Intramuscular vs Subcutaneous injection? *Decision time*

[stoshooo]

Ok today is decision day for my medication. I have been leaning toward Avonex, Rebif, or Copaxone. The question isn't about which med, but rather which is better - intermuscular or subcutaneous injections?? Anyone wanna throw their personal experience out there, I would love love love to hear it. I think tomorrow is the day we will decide and proceed.

From what I can tell - Avonex is intramuscular, once a week - and intramuscular allows the medication to enter the bloodstream more rapidly/immediately. And perhaps because of this, the immediate response is more acute. I also hear it hurts more?

The other two are every day or every three days, under the skin...

Who prefers what?? How do I make this decision... I never thought I'd be asking what kind of shot I should give myself... ha!

[Cat Mom]

I was on Rebif for almost 2 years when first dx. It didn't work for me and the side effects made me feel worse than the MS did. Switched to COpaxone in Aug 2007, had 2 steroid worthy flares, Jan/08 and Jan/09 and none since.

Needless to say, the daily shot is a small trade-off. No blood tests for liver enzymes, no flu like symptoms. It took a wee while to adjust to the site reaction but found a good routine based on others' experiences, mostly here on this message board.

Hope this helped.
Jen

[Bob698]

Well, first things first..

- Welcome to The Needle Club.
It isn't that bad and you'll get used to it faster than you might think. In truth, the 4 injectable meds (not counting Ty, its a bit of a different animal) are very similar in many ways with some minor differences. Meaning, pick one and give it a fair chance, see how it works out. If the one you picked just isn't working after, say, eight months you can always try another.


- Keep the big picture in view.
The DMD's don't make you feel better. That isn't what they were designed to do. The DMD's do just one thing but that thing can be huge if it slows down progression. Let your MRI machine and your Doc decide if your DMD is effective.


-Know what you're getting into.
Shot scheduals can be funny. I do my shot every other day and you'd think it would be easy to figure out which day is a shot day and which one isn't. Get a small Daily Planner and plan your shot days and site rotations. It pays to have something to look at.
Above all else, the time to do your shot is the time when you do your shot. Don't get into a habit of multitasking when you're supposed to be shoving a needle into yourself. That's the prime way to wind up with things like site reactions and infections. Set up your shot time so its the ONLY thing you're doing, come up with a shot ritual (ie, ALWAYS wash your hands as Step 1) and stick to it.

Understand that it "might" take time to build up a tolerance to your med. Look into how these meds work so you'll be ready to deal with it if it happens. Getting your tolerance up might be a piece of cake or a pain in the rear, some of us got whalloped for a while, some of us don't. There's no way to predict what your reaction will be like.

- Do your homework.

There are many threads and posts here about all of the DMD's, their ups and their downs. Keep in mind that all of our experiences are different but definatly use our experiences to your benefit.

All of the DMD's have toll-free help lines. Use them once you choose a med. Definatly use them if you think something's wrong.

If you have any specific questions, feel free to ask.

[lstrl]

I can only comment on the Avonex because that's all I've taken, but I'm a huge needle phobe with a low pain tolerance and I can say it's not that bad. I've only had 2 injections so far, but both times I felt a prick as the needle went in and then it burned when I actually pushed the medication into my body, but that was it. I had no lingering pain and the initial stick wasn't even that painful.

Have you ever had a flu shot? Taking Avonex should be similar to that or whenever you get a tetanus booster. I find that, after having a flu shot though, my arm is sore for a few days. Taking the Avonex in the thigh doesn't cause any kind of muscle soreness for me though.

Good luck with whatever you decide. I hope it works great for you.

[MarkLavelle]

I've only done Copaxone, but if my neuro had given me a choice(*) I might have tried Avonex first. I like the idea of only once a week, and I have a pretty good record of not getting many side effects of drugs. If side effects did become a quality of life issue, Copaxone would definitely have been #2. Knowing what flu shots feel like, I don't think the intramuscular aspect would be an issue for me at all.

OTOH, I'm totally fine with Copaxone. After more than a year, it's just what I do after my shower every day. I hardly ever think about it except then...

*: My neuro said the interferons were not for me. My immune system is already 'compromised' from past chemotherapy & radiation, and he feels that suppressing it further could raise my cancer risk.

[Alicious]

FWIW, I've done Copaxone and Rebif (subcutaneous) and Avonex (intramuscular) and Avonex actually hurt a whole lot less than the other two. Actually, Avonex felt like nothing most of the time, whereas that was rare for Rebif and never for Copaxone.

That being said, Copaxone is the safest, so I wish it worked for me.

[MSer102]

I think maybe the first question should be interferon or not interferon. If you pick not interferon then the other question automatically gets answered.

