Self-administered DMDs
Side effects
Symptoms such as muscle aches, a mild fever and chills can occur in the first 48 hours after taking
the drug. These can be reduced by taking the drug at bedtime so that you sleep through the side effects,
or by taking a pain relieving drug such as ibuprofen or paracetamol 30 minutes before the injection
and for up to a day afterwards, as you feel you need it.
These symptoms can occur with Avonex®, Rebif®,
Betaferon® or Extavia®.
They are quite common, affecting about 50% of patients at the early stage of their treatment.
However, these symptoms usually pass within 3 to 6 months of starting treatment and ease after the
first few injections. They can be minimised by starting on a lower dose and increasing it gradually
- something which your specialist can advise on.
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| A typical skin site reaction, which fades over time |
Skin often reddens in the area where you inject the DMD, although this fades in time. The site
of the injection may also become painful or quite hard and lumpy in places after a few months. Very
rarely (in about 1-2% of patients), the injection site can become dark or discoloured and this needs
to be reported to a doctor immediately as it may indicate necrosis.
This can occur with: Rebif®, Betaferon®,
Extavia® or Copaxone®.
Mild reactions can occur in up to 50% of people who take these DMDs.
However, you can reduce the likelihood of injection site reactions by good injection techniques.
These include keeping the skin clean, regularly changing the injection site and making sure that
the drug is at room temperature before injecting.
Some people experience a condition at injection sites called lipoatrophy. This is a condition which
can occur with many injected drugs and even with acupuncture needles, where the fat beneath the skin
is lost in small areas. This results in small 'craters' or indentations in the skin, which can sometimes
be disfiguring and do not usually get better with time. It is not clear exactly why lipoatrophy occurs,
but it seems to be more common in women than in men.
This can occur with Copaxone®.
Some degree of lipoatrophy has been reported to occur in a significant minority of patients who take
this DMD over a prolonged period (Edgar 2004, Mancardi 2000).
However, the long term effects can be minimised by inspecting injection sites regularly, keeping them
healthy and avoiding further injections in sites which have been affected.
Sometimes the drugs can cause irregular bleeding, early or late periods. If this causes you concern,
you should ask for a referral to a gynaecologist
This can occur with: Avonex®, Rebif®, Betaferon®
or Extavia®.
These symptoms affect fewer than 1 in 100 patients treated.
Rarely, DMDs can cause such things as mild anaemia,
liver abnormalities and reduction in white blood cell count. In most cases these effects are very
mild and will only be detected through a blood test.
This can occur with: Avonex®, Rebif®, Betaferon®
or Extavia®.
Liver abnormalities are relatively common in people who take these DMDs, affecting about 50-70% of
patients. However, they are usually mild and settle down on their own, and only lead to the need to
stop treatment in around 1 in 200 people (Francis 2003).
Depression is relatively common in people with multiple sclerosis, and there has been some debate about whether interferon betas can make this worse. If you have been prone to mood changes before starting to take these drugs, discuss this with your MS nurse and/or neurologist. If you have had depression in the past, then interferon beta will not be prescribed. Glatiramer acetate may still be suitable for you.
Some DMDs can cause a flare up of MS symptoms or an increase in spasticity following injection which
dies down within 48 hours. In some cases, this may be because the drugs cause a mild fever, as many
patients with MS find that their symptoms increase in responses to a rise in their body temperature.
This can occur with: Avonex®, Rebif®, Betaferon®
or Extavia®.
It is rare, and usually lessens over time.
Some people can experience a post-injection reaction which takes the form of chest discomfort or
a tightness in the chest, shortness of breath, anxiety, flushing, sweating and palpitations immediately
or within a few hours of injecting. These symptoms don't usually cause any problems and pass quickly
(in 30 seconds or so), but in some cases they can last for as long as 30 minutes. There is no consistency
- they can occur at any time and not just after the first injection.
This can occur with: Copaxone®
