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DRUGS & CONDITIONS

MULTIPLE SCLEROSIS

Multiple sclerosis, or MS, is a disease that affects the body’s central nervous system. The central nervous system is made up of the brain and spinal cord. With MS, the body’s immune system attacks the nervous system and destroys myelin.

Myelin is a fatty substance that coats and protects the nerves so impulses (messages) can travel down them. Myelin can be compared to the insulation on electrical wires. Over time, the actual nerves can also become damaged. 

Damaged areas of myelin and nerves are called lesions. Damage can also lead to permanent areas of scar tissue called plaques. The name “multiple sclerosis” refers to “multiple” meaning many, and “sclerosis” meaning “scars.”

Lesions and plaques can disrupt the flow of nerve impulses. This means messages sent from the brain and spinal cord to other body parts may be slowed down or blocked. Most MS symptoms are due to slow or blocked nerve impulses. 

It’s estimated that 2.5 million people worldwide have MS. Most people with MS are diagnosed between the ages of 15 and 50. It can also affect children and older people. Women are affected more than men.

 


TDD users please call toll-free at 1-800-863-5488.

This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty. 106-33707a   022715

DRUGS & CONDITIONS

MS FLARES

A multiple sclerosis (MS) flare―also called an exacerbation, attack, or relapse―is when a person’s MS symptoms suddenly get worse or they have new symptoms that last for a day or more. 

MS experts and neurologists (doctors who specialize in nervous system disorders) think flares happen as new lesions form or get bigger. They may be mild symptoms or severe, affecting a person’s daily routine. Most flares last from several days to weeks. But some people will have flares that last for months. 

When a person has recovered and the symptoms of a flare are gone, it’s called “being in remission.” But this doesn’t always mean a person’s MS is under control. Patients may not experience symptoms during remission although damage is taking place. Neurologists must check the nervous system for lesions and damage during this time.

 


TDD users please call toll-free at 1-800-863-5488.

This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty. 106-33707a   022715

DRUGS & CONDITIONS

PSEUDO-FLARES

A pseudo-flare (pseudoexacerbation) is a temporary worsening of MS symptoms without damage or inflammation to the myelin. A pseudo-flare can be caused by:

  • Infection (urinary tract infections are the most common type of infection)
  • Rise in body temperature
    • Using a hot tub or sauna
    • Exercise
    • Visiting a warm climate
  • Depression
  • Exhaustion
  • Stress


A neurologist can determine if symptoms are actually caused by new damage or are a pseudo-flare.

 


TDD users please call toll-free at 1-800-863-5488.

This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty. 106-33707a   022715

DRUGS & CONDITIONS

TYPES OF MS

Multiple sclerosis (MS) symptoms and how the condition progresses can vary greatly from person to person. This makes it hard for doctors to predict how MS will affect someone. But medical experts have divided MS into groups to help doctors choose the right treatment.

  • Relapsing-Remitting MS starts with a first flare that’s usually but not always followed by a period of full or almost-full remission. Weeks, months or years may go by before the next flare, followed again by a period of remission. This is the most common type of MS 
  • Primary-Progressive MS is when a person’s symptoms slowly get worse over time without periods of remission. But a person may have short-term or minor symptom relief. This type of MS usually begins after age 40 and affects men and women equally
  • Secondary-Progressive MS starts with MS that acts like relapsing-remitting then later acts like primary-progressive MS. This means that a person who once had flares followed by periods of improved symptoms (remission) starts to slowly get worse without true periods of remission
  • Progressive-Relapsing MS is the least common type of MS. MS of this type will steadily get worse from the very beginning. Symptoms flare with this type of MS, but people may or may not have periods of remission


Other, less-common types include:

  • Benign MS is when people have little or no change in disease after 15 years
  • Fulminate MS (also known as malignant MS, or Marburg MS) is when people experience rapid disease progression with severe relapses within 5 years of being diagnosed
  • Burned-out MS describes people whose MS symptoms slow down greatly as the person ages

 


TDD users please call toll-free at 1-800-863-5488.

