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• During a
  relapse, to make the attack shorter and less
  severe.
• Over a long period of time, to alter the natural course of
  the disease ( therapy).
• To control specific
  symptoms as they occur.

Controlling a relapse

Medications can shorten a sudden relapse and help you recover
more quickly. Temporary treatment with medications called
corticosteroids is the most common treatment used to
control a relapse. These medications have not been shown
to affect the long-term course of the disease or to prevent disability.

Altering the course of MS using disease-modifying treatment

Strong evidence suggests that MS is caused by the
immune system causing
inflammation and attacking the myelin-the coating
surrounding the nerve and nerve fibers. Medications that change the activity of
the immune system can reduce the number and severity of attacks that damage the
protective myelin.

Currently, interferon beta (Avonex and Rebif, and Betaseron),
glatiramer acetate (Copaxone), and mitoxantrone (Novantrone) are the only
medications that have been approved for this purpose. For people with
relapsing-remitting MS, these medications can reduce
the number and severity of relapses and can result in fewer brain lesions. They
may also delay disability in some people. Betaseron and Novantrone may delay
disease progression in some people with
secondary progressive MS.

Currently, there is no effective disease-modifying treatment for
primary progressive MS.

Relieving symptoms

Treating specific symptoms can be effective, even if it does not
stop the progression of the disease. Symptoms that can often be controlled or
relieved with medication include:

• Fatigue. Medications to reduce fatigue
  or help you sleep better may include amantadine (Symmetrel), modafinil
  (Provigil), or fluoxetine (Prozac).
• Muscle stiffness
  (spasticity) and tremors. Medications that may reduce muscles spasms or
  stiffness include baclofen (Lioresal), tizanidine (Zanaflex), dantrolene
  (Dantrium), gabapentin (Neurontin), diazepam (Valium), or clonazepam
  (Klonopin). Sometimes a combination of these medications works best to reduce
  your muscle symptoms.
• Urinary problems and constipation.
  Medications used to reduce frequent urination may include propantheline
  (Pro-Banthine), oxybutynin (Ditropan), or tolterodine (Detrol). Medications
  sometimes used to relieve constipation include bulk agents such as psyllium
  (Metamucil) or daily use of laxatives.
• Pain and
  abnormal sensations. Depending on the severity of the pain, both
  prescription and nonprescription medications may be tried. Prescription
  medications commonly used to reduce pain associated with MS include baclofen
  (Lioresal), carbamazepine (Tegretol), or gabapentin (Neurontin).
  Nonprescription medications may include acetaminophen, ibuprofen, or naproxen
  sodium.
• Depression. Antidepressant medications may be used to
  reduce depression that often occurs as a result of having MS. Antidepressants
  often tried include tricyclic antidepressants-such as amitriptyline (Elavil),
  desipramine (Norpramin), or imipramine (Tofranil)-or selective serotonin
  reuptake inhibitors (SSRIs)-such as fluoxetine (Prozac) or sertraline (Zoloft)
  among others.
• Sexual difficulties. Medications used
  to relieve sexual difficulties that can be associated with MS include
  sildenafil (Viagra) for both men and women. Yohimbine and clomipramine may also
  be given to improve
  erectile dysfunction.

MS can affect many parts of the nervous system and produce a wide
range of symptoms. The choice of medications depends on your symptoms.
Medication may be used only some of the time or regularly, depending on how
severe or constant a particular symptom is. Changes in diet, schedule,
exercise, and other habits can also help manage some of these symptoms. See the
Home Treatment section of this topic.

Medication Choices

Symptom management

Medications used to treat symptoms of an attack of multiple
sclerosis (MS) and help you recover more quickly from a relapse include:

• (such as
  methylprednisolone).
• ACTH (adrenocorticotropic
  hormone).
• Intravenous immunoglobulin (IVIG) or
  plasma exchange (neither is used frequently).

MS

Medications used specifically for relapsing-remitting MS to
reduce the number and severity of relapses and possibly delay disability
include:

• Interferon beta (Avonex, Rebif, and
  Betaseron).
• Glatiramer acetate
  (Copaxone).
• Mitoxantrone (Novantrone) for relapsing-remitting MS
  that is rapidly getting worse.

Secondary-progressive MS

Medications used to treat and possibly delay the progression of
secondary progressive MS that is also relapsing include:

• Interferon beta-1b (such as
  Betaseron).
• Mitoxantrone (Novantrone).

