased fracture risk, sexual dysfunction, exacerbated bladder issues |
| Muscle Relaxants | Baclofen, Tizanidine | Increased fatigue, muscle weakness, impaired balance |
| Antihistamines (Sedating) | Diphenhydramine | Worsened fatigue, dizziness, cognitive impairment |
| TNF-alpha Blockers | Adalimumab (Humira), Etanercept (Enbrel) | Increased risk of MS relapses, generally contraindicated |
| Anti-seizure Drugs | Gabapentin, Pregabalin | Compounded fatigue, drowsiness, impaired balance |
| NSAIDs (used with caution) | Ibuprofen, Naproxen | Increased risk of liver damage with some DMTs |
| Certain DMTs | Fingolimod, Natalizumab | Rebound disease activity if discontinued abruptly |
Conclusion
Navigating the complex landscape of medication management with multiple sclerosis is a critical component of treatment. While many drugs are necessary for managing symptoms and slowing disease progression, others can pose significant risks by exacerbating existing symptoms or creating dangerous drug interactions. Open and transparent communication with your entire healthcare team is the best strategy. By keeping your doctors informed of all medications and supplements you take and undergoing regular medication reviews, you can minimize potential harm and ensure your treatment plan is as effective and safe as possible. For more insights and resources on MS, consider visiting the MyMSTeam community.
