Doctors may recommend oral or infused steroid therapy for severe multiple sclerosis flare-ups that impact your functioning. Treatment with steroids can cause side effects.
If you have multiple sclerosis (MS), your doctor may prescribe steroids to treat episodes of disease activity. These episodes of new or returning symptoms are known as:
- flare-ups
- relapses
- exacerbations
- attacks
Steroids are intended to shorten the flare-up so you can get back on track sooner. It’s not necessary to treat all MS flare-ups with steroids, though.
These medications are generally reserved for severe flare-ups that interfere with your ability to function. Some symptoms of severe flare-ups include:
- severe weakness
- balance issues
- visual disturbances
Continue reading to learn more about steroids for MS and their potential benefits and side effects.
The type of steroids used for MS are known as glucocorticoids. They belong to a larger class of steroids called corticosteroids.
Glucocorticoid drugs imitate the effect of glucocorticoid hormones, which your body produces naturally. They work by reducing inflammation and weakening the immune system so it no longer attacks the myelin surrounding the nerve. They may also help close the impaired blood-brain barrier, which helps stop inflammatory cells from migrating into the central nervous system. This helps reduce inflammation and MS symptoms. Treatment may include:
Intravenous (IV) steroids
Healthcare professionals typically give high dose steroids through an IV once daily for 3 to 5 days. This usually occurs in an outpatient infusion center, except for people at risk of severe side effects or serious health concerns, who may need to be hospitalized.
Oral steroids
A doctor may recommend a course of oral steroids to treat a flare-up and for 1 or 2 weeks following IV treatment to help you safely taper off steroid use. Abruptly stopping steroids without tapering can potentially cause severe side effects. During this time, the dose is slowly decreased. Some people may continue to take oral steroids for as long as 6 weeks.
Injected steroids
Though less common, some doctors may recommend injected steroids in certain instances, such as if you have difficulty swallowing oral medications.
There’s no standard dosage or regimen for steroid treatment for MS. Doctors consider the severity of your symptoms and usually start with the lowest possible effective dose to limit side effects.
Doctors may recommend different steroid drugs based on the severity of your symptoms.
Methylprednisolone
Methylprednisolone may be administered as:
- an IV infusion (Solu-Medrol) for severe flare-ups
- an oral treatment (Medrol)
- an injection into the muscles, joints, soft tissues, or skin (Depo-Medrol, Solu-Medrol), which has a slower onset but lasts longer
Solu-Medrol infusion
If your doctor recommends infusion therapy, you may receive Solu-Medrol in an infusion center or hospital. Each infusion lasts about 1 hour, but this can vary. You might notice a temporary metallic taste in your mouth during the infusion.
Depending on how you respond, you may need a daily infusion for 3 to 7 days. Treatment typically lasts for 5 days.
Prednisone
Doctors may recommend oral prednisone (Prednisone Intensol and Rayos) in place of IV steroids, especially if you’re having a mild to moderate flare-up.
A doctor may also prescribe oral prednisone to help you safely taper off steroids after receiving IV steroids. You may take a decreasing amount of this drug over the course of several days to weeks.
Tapering guidance is often specific to each person and may be based on age and body weight. However, a typical tapering regimen for an adult might require you to reduce your prednisone doses every 3 to 7 days.
Prednisolone
Prednisolone is available as an oral tablet or syrup. The oral syrup is available under the brand name Prelone.
Doctors may prescribe prednisolone to help you safely taper off steroid use after IV steroids.
A 2021 study concluded that tapering oral prednisolone for 20 days after taking IV methylprednisolone has little effect on the health of people with MS. However, it may cause side effects such as increased appetite and weight gain.
Dexamethasone
Dexamethasone can be administered orally or via injection. The generic form of the drug is the only form that the Food and Drug Administration (FDA) has approved for the treatment of MS.
Your doctor will determine the right starting dose for you.