This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty. 106-33707a   022715

DRUGS & CONDITIONS

SIGNS AND SYMPTOMS

Each person’s multiple sclerosis (MS) symptoms can vary depending on the amount of damage, which nerves are affected and other factors. Symptoms may include:

  • Anxiety
  • Balance problems
  • Bladder issues like urgency or loss of bladder control
  • Bowel problems
  • Depression
  • Dizziness or vertigo
  • Fatigue
  • Mobility and walking issues
  • Numbness
  • Sleep issues
  • Pain
  • Pseudobulbar affect (inappropriate and uncontrollable laughter or crying) 
  • Sexual problems
  • Spasticity (muscle stiffness)
  • Speech difficulties
  • Swallowing problems
  • Tingling
  • Tremor (shaking)
  • Vision problems like blurry of double vision
  • Weakness


Most people have mild symptoms and live a productive, full life. But left untreated, MS can cause severe disability (for example, paralysis and blindness).

 


TDD users please call toll-free at 1-800-863-5488.

This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty. 106-33707a   022715

DRUGS & CONDITIONS

CAUSES AND RISK FACTORS

The exact cause of multiple sclerosis (MS) is unknown. Most experts think MS is an autoimmune disease, in which the body’s own immune system attacks and damages the nervous system. It’s unclear why some people’s immune systems attack, but certain factors may increase the risk, including:

  • Age: MS affects all age groups, but most people start having symptoms between the ages of 15 and 50
  • Sex: Women are more likely to develop MS than men
  • Genetics: You are at higher risk if one of your parents or siblings has MS
  • Certain infections: Some viruses have been linked to MS, including the virus that causes an infection called mononucleosis (Epstein-Barr virus)
  • Race: Caucasian (White, non-Hispanic) people, especially those who come from Northern Europe, are at higher risk. Asians, Africans, and Native Americans have the lowest risk
  • Climate: People living in temperate (not too cold or too hot) areas have a higher risk than those living in hotter areas near the equator or in very cold areas near the north and south poles
  • Low Vitamin D: Some experts think low levels of vitamin D in the body and/or less exposure to sunlight (see “Climate” bullet point) may increase the risk
  • Smoking: Studies have shown women who smoke are more likely to develop MS than women who don’t. Also, both men and women with MS who smoke have more flares and decline faster than non-smokers

 


TDD users please call toll-free at 1-800-863-5488.

This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty. 106-33707a   022715

DRUGS & CONDITIONS

DIAGNOSIS

There isn’t one test to diagnose multiple sclerosis (MS). Doctors must use many tests to rule out other conditions with similar symptoms and confirm an MS diagnosis. A doctor will ask for a person’s complete medical history and give them a physical exam. Depending on those results, a doctor may order: 

  • Blood tests to rule out infections or other conditions
  • Neurological history and tests to see how well your nervous system is working
  • Lumbar puncture or spinal tap to also help rule out infections and other conditions. A small sample of fluid from the spinal canal is removed and studied for substances that are linked with MS
  • Magnetic resonance imaging (MRI) scans to look for lesions on the brain and spinal cord

 


TDD users please call toll-free at 1-800-863-5488.

This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty. 106-33707a   022715

DRUGS & CONDITIONS

MS TREATMENT PLAN

MS is a lifelong condition that has no cure. But there are:

  • Medicines called disease-modifying therapies (DMTs) that help slow the progress of some forms of MS
  • Treatments to relieve flares. For example, steroids like prednisone or methylprednisolone
  • Physical therapy and medicine to manage certain symptoms like fatigue, depression, pain, spasticity, and bladder or bowel control


People can also help preserve their health now and later with an MS treatment plan. People should work with their neurologist and other providers, including their CareTeam pharmacists and nurses to create, start and follow a treatment plan. Think of it as a game plan to preserve the health of the nervous system and, in turn, quality of life.

The treatment plan priority for most people with relapsing types of MS is a DMT. Together, the DMT and MS treatment plan can help:

  • Slow or modify disease activity
  • Treat flares
  • Manage symptoms
  • Preserve physical function, mobility and safetY
  • Address emotional health and well-being 

 


TDD users please call toll-free at 1-800-863-5488.

This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty. 106-33707a   022715

DRUGS & CONDITIONS

DISEASE-MODIFYING THERAPIES

Medicines called disease-modifying therapies (DMTs) help slow the progress of some forms of multiple sclerosis (MS). DMTs can also reduce the number and severity of flares. Starting treatment early and staying on treatment long-term are both important factors in keeping MS from progressing. Without treatment, about half of people with relapsing-remitting MS progress to the more severe type, secondary-progressive MS, in 10 years. So far, no treatments can keep primary-progressive MS from getting worse. 