Primary-progressive MS

No medicines have been clearly proven to help, and none have
been approved for primary-progressive MS. Some of the newer and experimental
medications, such as
and
other medications and biological chemicals (derived
from or identical to substances produced by the body) are being tested for
primary-progressive MS.

Medications being studied

A variety of
immunosuppressants and
other medications and biological chemicals (derived
from or identical to substances produced by the body) have been tried as
therapy for MS. While none have been clearly proven beneficial and none have
been approved for treatment of MS, these medications may be used when standard
therapy fails.

Several medicines are currently being tested in
clinical trials. People with MS who have not responded
to standard therapy sometimes choose to participate in these trials. To learn
more about clinical trials, talk to your doctor or contact the National
Multiple Sclerosis Society at http://www.nationalmssociety.org.

What To Think About

Long-term treatment with interferon beta and glatiramer acetate
can improve the quality of life for some people who have relapsing-remitting MS
by making relapses less frequent and less severe. Some evidence suggests that
these medications may also reduce or delay future disability caused by this
form of the disease.

The National Multiple Sclerosis Society recommends that treatment
with interferon beta or glatiramer acetate be started as soon as it is clear
that you have MS. Most
neurologists support this recommendation and now agree
that permanent damage to the
nervous system may occur early on, even while symptoms
are still quite mild. Early treatment may help prevent or delay some of this
damage. In general, treatment is recommended until it no longer provides a
clear benefit.

Despite the recommendation, however, some people find it
difficult to decide whether to begin disease-modifying therapy, especially when
their symptoms have been fairly mild. Some may not want to bear the risks and
flu-like side effects of interferon therapy when they are not sure they need
it. Some may want to see whether their disease worsens before starting therapy.
A small percentage of people diagnosed with MS may never have more than a few
mild episodes and may never develop any disability, but the disease is
unpredictable. For more information, see:

Should I have disease-modifying therapy for
MS?

If you decide not to try disease-modifying therapy at this time,
work with your doctor to monitor your health through regular checkups and
periodic MRI scans to evaluate whether the disease is progressing. If new
lesions are developing or existing lesions are growing, you may want to
reconsider your decision and begin treatment.

Treating symptoms and relapses

The need and desire for medication vary. If your symptoms are
mild, you may choose to manage them without any medication. If you have
specific symptoms that are causing problems, certain medications may help you
keep them under control. Or you may want to use medication only during a
relapse.

You may also want to consider:

• The possible side effects of using steroids
  or other medications to treat symptoms or control a relapse. Some people have
  only minor side effects, but others may have side effects that concern them
  more than their MS symptoms.
• The costs of treating symptoms and
  controlling relapses. In some cases, using medication to control symptoms and
  relapses may reduce the need for hospital stays.
• Other personal
  issues that you face at work or at home.

Also keep in mind that it can be hard to tell whether
medication is helping. Multiple sclerosis is a disease with spontaneous
remissions, which means that your condition can improve on its own, without any
treatment. Just because your symptoms improve after treatment does not mean
that a treatment is working.

• Keep your blood sugar as close to normal as
  possible. The American Diabetes Association recommends a
  hemoglobin A_1c
  (HbA_1c) level of less than 7%. Some people may be
  able to achieve a normal level of less than 6%.² The
  lower the A_1c, the lower the chance of complications.
  The A_1c level is a measure of your blood sugar over the
  past 2 or 3 months.
• Eat a diet that spreads
  throughout the day.
• Get
  regular exercise.
• Take your prescribed insulin either by injection
  or through an
  insulin pump.
• Do not smoke.

For more information, see the Home Treatment section of the topic
Type
1 Diabetes: Living With the Disease.

Other measures to care for and protect yourself depend on which
complication you have.

Heart and large blood vessel disease

Even if you don’t have heart and blood vessel problems, you are
at risk for them.

• Don’t smoke. Smoking increases your risk of a
  heart attack or
  stroke, and makes many health problems
  worse.
• Take your blood pressure medicine, if
  prescribed.
• Take aspirin daily, if advised by your health
  professional.
• Drink alcohol in moderation. This means no more than
  1 drink a day for women and no more than 2 drinks a day for men. Discuss with
  your health professional whether you should drink alcohol.

Eye disease (diabetic retinopathy)

Call your eye specialist if you notice any changes in your
vision. Vision changes may mean worsening of diabetic retinopathy. Early
detection and treatment can help prevent vision loss.

