How NSAIDS Affect Multiple Sclerosis Fatigue

Fatigue can be a side effect of these medications

Ketoprofen (Orudis) 750 mg capsule. Credit: Photo Researchers / Getty Images

Fatigue is one of the most common and most disabling symptoms of multiple sclerosis (MS) and can be worsened by something that seems innocuous as the over-the-counter medications, including nonsteroidal anti-inflammatory drugs (NSAIDs).

Fatigue and Multiple Sclerosis

While much of the fatigue comes from the disease process itself or MS-related heat intolerance, there are many secondary causes of fatigue in MS.

One contributor could be some of the medications that you are taking to slow your MS or deal with specific symptoms. If you suffer from MS-related fatigue, it is important to investigate all possible causes, including side effects from some of your medications.

Use of NSAIDs in Multiple Sclerosis

Nonsteroidal anti-inflammatory drugs are probably the most commonly used class of drugs in the world. These drugs work by blocking certain enzymes, which produce prostaglandins, which are chemicals produced by the body that promote pain, inflammation and fever.

NSAIDs are widely available. They are preferred over other pain relief medications, because they do not tend to be addictive and, in most cases, do not produce the sedative effects that other pain medications do. People differ in their sensitivity to the NSAIDs, however, and some people may find that they contribute to their fatigue, especially at the higher doses.

Many people with MS take NSAIDs when they experience a new symptom, hoping that it will help. If you tend to do this, it is important to see your doctor before launching on a self-treatment regimen. Many MS symptoms do not respond to NSAIDs at all, as they are neuropathic (caused by damage to the nerves themselves) in origin and not caused by prostaglandins.

NSAIDs, though, are successfully and appropriately used by many people with MS to help counter the flu-like side effects of the interferon-based disease-modifying therapies (Avonex, Rebif and Betaseron), reduce swelling from Copaxone -related injection site reactions, counter side effects from other drugs or bring down fevers that tend to worsen MS symptoms or even lead to relapses. Also, let’s face it, most of us get headaches, from time to time, most of which respond to normal doses of NSAIDs.

The bottom line here is that it is okay to use NSAIDs if you have MS. Just make sure that they are really appropriate for the problem that you are trying to address and watch for any signs that they may be making your fatigue worse.

But Fatigue Isn’t Listed as a Side Effect 

Most of the medications listed below have “tiredness” or “drowsiness” as a potential side effect. Some list “dizziness” or “weakness.” Others also have side effects like “sweating,” “trembling,” “difficulty breathing,” “lightheadedness,” “flushing,” “confusion,” “nausea/vomiting” or “fainting spells.” For someone that does not have MS, many of these effects could just be a passing annoyance.

For those of us, however, who battle MS-related fatigue on a daily basis, any of the discomforts listed above may be enough to tip the balance between a good day and a bad day, fatigue wise.

List of Nonsteroidal Anti Inflammatory Drugs that May Contribute to Fatigue

Note to readers not is the U.S.: The list below includes brand names of drugs prescribed in the United States. For people in other countries, please refer to the generic name of the medication, which may be spelled differently depending on the country. Thanks for your understanding.

Ibuprofen (Motrin, Advil): Available as chewable tablets, oral suspension, tablets or capsules, it is also very commonly found as a “store brand” pain reliever.

Acetaminophen (Tylenol, Panadol, Feverall): Used to reduce fever and relieve pain, this is a common ingredient in many nonprescription medications that are designed to treat many symptoms, such as “cold and flu remedies.” It is also very commonly found as a “store brand” pain reliever. It is available as oral suspension or syrup, suppositories, tablets, caplets, chewable tablets or dissolving granules.

Fenoprofen (Nalfon): Often used to relieve mild to moderate pain, including arthritis pain and menstrual pain, it is available as a tablet or capsule.

Ketorolac (Toradol, Acular): Available as eye solution, injections or tablets, it is often used after eye surgery or for eye problems caused by seasonal allergies.

Naproxen (Aleve, Anaprox, Naprelan, Naprosyn): Anti-inflammatory drug available as oral suspension, tablets, caplets or delayed-release tablets.

Tolmetin (Tolectin): NSAID used in rheumatoid arthritis and juvenile arthritis, available as tablets and capsules.

Should You Stay Away from NSIADS

Just because it looks as if one of your medications may be contributing to your fatigue, it doesn’t necessarily mean that it is the end of the drug for you. Ask your doctor for help figuring this out. He or she may have some ideas about taking it at a different time of day or taking it with food. Maybe splitting the dose would reduce the side effects or maybe it comes in a different form, such as a time-released version, that may be better for you.

If none of these things seem like they will work, there may be all sorts of other things that the doctor can try, such as other medications or other types of therapy.

Think About Interactions Too: Maybe your medication wouldn’t cause fatigue if you didn’t take it at the same time as your other medications. Maybe it is not a good idea to wash it down with a margarita. Ask your doctor about these things.

Keep a Fatigue Log: When you are trying to pinpoint possible causes or contributors to your fatigue, it is important to keep a record of what you are experiencing, so that you can discuss it with your doctor. Make sure that you include your medications and when you took them.

But It’s Not a Pill: Even if your drug is not in tablet or injection form, it can still cause fatigue. Remember, patches, eye drops, nasal sprays and other methods of delivering medications are still getting the active ingredients in to your bloodstream in most cases.

Simply put, if it can help a symptom and have a positive effect, it can also have side effects.

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