- Methylprednisone 1g/day in divided doses for 3-5 days.
- Oral prednisone 1250 mg every other day for 5 days
- Intravenous adrenocortical hormones.
- Alemtuzumab – Can cause thyroid disorder, infusion reactions, increased infections (screen for herpes and TB before giving), may risk some cancers, vaccinate 6 weeks prior to therapy, avoid live vaccines during treatment.
- B – interferon – flu-like symptoms, injection site problems
- Dimethyl fumarate – GI and skin reactions
- Glatiramer acetate – injection site reactions, chest pain, shortness of breath,
- Fingolimod – Contraindicated in mi, unstable angina and stroke, heart failure class III/ IV monitor for bradycardia, avoid he vaccines.
- mitoxantrone – only second line due to toxicity. Can cause leukemia-like disease
- Natalizumab – relapsing forms, only through special program due to leukoencephalopathy risk.
- Teriflunomide – Secondary, hepatotoxicity, neutropenia, increased infection risk.
Fatigue: non-pharmacologic (rest, sleep management, cooling) or amantadine or methylphenidate
Spasticity: Baclofen or tizanidine
Walking Impairment: Dalfampridine (K+ Channel Blocker): may cause seizures, UTI, insomnia
Pseudobulbar affect: Dextromethorphan/Quinidine