If you have severe vision loss from diabetic retinopathy,
vision aids can help. Your local or state organization
for the visually impaired can help you find these aids.

For more information, see the topic
Diabetic Retinopathy.

Kidney disease (diabetic nephropathy)

• Take your
  blood pressure medications, if prescribed. Your blood
  pressure should be less than 130/80 mm Hg. Ask your health professional if you
  need to monitor your blood pressure at home.
• Get no more than 10%
  of your daily calories from protein foods if you have small amounts of protein
  in your urine (microalbuminuria).²
• Limit
  salt in your diet because it makes your body retain fluid and can increase your
  blood pressure.

For more information, see the topic
Diabetic Nephropathy.

Foot problems

Daily care of your feet is very important. Because
diabetic neuropathy and diabetic damage to the blood
vessels in your legs can lead to severe infections and deformities of your
feet, seek treatment for any foot problem, no matter how minor it seems. Even a
small foot injury can lead to serious complications.

For more information, see

Foot care for people with
diabetes

Nerve damage (diabetic neuropathy)

If it affects your ability to feel (peripheral
neuropathy):

• Turn your water heater down, and use a bath
  thermometer or have someone test your bath water to make sure it is not too
  hot.
• Don’t go barefoot. Always wear shoes, even in the
  house.
• Don’t use an electric blanket.
• Arrange your
  furniture so that the walkways through your house are free of clutter.

If it affects your body’s internal (autonomic neuropathy):

• Eat smaller, more frequent meals that contain
  less fat and fiber, if you have
  gastroparesis or other digestive
  problems.
• Drink more fluids each day, if you have urinary problems
  or profuse sweating. This will prevent urinary tract infections and
  dehydration.
• Try a device for erection
  problems or a cream for vaginal dryness, if you have sexual
  problems. Talk to your health professional about medication for erection
  problems (Cialis, Levitra, Viagra). For more information, see the topic
  Erection Problems.
• Check your blood sugar
  level frequently during the day and during the night , if you have
  hypoglycemia unawareness.

If it affects one nerve (focal
neuropathy):

• Wear a joint splint, if your health
  professional advises.
• Take breaks during activities that require
  repetitive movements.
• Make sure your work area has appropriate
  support for the affected joint.

For more information, see the topic
Diabetic Neuropathy.

If you have high blood pressure (or hypertension) and are having problems
with erectile dysfunction (ED), the first step toward a solution is to see your
doctor. You may be a bit hesitant to discuss your sex life with a doctor, but
rest assured. Your doctor has heard it all before and will know how to help
you.

Erectile dysfunction is fairly common in men with high blood pressure. One
study in the Journal of the American Geriatrics Society found that
nearly half of men aged 40 to 79 with high blood pressure had it.

Your doctor will need a lot of information from you before suggesting any
treatment. If this doctor had been involved in your care for high blood
pressure in the past, you can talk about how well you’ve been your
blood pressure and about how you are doing with the medications you’re taking.
If you are meeting with a new doctor, you will share all that, plus
information about other health problems you may have, like diabetes or high
.

Telling a doctor that you have difficulty with your erection is not the
easiest thing to do. But to get the right care you have to tell your doctor
everything, including the truth about things like drinking a lot of alcohol,
doing drugs, or smoking cigarettes. It’s in your best interest to be totally
honest.

You may also feel if the doctor asks a lot of questions about
your sex life and your emotions. You may be asked things like:

• What’s your sexual ?
• Do you have a steady partner? Multiple partners?
• How is sex with your partner? Has anything changed recently?
• Has anything upsetting happened to you lately?
• In general, are you under a lot of stress?
• Do you feel depressed a lot?

Again, it’s best to answer honestly, even though these things are very
personal.

A doctor you are seeing for the first time may also need to examine your
penis, testicles, and prostate gland. Some men have their testosterone level
tested.

There is another test that is done sometimes to see whether you get
erections while you are asleep. The doctor may send you home with a special
tape that you wrap around your penis before you go to bed. If the tape is
broken in the morning, you’ve had an erection during the night. That means the
cause of your erection problem may not be physical.

In many cases erectile dysfunction does have a physical cause.

The first treatment doctors usually try is one of the erectile dysfunction
pills: Cialis, Levitra, or Viagra.