Everyone responds to medicine differently. Doctors choose the most appropriate treatment based on the type of MS, possible side effects, and the risks/benefits of each therapy. Currently available DMTs (as of January 2015) are listed in the table below.
 

Name**

How given

Selected, possible side effects

Selected additional information

Interferons (interferon beta-1a and interferon beta-1b)

SC injection or self-injection (shot)

Flu-like symptoms
Headache
Pain at injection site
Depression
Liver damage

  • Blood tests to check liver function are needed

  • Used with caution in people with depression

Glatiramer acetate

SC injection or self-injection (shot)

Hive or pain at injection site
Shortness of breath
Chest pain
Flushing

  • Side effects usually happen right after injection and disappear within 15 minutes

Fingolimod

Orally

Nausea, vomiting
Edema (swelling) behind the eye
Liver changes
Increased risk of blood cancer
Heart disease or damage

  • First approved oral DMT

  • Blood pressure and heart monitoring are needed

  • Blood work to check liver and white blood cell counts are needed

  • Vision tests are needed

Teriflunomide

Orally

Headache
Hair loss
Increased liver enzymes
Increased risk of infections
High blood pressure

  • Risk of severe liver damage

  • Harmful when used in pregnancy

  • Side effects happen more often at the start of therapy and subside after 1 or 2 months

Dimethyl fumarate

Orally

Nausea
Diarrhea
Lowered white blood cell count
Rash
Flushing

  • Side effects happen more often at the start of therapy and subside after 1 or 2 months

  • Tests to check blood cell counts are needed

Mitoxantrone

IV infusion

Nausea
Vomiting
Increased risk of blood cancer
Heart disease or damage

  • Must be given at a medical facility every 3 months

  • Reserved for people who fail other treatments or those people who have severe, advanced MS

  • Can only be given safely for 2 to 3 years

Natalizumab

IV infusion

Increased risk of viral infection of the brain, PML
Headache
Fatigue
Allergic reaction
Hypersensitivity reaction

  • Must be given at a registered infusion facility

  • Only for people who fail other treatments or those people who have more severe or active MS

  • Requires monitoring through manufacturer safety/support program

Alemtuzumab

IV infusion

Infusion-related reactions
Increased risk of infections
Emergent autoimmune diseases

  • Approved as second-line therapy for people who fail or don’t tolerate other DMT

  • Only available through REMS safety program

DMTs=disease-modifying therapies; SC=subcutaneously or under the skin; IV=intravenously or in the vein; MS=multiple sclerosis; Orally=by mouth or swallowed; PML=progressive multifocal leukoencephalopathy; REMS=Risk Evaluation and Mitigation Strategy
*Everyone responds to medicines differently. Doctors will choose the most appropriate treatment based on the type of MS, possible side effects, and the risks/benefits of each therapy. Available DMTs as of January 2015 are listed.
**Generic or chemical name only
 

Side Effects

All DMTs may cause side effects. Some may even cause more serious side effects, including depression. Doctors may do tests to check for certain serious side effects. And people who take higher-risk DMTs are monitored closely through manufacturer safety and support programs. 

Most minor side effects will lessen with continued use. Until then, over-the-counter medicines, like acetaminophen, may ease flu-like symptoms and headaches. Proper rest and staying hydrated may also help. Fatigue is another common side effect of DMTs like beta interferons. People should rest often and try to plan their day and tasks around when they have the most energy. Neurologists or CareTeam pharmacists and nurses can provide advice on relieving side effects and overcoming treatment challenges. 

Some people―especially people in remission or with mild MS symptoms―may worry that a DMT will make them feel worse, not better. With MS, their long-term health is at stake. And the choices made today may help people to live a full life in the years to come. DMTs should be started early and only stopped or changed if a doctor decides the side effects are too severe, it’s not working or a better option is available. 

 


TDD users please call toll-free at 1-800-863-5488.

This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty. 106-33707a   022715

DRUGS & CONDITIONS

FLARES AND PSEUDO-FLARES

During a flare, the nerves become inflamed. Steroids (also called corticosteroids) are prescribed to reduce this inflammation. Examples of steroids are prednisone and methylprednisolone. 

Steroids are taken for a short time to help with flare symptoms only. They are not taken on a long-term basis nor do they help treat the long-term outcomes of multiple sclerosis (MS). Side effects of steroids may include changes in mood, water retention, increase in blood pressure and poor sleep.

