Of course, if you’re not sure whether what you’re experiencing is a drug side effect or whether it’s considered “serious,” speak to your doctor or pharmacist. And if drug side effects are preventing you from using prescribed MS medications, let your healthcare team know. There may be alternatives to the drug you’re using or ways to reduce the side effects.
Injectable MS Medications
Injectable medications for multiple sclerosis — of which there are currently seven — can cause pain at the injection site, as well as skin redness and firm welts in the area. According to Jacqueline Nicholas, MD, MPH, a neuroimmunologist at OhioHealth Multiple Sclerosis Center in Columbus, Ohio, the following techniques can help prevent or reduce these reactions: Pretreat with ice or heat. Before injecting, Dr. Nicholas recommends applying ice to the skin to make the area cold or a heating pad to make it warm. The change in temperature seems to reduce the pain from the injection. Take a shower first. Nicholas tells her patients to take their injections right after showering. “When the skin is wet, it’s more porous, and many patients find it easier to inject then,” she says. Apply a witch-hazel pad. After an injection, Nicholas suggests applying a witch-hazel pad (often used for hemorrhoid relief) to the injection site. This helps to narrow the blood vessels in the skin, preventing the body’s release of histamine, a chemical that can cause pain and itchiness, Nicholas explains.
Oral MS Medication and Flushing
One oral MS disease-modifying therapy, Tecfidera (dimethyl fumarate), can cause flushing, or a feeling of warmth accompanied by redness. “Women often describe this feeling as being like a hot flash they would normally only experience during menopause,” says Nicholas. “They feel hot, and their skin looks red on their face and chest. It can tingle and even itch, and it typically lasts 10 to 15 minutes, but that can decrease over time while on treatment.” She notes that taking an aspirin before taking the medication can reduce the flushing, or in some cases prevent it completely. According to the prescribing information for Tecfidera, aspirin without enteric coating should be taken 30 minutes before taking Tecfidera. (Enteric coating is sometimes called “safety coating.”)
IV Infusions for MS and Rashes
MS drugs that are delivered intravenously have the potential to cause allergic reactions, resulting in a rash. This rarely occurs with Tysabri (natalizumab), but it occurs more commonly with a drug called Rituxan (rituximab) that is not specifically approved for MS but is sometimes used to treat it. To reduce redness and hives from such reactions, the antihistamine Benadryl (diphenhydramine) or steroids are given. Nicholas says slowing down the infusion can also help. Tysabri Normally, Tysabri is given over the course of an hour in a medical facility, after which a person must remain at the facility for an additional hour for observation, so that any serious allergic reactions can be treated promptly. The requirement to stay for observation may be lifted after a certain number of infusions with no allergic reaction. However, allergic reactions can occur more than two hours after the start of an infusion and can occur for the first time after a dozen uneventful infusions. Lemtrada Another infused MS disease-modifying drug, Lemtrada (alemtuzumab), can cause a rash that commonly appears as red patches on the chest and arms and may be itchy. “There is also a risk of an autoimmune attack against the platelets, called ITP, which could appear as a petechial rash,” says Nicholas. Signs of ITP, or immune thrombocytopenia, include small red, pink, or purple spots on the skin (petechiae); easy bruising; or bleeding that takes a long time to stop. You should report any of these signs promptly to a healthcare professional. Lemtrada has also been associated with rare cases of skin cancer. Nicholas recommends that people with MS receive skin screening from a dermatologist to look for suspicious moles before they begin treatment with Lemtrada, and that they get rescreened every year while they’re on it.