Typically you will see the doctor again for follow-up around the time that
your runs out. You can talk then about any issues you may be
having with the medication. Maybe it’s not working as well as you’d like. If
not, you can make sure you’re using it correctly. The doctor might switch you
to a different drug or a different type of treatment if thing’s aren’t
improving.

It’s a good idea to stay in touch with your doctor about your erectile
dysfunction. Changes in your health over time may affect your treatment. But
you don’t need to be in the doctor’s office more often. Since you will already
have regular checkups for managing your blood pressure, bring up your erectile
dysfunction treatment at those visits.

Remember, there’s no such thing as a bad question. Your doctor asks you lots
of questions. Feel free to ask as many of your own, until you’re confident that
you understand all the risks and benefits of your treatment. Also, it’s
important to show your doctor all the other medications that you take. And, if
the doctor doesn’t know the answer to a question you ask, you can have them get
back to you with it.

If you ever feel like your concerns are being ignored, don’t accept it. Find
another doctor who will talk to you.

But most doctors genuinely want to work together with you to solve your
health problems. You can help them help you by taking an active role in your
care.

Nitroglycerin comes in a tablet or spray form, or as
a long-acting pill. The quick-acting pill or spray forms are used under the
tongue (sublingually). Your health professional will prescribe the right amount
for you; do not use another person’s nitroglycerin.

When do I use nitroglycerin under the tongue?

Your health professional will advise you when to use your
nitroglycerin. Generally, nitroglycerin under the tongue is used:

• To relieve sudden angina.
• Before
  stressful activities that can cause angina, such as walking uphill or having
  sexual intercourse.

How do I use nitroglycerin under the tongue?

• Sit or lie down to take your nitroglycerin.
  If you are driving, pull over and park the car. Taking nitroglycerin can lower
  your blood pressure, which sometimes may cause you to pass out, especially if
  you are standing up.
• For sudden episodes of angina, use
  nitroglycerin in a tablet or liquid spray form.
  • The tablet should be placed under your
    tongue and left until it dissolves. If you accidentally swallow the tablet,
    take another. The medicine won’t work if it is swallowed.
  • To use
    the spray, lift your tongue and depress the spray canister button once.
• Take one tablet or spray dose. If after 5
  minutes the chest pain is not better or gets worse, call 911 or other emergency
  services .
• After calling
  911 , continue to stay on the phone with the emergency
  operator; he or she will give you further instructions.
• Regardless
  of what happens, you should let your health professional know that you had an
  episode of angina. If this is unusual for you, your angina episodes are
  occurring more frequently or lasting longer, or you need more medicine to
  control them, tell your health professional. Report any change in your chest
  pain (unstable angina) to your health professional.

A fresh tablet should taste bitter and sting when you put it
under your tongue. If it does not, it probably is not effective and you should
take another.

Are there side effects or interactions with other drugs I should be aware of?

Normal, temporary side effects of nitroglycerin include a warm or
flushed feeling, headache, dizziness, or lightheadedness. You may also feel a
burning sensation under your tongue.

Do not take the erection-enhancing medicine sildenafil (Viagra),
vardenafil (Levitra), and tadalafil (Cialis) if you are taking nitroglycerin.
Combining nitroglycerin with any of these medicines can cause a
life-threatening drop in blood pressure. If you develop chest pain and have
taken one of these erection-enhancing medicines, be sure to tell your health
professional so that you are not given nitroglycerin or another nitrate
medicine.

Do not take the
pulmonary hypertension medication sildenafil (Revatio)
if you are taking nitroglycerin or another nitrate medication.

How should I store nitroglycerin?

Store nitroglycerin pills in a (such as brown),
airtight, glass container that you cannot see through. Keep nitroglycerin pills
and liquid spray away from heat or moisture. Remove the cotton stopper from the
bottle.

Can nitroglycerin get old and lose potency?

If nitroglycerin is old, the tablets may not work well. Get a new
as soon as possible if your supply is past the expiration date.
Usually you should replace your tablets every 3 to 6 months.

There are ways to tell whether your nitroglycerin is still
effective. You should have a headache when you use it. Or if you use
nitroglycerin under your tongue, you should feel a slight tingle or burn when
you place it there. If you do not notice these signs, your nitroglycerin is
probably old. In this case, contact your health professional to get a new
prescription. Fill the prescription as soon as possible, and discard your
out-of-date nitroglycerin.