Disease-modifying therapies (DMTs) don’t cure your MS. People may still have pseudo-flares even if they take their medicine faithfully. If a person has too many flares or if their neurologist sees too many new lesions, he or she may want to change the treatment. If you have MS, see your neurologist and CareTeam if you are having new or worsening symptoms or a pseudo-flare that lasts more than a few days. Don’t stop your DMT because you don’t feel that it’s working. Make and keep all MRI and provider appointments to stay ahead of your health, too.

Try to prevent pseudo-flares by avoiding factors that cause them. For example: 

  • Many people’s MS symptoms get worse as the body temperature rises. Avoiding hot areas, hot tubs, and saunas and using devices like cooling scarves or vests can be helpful.
  • Stress can trigger and worsen MS symptoms. Yoga, massage, meditation, support groups, seeing a counselor and staying connected to friends and family may help.
  • Infections and illnesses are also culprits. A healthy diet and the right amount of exercise and rest can help keep the body in tip-top shape to help fight infections. Getting a yearly flu-shot and other vaccines, avoiding large crowds during cold and flu season and practicing good handwashing habits can help too.

 


TDD users please call toll-free at 1-800-863-5488.

This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty. 106-33707a   022715

DRUGS & CONDITIONS

SYMPTOMS

Multiple sclerosis (MS) can cause a variety of symptoms that can interfere with daily activities. It’s important for patients to talk to their doctor about any new or worsening symptoms. And they should see their neurologist if symptoms are severe or last more than a few days. If the severe symptoms are a flare, doctors may prescribe steroids. Treatment options are available for milder symptoms. For example:

  • Depression: Depression is a common symptom of MS. Depression can also be a side effect of some medicines including steroids or some disease-modifying therapies (DMTs). Depression can make other MS symptoms such as pain and fatigue worse. Antidepressant medicines such as selective serotonin reuptake inhibitors (SSRIs) can often help with depression. And counseling and support groups are helpful, especially when combined with an SSRI or other antidepressant.
  • Fatigue: Fatigue caused by MS and DMTs can be managed with medicines, physical therapy, sleep therapy, stress management and support groups.
  • Muscle Weakness: Medicines called muscle relaxants are used to treat muscle stiffness or spasms. Muscle stiffness and spasms are common MS symptoms. 
  • Pain: Patients with MS may experience different pain varieties. Some treatment options include medicines, heat therapy, massage and physical therapy.
  • Problems with Balance, Strength, and Walking: A physical therapist or occupational therapist work with people to make daily activities and tasks easier. Tools like canes, walkers, scooters and wheelchairs also help with mobility.
  • Problems with Bladder: Urinary frequency, urgency, and/or loss of bladder control may occur. A urologist (doctor who specializes in bladder problems) can help with these symptoms, including prescribing medicine.
  • Problems with Constipation: Constipation is another common MS symptom. High-fiber diets, laxatives or other medicines can help.

 


TDD users please call toll-free at 1-800-863-5488.

This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty. 106-33707a   022715

DRUGS & CONDITIONS

LIFESTYLE CHANGES

Dealing with multiple sclerosis (MS) can disrupt a person and their loved ones’ lives. But most people should try to keep up their usual daily activities. Healthy lifestyle changes can help prevent flares and relieve symptoms so people can keep their quality of life. For example: 

  • Rest. Fatigue is one of the most common MS symptoms and is a side effect of some disease-modifying therapies (DMTs) like beta interferons. People should rest often and try to plan their day and tasks around when they have the most energy.

  • Exercise. Exercise can help improve muscle strength, balance and coordination, which all can be affected by MS. Swimming and water exercises are good options for heat-sensitive people. Yoga, walking and biking are also good options.

  • Staying cool. Some MS symptoms get worse as the body temperature rises. Avoiding hot areas and using devices like cooling scarves or vests can be helpful.

  • Eating a balanced diet. Eating healthy is smart for everyone, including people with MS. A healthy diet can help keep the immune system strong. Some studies suggest a diet low in saturated fat but high in omega-3 fatty acids found in olive and fish oils may be helpful.

  • Managing stress. Stress can trigger and worsen MS symptoms. Yoga, massage, meditation, support groups, seeing a counselor and staying connected to friends and family may help.

  • Quit smoking. People who smoke have a higher risk of developing MS later in life. Smoking can also worsen the progression of MS.