The interferons have more overall side effects than Copaxone does. So if you want the fewest overall side effects then Copaxone is better and Copaxone only comes subcutaneous. So if you pick Copaxone there isn't any other question left. But if you pick Copaxone you'll have to put up with the injection site reactions.

Its only if you pick an interferon that you have to choose intramuscular or subcutaneous.

You have it backwards about Avonex. Intramuscular means that the medicine is released and absorbed more SLOWLY - not more rapidly - and that's why you only have to take it once a week. It gets released and absorbed through the whole week.

The subcutaneous medicines are the ones that are released and absorbed more RAPIDLY so they have to be replenished more often with shots every day or every couple of days.

I've been on Avonex and Rebif and Copaxone. Avonex injections were practically painless and there weren't any injection site reactions because the medication isn't deposited near the skin. Rebif and Copaxone sting like crazy and can cause some really unpleasant injection site reactions like burning and itching and rashes and welts as well as pain. On Rebif I had a big area of dead skin that took months to clear up.

If want the least pain the least often you might be happiest with Avonex. (I was.) You'll have to get through the interferon flu-like side effects for a few weeks until you get used to it. If you don't want flu-like side effects you might be happiest with Copaxone. You'll have to see how bad your injection site reactions and injection pain are.

Maybe you've seen that there are auto-injectors for the medications. There wasn't one for Avonex when I was on it but I tried them for Rebif and Copaxone. A lot of people find that their injection site reactions are much worse with the autoinjectors and better with manual injection because manual injection gives you control of how fast and deep you inject. And its much easier to just inject manually. Way too much trial and error and having to change the injection setting depending on where your injecting.

[stoshooo]

You have it backwards about Avonex. Intramuscular means that the medicine is released and absorbed more SLOWLY - not more rapidly - and that's why you only have to take it once a week. It gets released and absorbed through the whole week.

ahhhh thank you, that makes way more sense! Well, it sounds to me like the actual shot - is just something you get used to - that is the trend I am hearing here... Therefore, I think my first choice is going to be Copaxone - given the description of side-effects, which sound like something I can deal with. Stay tuned...my neurologist is going to put in paperwork this afternoon - wish me luck!!

[TLC_31]

I chose Avonex almost nine years ago, in large part because I’d have to deal with it only once a week. The longer needle looks more intimidating, and it’s also thicker (normally a 23-gauge needle for Avonex prefilled syringes compared to 29-gauge needles for the subcutaneous injections). However, I’ve never found it to be as painful as it looks. The cat scratching me for whatever reason can be more painful.

I question the assertion in this thread that “interferons have more overall side effects than Copaxone does.” They all have side effects, albeit different, and the intensity of side effects can vary greatly from one person to another. Some feel no effects, others ultimately have to stop the medication. There are ways to mitigate the common “flu-like” side effects of interferons (although those ways aren’t fool-proof for everyone), and I presume there are tricks to dealing with the side effects of Copaxone.

I’m also curious to see some documentation for the assertion that “Copaxone is the safest.” All three drugs mentioned by the original poster have similar long-term safety profiles and efficacy rates, and I would be comfortable using any of them.

[Alicious]

Much luck to you!

[Bob698]

To the O.P., please make sure you understand the concept of "risk vs. reward".
Think of anything you can imagine. The chances are pretty good that someone somewhere will have a bad reaction to it. The odds may be tiny but someone will have a bad time.

I've read other posters here in the past who would not consider a given med based on a very small chance they could have a bad reaction. While the chance may exist, the odds of a bad reaction could be very small.

This is what I meant by doing your homework.
You may want to ask your Dr. or their staff before you make a final deccision. It seems that many Neuro's tend to "punt" when it comes to discussing these meds, but try to pin them down. Ask them that if they had your symtoms, what which med would they consider?

[andi b]

Interesting how different neuros have different opinions on interferons. I have been on Avonex for about 2 years and 3 months; had breast cancer 12 years ago with chemo. Nothing was ever mentioned about my having a compromised immune system from the chemo. I've done just fine on it, for what it's worth.

*: My neuro said the interferons were not for me. My immune system is already 'compromised' from past chemotherapy & radiation, and he feels that suppressing it further could raise my cancer risk.

[Westgrl]

Interesting how different neuros have different opinions on interferons. I have been on Avonex for about 2 years and 3 months; had breast cancer 12 years ago with chemo. Nothing was ever mentioned about my having a compromised immune system from the chemo. I've done just fine on it, for what it's worth.

I agree. When I asked my doctor if these meds, and I am on Avonex, were an immune suppressor, he said no. They are an immune modifier. I have been on Avonex for a year now & have found no change in my ability to get sick so I tend to believe him.

Yet, another patient will have a doctor telling them it does suppress the immune system. Sometimes I wonder just how much knowledge these doctors have on these medications.