Other names: methylprednisolone, Medrone, Solu-Medrone

Steroids (also known as corticosteroids) may be used to treat relapses in multiple sclerosis. Methylprednisolone is the steroid most often prescribed.

Not all relapses need treatment as, in most cases, the symptoms will gradually improve on their own. If the symptoms of your relapse are causing significant problems, such as affecting your eyesight or making walking difficult, your MS team or GP may suggest that you have a short course of high dose steroids. They should explain the benefits and potential side effects of taking steroids so that you can decide together on the best course of action in your particular situation.

Steroids can help the symptoms of your relapse improve more quickly. However, taking steroids will not have any impact on your ultimate level of recovery from a relapse or the long-term course of your MS.

Methylprednisolone can be taken as tablets or by intravenous infusion (drip). The recommended treatment courses are:

  • tablets: methylprednisolone 500mg daily for 5 days
  • intravenous infusion (drip): methylprednisolone 1000mg daily for 3–5 days

The side effects of methylprednisolone are usually mild and will go away quickly when you finish the treatment course.  The most common side effects include a metallic taste, indigestion, difficulty sleeping, mood swings or altered mood and flushing of the face.

What are steroids used for in MS?

Steroids (also known as corticosteroids) may be used to treat a relapse in MS. Methylprednisolone is the recommended steroid.

Steroids can help the symptoms of your relapse improve more quickly. However, taking steroids will not have any impact on your ultimate level of recovery from a relapse or the long-term course of your MS.

Steroids work best if you begin taking them as soon as possible after the start of your relapse. The NICE MS Guideline recommends that you begin taking steroids within 14 days of the start of your relapse.

Who can take steroids?

Once your MS team or GP has confirmed that you are having a relapse, they should discuss your symptoms with you and decide whether you need treatment for the relapse itself or for the symptoms you are experiencing.

Each relapse is different and in most cases your symptoms will gradually improve on their own so you may not need to take steroids. But if the symptoms of your relapse are causing significant problems, such as affecting your eyesight or making walking difficult, your MS team or GP may suggest a short course of high dose steroids. Your MS team or GP should explain the benefits and potential side effects of taking steroids so that you can decide together on the best course of action in your particular situation.

Before starting steroids, it is important that your MS team or GP check for signs of an infection, which should include a test for a urinary tract infection. If you are unwell, for example if you have a cold, a bladder infection or a stomach bug, you will often find that your MS symptoms get worse. Once you have recovered from the cold or treated the infection, your symptoms should start to improve. Checking for an infection is also important because steroids can make infections worse.

You should also tell your doctor if you are diabetic (taking steroids can affect your sugar levels) or if there is a chance you may be pregnant.

How do I take steroids?

The NICE MS Guideline recommended treatment course for methylprednisolone is:

  • tablets: methylprednisolone 500mg daily for 5 days

Methylprednisolone is usually supplied as tablets containing 100mg of the medicine. You will need to take five tablets a day for five days in a row. You need to take all five tablets at one time in the morning with food and they should not be taken as individual tablets throughout the day.

Methylprednisolone can irritate the lining of your stomach and cause side effects like heartburn or indigestion. Taking the pills with food can help to reduce this. You may be prescribed other medicines to protect the lining of your stomach (this is often omeprazole or ranitidine). Methylprednisolone can also cause difficulties with sleeping so taking the pills in the morning will help to minimise this.

If a previous course of steroid tablets did not ease your relapse or caused you significant side effects, or if your current relapse is severe and you need to be treated in hospital, your MS team may recommend you take methylprednisolone by intravenous infusion:

  • intravenous infusion (drip): methylprednisolone 1g daily for 3-5 days

The NICE MS Guideline also recommends that steroids should be started as early as possible and within 14 days of the onset of relapse symptoms.

Health professionals who are not specialists in MS, including some GPs and A&E staff, may not realise that a high dose of steroids is needed to treat a relapse. If you are unable to contact your MS team, you may need to bring this to the attention of any health professional who offers you steroid treatment. Some MS services produce a card with details of the recommended treatment for a relapse that you can show other health professionals.

What side effects could I get with steroids?

Not everyone experiences side effects when taking steroids but some people do. In the short-term, the side effects of steroids are usually mild and will go away soon after you finish the treatment course. However, steroids can make some people feel quite unwell, so you should always make sure you discuss the benefits and potential side effects of taking steroids with your MS team or GP before you start a course of treatment.

Potential side effects include:

  • a metallic taste
  • indigestion, stomach pain, stomach upset
  • difficulty sleeping, insomnia
  • altered mood or mood swings, restlessness, mild euphoria, anxiety
  • flushing of the face
  • increased appetite
  • headache
  • palpitations (a faster than normal heart rate)
  • chest pain
  • rash
  • swelling of the ankles

A few people may experience quite severe changes in mood, from feeling very high (mania) to very low (depression or even suicidal). It is important to warn your family and friends that this may happen as this will help them to support you.

Long-term treatment with steroids can lead to further potential side effects such as weight gain, acne, cataracts, osteoporosis (thinning of the bones), diabetes and deterioration of the head of the thigh bone (known as avascular necrosis of the hip) and should be avoided.

To prevent the effects of long-term treatment, many MS teams will therefore give you no more than three courses of steroids in one year.

How do steroids work?

Steroids suppress the immune system and reduce inflammation around the site of nerve damage.

Steroids research

The first steroid to be used for treating MS relapses was adrenocorticotrophic hormone (ACTH), derived from a naturally occurring hormone. Since the 1980s it has been replaced by synthetic steroids such as methylprednisolone.

Many studies have shown that steroids are effective at speeding up recovery from relapses.

A recent review compared the effectiveness and safety of oral and intravenous steroid treatments for people with MS. The review found that both treatments appeared to be equally effective and safe. A more recent French study has confirmed this finding.

References

  • National Institute for Health and Care Excellence (NICE). Multiple sclerosis: management of multiple sclerosis in primary and secondary care. [CG186]. London: NICE; 2014. Full guideline
  • Burton JM, et al. Oral versus intravenous steroids for treatment of relapses in multiple sclerosis. Cochrane Database of Systematic Reviews 2012, CD006921. Full article
  • Filippini G, et al. Corticosteroids or ACTH for acute exacerbations in multiple sclerosis. Cochrane Database of Systematic Reviews 2000;CD001331. Full article
  • Le Page E, et al. Oral versus intravenous high-dose methylprednisolone for treatment of relapses in patients with multiple sclerosis (COPOUSEP): a randomised, controlled, double-blind, non-inferiority trial. Lancet 2015;386(9997):974-81. Summary
  • Sloka JS, et al. The mechanism of action of methylprednisolone in the treatment of multiple sclerosis. Multiple Sclerosis Journal 2005;11:425-432. Summary
  • Miller H, et al. Multiple sclerosis: treatment of acute exacerbations with corticotrophin (ACTH). Lancet 1961; 2: 1120–1122. Summary

Last updated: 6 July 2016
This page will be reviewed within three years