 


TDD users please call toll-free at 1-800-863-5488.

This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty. 106-33707a   022715

DRUGS & CONDITIONS

STAYING ON TRACK

It can be hard to remember when and how to take your disease-modifying therapies (DMTs) or medicine to treat multiple sclerosis (MS) symptoms. But DMTs can only help slow the progress of your MS if taken exactly as prescribed. And most people can lead a fuller life by managing bothersome symptoms. People should never change or stop medicines without talking to their doctor. Following these tips can help people stay on track for best outcomes.

  • Take medicines as part of a daily routine
    • It’s best to take medicines the same time(s) each day or week. For example, when eating breakfast or setting an alarm before bed
  • Use medicine reminders
    • Doctor may order MRIs, blood work or other tests to check for response to treatment. Write down and keep all doctor, MRI and blood work visits. Skipping could affect treatment goals
    • Set a standing alarm on the cell phone. Use the CVS Specialty mobile app―anyone can download and use it free from Google® Play or Apple® iTunes stores
    • Post a sticky note where it can be seen easily. For example, on the bathroom mirror or refrigerator
    • Schedule tasks or appointments on the computer
    • Use a pill box or make a check-off chart
  • Make and keep doctor and blood work appointments
    • Doctor may order MRIs, blood work or other tests to check for response to treatment. Write down and keep all doctor, MRI and blood work visits. Skipping could affect treatment goals
  • Join a support group
    • Join an in-person or online support group. Talking to others living with MS may help you cope with treatment and everyday challenges
  • Work with the entire health care team
    • Work closely with doctors, pharmacists, nurses, and laboratory and other providers. Stay in touch and don’t be afraid to ask questions. Doctors and our CareTeam clinicians can give advice on relieving side effects, missed doses, creating an easy-to-follow medicine schedule and more
  • Go online
    • Create a secure, online specialty prescription profile to manage your MS treatment anywhere, anytime. Just visit our homepage and register in a few easy steps.

 


TDD users please call toll-free at 1-800-863-5488.

This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty. 106-33707a   022715

DRUGS & CONDITIONS

CAREGIVER TIPS

Multiple sclerosis (MS) not only affects the person who has the disease, it also affects family and friends. Living with MS can be overwhelming and disruptive to you and your loved ones’ lives. Caregivers need to stay on top of their physical and emotional health, too. The following tips may help. 

  • Good health tips include:
    • Exercise
    • Eat a healthy diet
    • Get enough rest
    • Keep regular doctor and dental visits
  • Open, honest communication is a key to success.
  • Surround yourself with a support network. Never be afraid to ask for help. Many people can offer support, including:
    • Family and friends
    • Neurologists and other doctors
    • Physical therapists and occupational therapists
    • Counselors
    • Self-help groups (some are even available on the Internet)
    • Religious and spiritual communities
    • CVS/specialty pharmacists and nurses

 


TDD users please call toll-free at 1-800-863-5488.

This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty. 106-33707a   022715

DRUGS & CONDITIONS

COMMON QUESTIONS

We know living with multiple sclerosis (MS) requires extra care. With CVS Specialty™ Pharmacy, you can count on the support of your own CVS Specialty MS CareTeam, led by clinicians who are specially trained in MS. They help you manage your MS and stay on track with your treatment—so you can focus more on living your life. Whether it’s about side effects, how to take your medicines, or ideas on how to stay healthy, they’re always ready to help.

Learn about MS to take more charge of your health. To help you get started, we’ve listed some common questions other MS patients have asked us. Didn’t find your answers here? Call your MS CareTeam at 1-800-237-2767—anytime—to learn more.
 

Click on a question below to jump to the answer.
 

What are the symptoms of multiple sclerosis (MS)?

What is a multiple sclerosis (MS) flare?

Is there a cure for multiple sclerosis (MS)?

How do I know that my disease modifying therapy (DMT) is working?

How long will it take before my disease modifying therapy (DMT) starts working?

Why should I take a disease modifying therapy (DMT) if I don’t have multiple sclerosis (MS) symptoms?

If I have a flare, does that mean my disease modifying therapy (DMT) isn’t working?

Will I have to give myself injections for the rest of my life?

What is progressive multifocal leukoencephalopathy?

What are signs of progressive multifocal leukoencephalopathy (PML)?

