Steroids (also known as corticosteroids) are medicines that may be used to treat some relapses in multiple sclerosis. A short course of high dose steroids can help speed up your recovery from a relapse. Methylprednisolone (Medrone or Solu-Medrone) is the steroid that is recommended for treating MS relapses. You take it as tablets, or it may be given in hospital by a drip (intravenous infusion).
Not all relapses need treatment with steroids. You may be offered them if the symptoms are having a big impact on your life.
Whether steroids are recommended or not should be decided by your MS team. Your GP may prescribe steroids after consulting with an MS health professional, such as your neurologist.
This page covers when steroids may be used to treat MS relapses, how they’re taken and possible side effects.
Steroids, or corticosteroids, are synthetic (man-made) versions of hormones that naturally occur in the body. These medicines are used in a range of conditions to reduce swelling (inflammation) and calm the immune system. The doses you take of steroid medicines are much higher than your body would usually produce.
Corticosteroids are not the same as anabolic steroids which are often associated with muscle building.
What are steroids used for in MS?
Steroids are used to treat some MS relapses. They can help improve the symptoms of your relapse more quickly and reduce the overall length of a relapse.
Research suggests that treatment with steroids can reduce the length of relapses by an average of 13 days.
However, you will reach the same level of recovery whether you have steroids or not. Recovery may just take a little longer without steroids. Taking steroids will not impact on the long-term course of your MS.
Methylprednisolone is the recommended steroid for treating MS relapses. This medicine suppresses your immune system and reduces inflammation in the areas where nerves are being attacked.
Methylprednisolone is a slightly stronger version of prednisolone (NHS.UK), another corticosteroid medicine.
When should a relapse be treated with steroids?
Not all relapses need treatment as, in most cases, the symptoms will gradually improve on their own.
Once your MS team has confirmed that you are having a relapse, they should discuss your symptoms with you and decide whether you need treatment for the relapse.
If your symptoms are mild and are not interfering too much with your everyday life, then you probably won’t be offered steroids. Your MS team may recommend treatments for individual symptoms instead.
If the symptoms of your relapse are significantly impacting your daily activities, work or independence, for example by affecting your eyesight or making walking difficult, your MS team 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 for you.
You may need to be monitored more closely while taking steroids if:
- you are diabetic (taking steroids can affect your sugar levels)
- you have a mental health condition
- you have a heart condition
- you are pregnant.
You should tell your doctor if any of the above apply to you.
Health professionals who are not specialists in MS may not realise that a high dose of steroids can be used to treat a relapse. Some MS services produce a card with details of the recommended treatment for a relapse that you can show other health professionals. Speak to your MS team to see if this is something they can provide.
Why haven't I been offered steroids?
Your MS team will check for signs of infection before prescribing steroids. This should include a test for a urinary tract infection (UTI). They will also check for infections such as respiratory infections.
They will not prescribe steroids if your symptoms are caused by an infection rather than a relapse. This is sometimes called a pseudo relapse. UTIs, colds and stomach bugs can all make MS symptoms worse. Once you’ve recovered or treated the infection, your symptoms should start to improve.
Checking for an infection is important because steroids can mask the signs of an infection and make infections worse.
Your MS team may also advise against steroids if the possible side effects outweigh the short-term benefits of treatment. This may be the case if your relapse symptoms are mild and not significantly impacting your life.
If you’ve already had high dose steroids three times in the past year, you would not usually be offered another treatment course. This is because frequent use of steroids can increase your risk of more serious side effects such as weakening bones (osteoporosis).
Steroids work best if you begin taking them as early as possible. It’s recommended that you begin taking steroids within 14 days of the start of your relapse.
Methylprednisolone can be taken as tablets or given into a vein by a drip (intravenous infusion). It’s usually given as tablets first.
Research comparing oral vs intravenous steroids has found that they are both equally effective and safe.
Gradually reducing the dose at the end of the treatment course (known as tapering) is not recommended for short courses of high dose steroids.
The recommended treatment course for oral methylprednisolone is:
- 500mg daily for five days.
It is 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. 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, such as omeprazole (NHS.UK), to protect the lining of your stomach. Methylprednisolone can also cause difficulties with sleeping so taking the pills in the morning will help to minimise this.
Intravenous methylprednisolone
Your MS team may recommend intravenous methylprednisolone if:
- a previous course of steroids tablets did not ease your relapse
- you experienced significant side effects from steroid tablets
- your current relapse is severe, and you need to be treated in hospital.
They may also be recommended if your MS team needs to monitor you more closely while you’re taking steroids because of another health condition (such as diabetes or a mental health condition).
