from Medscape Neurology & Neurosurgery
For a patient with multiple sclerosis (MS) and symptomatic palpitations (premature atrial contractions [PACs], premature ventricular contractions [PVCs]) due to mitral valve prolapse, are beta-blockers generally safe?
David Spilker, MD
from Mark S. Freedman, MD, 08/26/2002
There are no medications known to exacerbate MS disease processes, with the exception perhaps of the new anti-tumor necrosis factor (TNF) drugs used for inflammatory bowel disease and rheumatoid arthritis (eg, infliximab). Of these, only lenercept (a recombinant TNF receptor p55 immunoglobulin fusion protein (sTNFR-IgG p55) has been shown to induce relapses in a phase 2 study in MS. Although it is unlikely that patients who have MS would be treated with these agents, it is possible to have both diseases concurrently and therefore caution needs to be exercised when choosing disease-modifying agents for one condition that might adversely affect a concomitant condition.
However, medications can lead to an exacerbation of MS symptoms. For example, for a patient with MS who is already having some symptoms of frequency and urgency of the bladder, prescribing a diuretic to control blood pressure might well lead to bladder incontinence. In the case of beta-blockers, if there was an element of borderline male sexual dysfunction, these agents could possibly exacerbate this problem. Many medications will affect fatigue. Virtually all of the pain drugs, many of the antidepressants, and some of the bladder and spasticity agents could aggravate an underlying fatigue state. Few agents will make spasticity worse; however, at times overzealous treatment of spasticity in certain patients can lead to weakness. Such patients usually depend on their spasticity for some degree of ambulation.
TNF neutralization in MS: results of a randomized, placebo-controlled multicenter study. The Lenercept Multiple Sclerosis Study Group and The University of British Columbia MS/MRI Analysis Group. Neurology. 1999;53:457-465.
About the Panel Members
Mark Freedman, MD, Professor of Neurology, University of Ottawa, Canada, and Director, Multiple Sclerosis Clinic, Ottawa Hospital, Canada.
Medscape Neurology & Neurosurgery 4(2), 2002.
© 2002 Medscape