Why am I feeling depressed? Can depression be a side effect of my medicine?

Why am I having a hard time swallowing?

Why do I feel like my tongue is burning?

Can Tecfidera® (dimethyl fumarate) cause my skin to become red and warm?

Can multiple sclerosis (MS) cause hearing loss?

Why do I feel body vibrations or tremors?

What can I do to improve my walking and moving problems?

Has anyone had a bad experience with the artificial sweetener, aspartame?

Are bladder and bowel problems symptoms of multiple sclerosis (MS)?

I have an electric shock feeling that spreads through my back. What is this?

Can multiple sclerosis (MS) cause intense burning in my feet at night?

How can I overcome or “fight through” needle fatigue?

Where can I find out information about multiple sclerosis (MS) and treatments?


What are the symptoms of multiple sclerosis (MS)?

Your MS symptoms may be different than another person’s. And your symptoms may change over time. Each person’s MS symptoms vary depending on the amount of damage, which nerves are affected and other factors. But some more common symptoms include:

  • Fatigue
  • Numbness or tingling
  • Vision changes
  • Tremor
  • Having a hard time moving and walking
  • Having trouble focusing and remembering

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What is a multiple sclerosis (MS) flare?

An MS flare―also called an exacerbation, attack or relapse―is when a person’s MS symptoms suddenly get worse or they have new symptoms that last for a day or more.

Neurologists (doctors who specialize in nervous system disorders) think flares happen as new lesions form or get bigger. They may be mild symptoms or severe, affecting a person’s daily routine. Most flares last from several days to weeks. But some people will have flares that last for months.

Talk to your doctor about any new or worsening symptoms. And visit your neurologist if symptoms are severe or last more than a few days. In the case of severe flare symptoms, your neurologist may prescribe medicines called steroids to help decrease inflammation, symptoms and length.

When a person has recovered and the symptoms of a flare are gone, it’s called “being in remission.” But this doesn’t always mean a person’s MS is under control. Patients may not experience symptoms during remission but damage can still be taking place. Neurologists check the nervous system for lesions and damage on a regular basis to see how the MS is progressing.

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Is there a cure for multiple sclerosis (MS)?

There’s no cure for MS. However, a group of medicines called disease modifying therapies—or DMTs—help slow the progress of some forms of MS. DMTs help decrease the number of flares and help to slow lesions from forming.

Other medicines may be used to relieve MS flares. For example, steroids like prednisone or methylprednisolone. Physical therapy and medicine are both used to manage certain symptoms like fatigue, depression, pain, spasticity, and bladder or bowel control.

Scientists are researching MS to better understand the condition. And they’re studying to see if other medicines can help treat MS.

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How do I know that my disease modifying therapy (DMT) is working?

DMTs are meant to slow the progress of multiple sclerosis (MS) and limit damage to your nervous system, but you may not feel them working. You can still have flares while on DMTs, but the number and severity should decrease. Your neurologist should be able to see the effect of DMTs with magnetic resonance imaging (MRI) scans and other tests.

If you are having frequent or severe flares, talk to your neurologist. Your neurologist may check for new lesions. The results can help decide the best treatment for you.

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How long will it take before my disease modifying therapy (DMT) starts working?

The effect of DMTs can vary from one person to another, but typically DMTs can take several months to fully begin working in your body. It’s possible you may have symptoms when you first start on your DMT. Your neurologist may wait for your DMT to fully take effect before deciding if it’s the best treatment for your multiple sclerosis.

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Why should I take a disease modifying therapy (DMT) if I don’t have multiple sclerosis (MS) symptoms?

Your MS could be causing serious and maybe, permanent damage even before you have symptoms. Starting your DMT as early as possible can help slow future damage by decreasing:

  • The number and severity of flares
  • Lower the number of lesions seen on an MRI
  • The degree of disability

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If I have a flare, does that mean my disease modifying therapy (DMT) isn’t working?

DMTs don’t cure multiple sclerosis (MS). You can still have MS symptoms and flares even if you take your medicine exactly as your doctor told you. However, DMTs help decrease the number and severity of MS flares and they can slow or prevent new lesions from forming.

If you have frequent or severe flares, your neurologist may want to change your treatment. Always talk to your neurologist and MS CareTeam if you are having new or worsening symptoms. Most flares resolve over time, but visit your neurologist if your symptoms are severe or last more than a few days. Your doctor may prescribe a steroid or other medicine to relieve flare symptoms.