The recommended treatment course for intravenous methylprednisolone is:
- 1g (1000mg) daily for three to five days.
Intravenous methylprednisolone is given in hospital. It is delivered through a vein in your arm using a drip. The infusion itself usually takes 30 minutes to an hour. Depending on the hospital, you may have an assessment by a doctor beforehand and a period of monitoring afterwards. You can expect the whole process to take about half a day. This can be done as a day patient (day case) where you come into the hospital each day for the infusion and then go home. Or you may be admitted as an inpatient and stay in hospital for the full treatment course.
How long does it take for steroids to work?
Steroids begin reducing inflammation soon after they’re taken, usually within a few hours. Some people start noticing improvements in their symptoms within a few days, however for others it can take longer.
When a relapse happens, it causes inflammation and damage to the covering of your nerves (myelin) in the brain and spinal cord. Taking steroids reduces this inflammation, but your body still needs time to try and repair the damaged myelin or work out how to reroute messages around it. This process of recovery from a relapse usually happens within the first two to three months.
Read more about what happens in a relapse.
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 before you start treatment.
Common side effects of methylprednisolone include:
- digestive problems, such as stomach pain, stomach upset, indigestion and stomach ulcers
- increased risk of infections
- high blood pressure (NHS.UK) (symptoms are headaches and generally feeling unwell)
- swelling, particularly in the lower legs, ankles and feet
- metallic taste in the mouth
- muscle cramps, spasms or weakness
- sleeping problems, including insomnia
- changes to your mood, such as mood swings, anxiety and depression
- flushing of the skin
- increased appetite
- changes in heart rate (irregular beating, or a very fast or slow pulse).
Difficulty getting to sleep or staying asleep for long enough (insomnia) is more frequently reported in people who’ve taken oral steroids than intravenous steroids.
Mental health problems affect around five in every 100 people taking methylprednisolone. A small number of people may experience quite severe changes in mood, from feeling very high (mania) to very low (depression or even suicidal thoughts). It’s important to make your family and friends aware that this may happen so they’re ready to support you if needed.
Cases of liver damage have been reported in between three and nine people in every 100 after intravenous methylprednisolone. Most people fully recover. Severe cases are rare.
Long-term or frequent treatment with steroids can lead to further potential side effects such as weight gain, acne, cataracts, thinning of the bones (osteoporosis), diabetes (raised blood sugar levels) 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 give you no more than three courses of steroids in one year.
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Burton JM, et al.
Oral versus intravenous steroids for treatment of relapses in multiple sclerosis.
Cochrane Database of Systematic Reviews 2012, CD006921.
Full article (link is external)
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 (link is external)
Sloka JS, et al.
The mechanism of action of methylprednisolone in the treatment of multiple sclerosis.
Multiple Sclerosis Journal 2005;11:425–432.
Summary (link is external)
National Institute for Health Care Excellence.
Managing a relapse (Clinical Knowledge Summaries).
London: NICE; 2024 [accessed online February 2026].
Full summary (link is external)
Lattanzi S, et al.
Oral and intravenous steroids for multiple sclerosis relapse: a systematic review and meta-analysis.
Journal of Neurology 2017;264(8):1697–1704.
Summary (link is external)
Liu S, et al.
Oral versus intravenous methylprednisolone for the treatment of multiple sclerosis relapses: A meta-analysis of randomized controlled trials.
PLoS ONE 2017;12(11): e0188644.
Full article (link is external)
Pietris J, et al.
The Efficacy, Adverse Effects and Economic Implications of Oral Versus Intravenous Methylprednisolone for the Treatment of Optic Neuritis: A Systematic Review.
Seminars in Ophthalmology 2024;39(1):6–16.
Summary (link is external)
Nociti V, et al.
Liver injury after pulsed methylprednisolone therapy in multiple sclerosis patients.
Brain and Behaviour 2018;8(6):e00968.
Full article (link is external)
Namaei P, et al.
Evaluation of liver injury in multiple sclerosis patients receiving pulsed steroid therapy.
Multiple Sclerosis and Related Disorders 2022;65:103968.
Summary (link is external)
This information has been developed by the MS Trust Health Information team. Our team produces accurate evidence-based information to help you navigate your every day – working alongside health professionals. We would like to thank Lesley Catterall, MS Specialist Nurse, Central and North West London NHS Foundation Trust, and Brina Bharkhada, Specialist Pharmacist in MS, University College London Hospitals NHS Foundation Trust, for checking the clinical accuracy of this information.