Betamethasone
Betamethasone is an injectable drug that’s available as a generic drug and as the brand-name drug Celestone Soluspan. Betamethasone is also available in other forms, but those forms are rarely used to help treat MS.
As with dexamethasone, you typically take a standard dosage for one week, followed by a gradually decreasing dosage as you taper off.
It’s important to note that corticosteroids aren’t expected to provide long-term benefits or change the course of MS. However, they can help you recover from flare-ups faster. It may take a few days to feel your MS symptoms improve.
Just as MS varies so much from one person to another, so does steroid treatment. It’s not possible to predict how well it’ll help you recover or how long it’ll take.
A review of research from 2020 suggests that comparable doses of oral corticosteroids may be similarly effective to high dose IV methylprednisolone. The review’s authors recommended healthcare professionals prescribe oral corticosteroids for treating flare-ups in people with MS during the COVID-19 pandemic to reduce their risk of catching COVID-19 when visiting the hospital for IV steroids.
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Since oral steroids are more convenient and less expensive, they may be a good alternative to IV treatments, especially if infusions are a problem for you.
Occasional use of high dose corticosteroids is usually well tolerated, but these drugs do have side effects. Some you’ll feel immediately. Others may be the result of repeated or long-term treatments.
Short-term side effects
While taking steroids, you may experience a temporary surge of energy, making it difficult to sleep or even sit still and rest. They can also cause mood and behavior changes. You might feel overly optimistic or impulsive while on steroids.
Together, these side effects may make you want to tackle large projects or take on more responsibilities than you should.
These symptoms are generally temporary and start to improve as you taper off the medication.
Other potential side effects include:
- acne
- facial flushing
- allergic reaction
- depression
- swelling of the hands and feet from fluid and sodium retention
- headache
- increased appetite
- increased blood glucose
- increased blood pressure
- insomnia
- lowered resistance to infection
- metallic taste
- muscle weakness
- stomach irritation or ulcers
Long-term side effects
Long-term steroid treatment can potentially increase the risk of additional side effects such as:
- cataracts
- worsening glaucoma
- diabetes
- osteoporosis
- weight gain
In pregnancy
According to a 2020 literature review, people in their first trimester of pregnancy should avoid using corticosteroids to help treat their MS. This is because corticosteroid usage increases the risk of miscarriage or low birth weight.
The researchers also recommended that corticosteroids only be used in situations where flare-ups are substantially affecting daily activities.
Dexamethasone and betamethasone shouldn’t be used during pregnancy at all.
Corticosteroids can affect your production of the hormone cortisol, especially if you take it for more than a few weeks at a time.
However, if you suddenly stop taking corticosteroids or if you taper off too fast, you might experience withdrawal symptoms. It’s important to carefully follow your doctor’s instructions regarding tapering off corticosteroids.
Symptoms that indicate you’re tapering off too quickly may include:
- body aches
- muscle and joint pain
- fatigue
- lightheadedness
- weakness
- confusion
- drowsiness
- headache
- loss of appetite
- weight loss
- peeling skin
- nausea
- upset stomach and vomiting
Corticosteroids can treat severe symptoms and shorten the length of an MS flare-up. But they don’t treat the disease itself.
Treatment for MS flare-ups isn’t urgent except for vision loss. However, it should be started as soon as possible to improve your quality of life.
Consider discussing the benefits and side effects of these medications with your doctor. In deciding whether or not to take steroids for a MS flare-up, a doctor may consider:
- the severity of your symptoms and how your flare-ups affect your ability to carry out your daily tasks
- how each type of steroid is administered, and whether you’re able to follow the treatment regimen
- the potential side effects and how they may affect your ability to function
- any potential serious complications, including how steroids may affect any other health conditions such as diabetes or mental health disorders
- any possible interactions with other medications
- which steroid treatments are covered by your medical insurance
- what alternative treatments are available for the specific symptoms of your flare-ups
It’s a good idea to have this discussion the next time you visit a neurologist. That way, you’ll be prepared to decide in a flare-up.