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Will I have to give myself injections for the rest of my life?

It depends on many factors. Disease modifying therapies (DMTs) are given by injection (shot), orally (by mouth) and intravenous infusion (into the vein). After reviewing your medical history, you and your neurologist will decide what treatment is best for you.

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What is progressive multifocal leukoencephalopathy?

Progressive multifocal leukoencephalopathy—or PML—is a rare but serious infection that affects the brain. PML is caused by the John Cunningham (JC) virus. The virus is harmless in most people but it can cause PML in people with weakened immune systems. Some reported cases have linked PML to certain DMTs to treat MS, which include: Tysabri® (natalizumab), Gilenya® (fingolimod) and Tecfidera® (dimethyl fumarate).

Talk to your doctor about your risk for PML.

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What are signs of progressive multifocal leukoencephalopathy (PML)?

Symptoms of PML may include:

  • Weakness on one side of the body
  • Problems with eyesight, strength, balance, thinking
  • Having trouble using arms and legs

Some PML symptoms are similar to multiple sclerosis (MS) symptoms. That said, patients taking Tysabri® (natalizumab), Gilenya® (fingolimod) or Tecfidera® (dimethyl fumarate) who experience these symptoms should not ignore them and should contact their neurologist right away. Patients should not stop taking their MS medicine without first talking with their neurologist.

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Why am I feeling depressed? Can depression be a side effect of my medicine?

Depression is a common symptom of MS and a side effect of some disease modifying therapies (DMTs) like beta-interferons (including Avonex®, Rebif®, Plegridy® and Betaseron®). Don’t ignore changes in your mood. Talk openly about them and other depression symptoms with your neurologist. Medicines called anti-depressants can help with both depression and anxiety. Sharing your feelings with others living with MS, family and friends can also help.

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Why am I having a hard time swallowing?

Swallowing problems—or dysphagia—can be a symptom of multiple sclerosis (MS). It happens more often in advanced MS, but it can happen at any stage. A speech pathologist may be able to help with exercises to improve swallowing so talk to your neurologist right away.

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Why do I feel like my tongue is burning?

Nerve symptoms like nerve pain, numbness, tingling and burning feelings are common side effects of multiple sclerosis (MS). Your MS could be causing the burning sensation in your tongue. Contact your neurologist. He or she may prescribe a medicine to help with nerve symptoms. Some examples include gabapentin or amitriptyline.

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Can Tecfidera® (dimethyl fumarate) cause my skin to become red and warm?

When your skin feels warm, red or itchy is called flushing. And flushing is a common side effect of Tecfidera. According to the manufacturer, about 4 out of 10 patients in clinical trials had flushing when using Tecfidera. It happens more at the start of therapy but gets better over time. Patients can reduce flushing by:

  • Taking Tecfidera with food
  • Taking non-enteric coated aspirin about 30 minutes before taking Tecfidera. Do not take aspirin before checking with your neurologist first. Aspirin is not safe for everyone.

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Can multiple sclerosis (MS) cause hearing loss?

Hearing loss is a symptom of MS, but it’s not a very common symptom. About 1 out of 16 MS patients notice changes in their hearing. And it’s very rare for hearing loss to be their first MS symptom.

Your hearing loss may be from MS or another cause. So, if you are having hearing loss, talk to your neurologist. He or she may suggest you see an audiologist. Audiologists are health care providers who help assess and treat hearing loss.

 

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Why do I feel body vibrations or tremors?

Body tremors and feeling shaky can be multiple sclerosis (MS) symptoms. Having tremors can affect your confidence and how you feel about yourself. Your neurologist may prescribe medicine to help relieve some of these symptoms. They can include hydroxyzine, propranolol, clonazepam or other treatments. Talk to your neurologist to about these symptoms.

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What can I do to improve my walking and moving problems?

Many people have trouble walking and moving because of multiple sclerosis (MS). That’s because of common MS symptoms like muscle weakness or tightness, balance problems, fatigue, or feeling numb in legs and feet. Walking and moving problems can affect your daily life. And you’re at greater risk of falling down and injuring yourself. The good news is you can help prevent falls and improve your quality of life with these tips:

  • Try exercise and physical therapy to gain muscle strength
  • Use right assistive devices like canes or walkers
  • Ask your neurologist about the medicine, Ampyra® (dalfampridine) which may improve walking

Talk to your neurologist to find the right treatment plan for your walking and moving problems.

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Has anyone had a bad experience with the artificial sweetener, aspartame?

According to the U.S. Food and Drug Administration (FDA), aspartame is considered safe for the general population. A common myth is that aspartame can cause multiple sclerosis (MS). But at this time and based on studies done so far, scientists have not found a link between aspartame and MS.

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Are bladder and bowel problems symptoms of multiple sclerosis (MS)?

Yes. Bladder and bowel problems are common MS symptoms. About 8 out of 10 people have bladder problems like getting up often at night to urinate or having trouble holding their urine. And bowel problems like constipation or loss of bowel control are common.

Diet, exercise and over-the-counter medicine can help with these problems. There are several prescription medicines that may help, too. Talk to your neurologist to find the best treatment for your symptoms.

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I have an electric shock feeling that spreads through my back. What is this?

It may be a type of pain called Lhermitte’s sign that’s caused by multiple sclerosis (MS). Lhermitte’s sign is a brief, stabbing, electric shock-like sensation that runs from the back of the head then down the spine. It’s brought on by bending the neck forward. Medicine that treats nerve pain, like gabapentin, may help with this condition. Your neurologist can determine if your pain is Lhermitte’s sign and help treat it.

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Can multiple sclerosis (MS) cause intense burning in my feet at night?

Yes, MS can cause burning, aching or “girdling” in areas of your body. This is called dysesthesias. Dysesthesias usually affect your legs and feet. But it may also affect your arms and trunk. Dysesthesias may feel like your stomach or chest area is being squeezed tightly. That’s why this condition is also called the "MS Hug.” This feeling can be very uncomfortable. And it may even be painful. Dysesthesias aren’t usually dangerous. But if the pain is severe enough, it can interfere with a person's activities. Medicine for nerve symptoms, like gabapentin or amitriptyline, may help. Talk to your neurologist to learn more.

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How can I overcome or “fight through” needle fatigue?

Needle fatigue is common in patients with multiple sclerosis (MS) who inject their medicine on a regular basis. It means you may feel too tired, sore or unmotivated to inject yourself. So it can be hard staying on your MS regimen. Follow these tips to help overcome needle fatigue:

  • Rotate injection sites as instructed by your neurologist
  • Put ice to numb the area before injecting
  • Talk to your neurologist about:
    • Taking an over-the-counter pain reliever about 30 minutes prior to your injection
    • Taking an oral disease modifying therapy (DMT) instead
    • Change to a DMT you don’t have to inject as often

It may also help to:

  • Create a schedule that works with your daily life
  • Make a comfortable space in which to inject
  • Play your favorite music while you inject
  • Reach out to others, like family and friends for support
  • Join an online social network to connect with other people living with MS like MyMSTeam. You can sign up for free at www.MyMSTeam.com/CVS

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Where can I find out information about multiple sclerosis (MS) and treatments?

Visit these websites to learn about MS treatment, tips for managing daily life, help for caregivers and links to other news.

National Multiple Sclerosis Society
www.nationalmssociety.org

Multiple Sclerosis Association of America
www.msassociation.org

Multiple Sclerosis Foundation
www.msfocus.org

The Myelin Project
www.myelin.org

MS Association of America
www.mymsaa.org

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TDD users please call toll-free at 1-800-863-5488.

This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers that are not affiliated with CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2016 CVS Specialty. All rights reserved. 75-38753A 071416

DRUGS & CONDITIONS

SUPPORT

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Contact your CVS Specialty Care Team toll-free at 1-800-237-2767, if you have questions or concerns about your health or treatment. A pharmacist, nurse, or counselor is ready to help.

Resources

Learning about MS gives people more tools to manage their health and live better. Visit these websites to learn about MS medication, tips for managing daily life, help for caregivers and links to other MS news.

MS Association of America
www.mymsaa.org

Multiple Sclerosis Foundation
www.msfocus.org

National Multiple Sclerosis Society
www.nationalmssociety.org

The Myelin Project
http://www.myelin.org

 


TDD users please call toll-free at 1-800-863-5488.

This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about the information you find. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content.

CVS Specialty does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Specialty.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

©2015 CVS Specialty. All rights reserved. This document contains confidential and proprietary information of CVS Specialty and cannot be reproduced, distributed or printed without written permission from CVS Specialty. 106-33707a   022715