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Prescription Medications
Nonsteroidal anti-inflammatory drugs: These drugs can be used to relieve pain in CFS patients. Some are available as over-the-counter medications.
Low-dose tricyclic antidepressants:
Tricyclic agents may be prescribed for CFS patients to improve sleep and to relieve mild, generalized pain. Examples include doxepin (Adapin, Sinequan), amitriptyline (Elavil, Etrafon, Limbitrol, Triavil), desipramine (Norpramin), and nortriptyline (Pamelor).
Other antidepressants:
Newer antidepressants have been used to treat depression in CFS patients, although non-depressed CFS patients receiving treatment with serotonin reuptake inhibitors have been found by some health care providers to benefit from this treatment as well or better than depressed patients. Examples of antidepressants used to treat patients with CFS include serotonin reuptake inhibitors, such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil); venlafaxine (Effexor); trazodone (Desyrel); and bupropion (Wellbutrin). A number of adverse reactions, varying with the specific drug, may be experienced, but include agitation, sleep disturbances, and increased fatigue.
Anxiolytic agents:
Anxiolytic agents may be used to treat symptoms of anxiety in CFS patients. Examples include alprazolam (Xanax) and lorazepam (Ativan). Clonazepam (Klonopin) is another member of this family of drugs that is used to control exaggerated nervous systems problems such as vertigo, burning or exaggerated tenderness in the skin, and "nervous" limb movements, may also be useful. However, they should not be used in the general treatment of CFS. Common adverse reactions include sedation, amnesia, and symptoms accompanying acute withdrawal (insomnia, abdominal and muscle cramps, vomiting, sweating, tremors, and convulsions).
Stimulants:
Fatigue by itself is not a good indication for symptomatic therapy. However, if the fatigue represents lethargy or daytime sleepiness, treatment may be indicated. Trials of a wakefulness agent, modofanil (Provigil), have been completed, but the results have not yet been published. In a small group of patients with excessive sleepiness, the drug decreased symptoms compared with placebo. This drug is currently indicated only with the diagnoses of narcolepsy and excess daytime sleepiness when identified by the proper sleep studies.
Antihypotensive/antitachycardia therapy:
CFS does not respond to treatment with antihypotensive or antitachycardic drugs and general use of such medications may be harmful. However, such medications may be useful in specific circumstances. For example, fludrocortisone (Florinef) has been prescribed for CFS patients who have had a positive tilt table test. However controlled studies have not found Florinef alone effective in the general treatment of CFS patients. Beta blockers such as atenolol (Tenormin) have also been prescribed for patients with orthostatic hypotension. Midodrine (Proamatine), an agent that directly increases blood pressure, may be useful in selected patients identified by an abnormal tilt test. Increased salt and water intake is also recommended for these patients but should be done only under supervision of a health care provider. Adverse reactions include elevated blood pressure and fluid retention.
Experimental Drugs and Treatments
Ampligen
Ampligen is a synthetic nucleic acid product that was designed to stimulate the production of interferons, a family of immune response modifiers that are also known to have antiviral activity. Although it may not directly induce interferon, reports of double-blinded, placebo-controlled studies of CFS patients documented modest improvements in cognition and performance among Ampligen recipients compared with the placebo group. These preliminary results will need to be confirmed by further study. The Food and Drug Administration (FDA) does not approve Ampligen for widespread use, and the administration of this drug in CFS patients should be considered experimental. Ampligen is not widely available, is costly, and is generally not reimbursable through insurance programs. Finally, although most recipients of Ampligen tolerated the drug well, adverse reactions, such as liver damage, were reported and are still incompletely characterized.
Gamma globulin
Gamma globulin is pooled human immune globulin and contains antibody molecules directed against a broad range of common infectious agents. Gamma globulin is ordinarily used as a means for passively immunizing persons whose immune system has been compromised, or who have been exposed to an agent that might cause more serious disease in the absence of immune globulin. Gamma globulin is not effective in the treatment of CFS. Serious adverse reactions are uncommon, although in rare instances gamma globulin may initiate anaphylactic shock.
Corticosteroids
Controlled studies of corticosteroids have been conducted because some patients with CFS had a slight decrease in urinary cortisol levels. Some benefits were noted in patients treated with low dose hydrocortisone but the effects disappeared after one month. High dose replacement therapy had some benefit but was complicated by attendant adrenal suppression.
Kutapressin
Kutapressin is a crude extract from pig's liver. It is not readily available and there is no scientific evidence that it has any value in the treatment of CFS patients. Kutapressin can elicit allergic reactions.
Neurosurgery
Unpublished reports of malformations at the base of the skull (Chiari malformations) as being causative of CFS have been circulated, and surgical intervention has been suggested in some of those unsubstantiated reports. Surgical intervention is not recommended at this time.
While prescription drugs may offer some relief from the symptoms associated with CFS, potential side effects are often more problematic than the illness itself.
Potential Dangers Associated with Prescription Drug Therapy
NSAIDs causes 10,000-20,000 Deaths a Year
A person taking NSAIDS is seven times more likely to be hospitalized for gastrointestinal adverse effects. The FDA estimates that 200,000 cases of gastric bleeding occur annually and that this leads to 10,000 to 20,000 deaths each year.5
Studies also show that neither drug (Celebrex ) alleviated pain any better than the older medicines. And the drugs cost close to $3 a pill; over-the-counter pain relievers, in contrast, cost pennies a dose.
Benzodiazepines (Tranquilizers) Medications
- Xanax, Klonopin, Ativan, Restoril, Busbar, Tranxene, Serax, Librium, Tegretol, Valium, Trileptal, Seraquel, Risperdal, and Symbax.
Side effects associated with these medications include:
sleep disturbances (poor sleep), seizures, neuropsychiatric disturbances (mania, depression, suicide, etc.) tinnitus (ringing in the ears), transient memory loss (amnesia), dizziness, agitation (anxiety), disorientation, hypo-tension (low blood pressure), nausea, edema (fluid retention), ataxia (muscular in-coordination), tremors, sexual dysfunction (decreased desire and performance), asthenia (weakness), somnolence (prolonged drowsiness or a trance-like condition that may continue for a number of days), and headaches. The big problem with these medications is that they are loaded with side-effects that cause further health problems (depression, fatigue, memory loss, “fibro fog’” etc.) yet don’t promote deep, restorative sleep.
Stimulants - Adderall, Concerta, Cylert, Etc
Stimulants such as Adderall (amphetamine), Concerta (methylphenidate), Cylert (pemoline), Dexedrine (dextroamphetamine sulfate), Focalin (dexmethylphenidate HCL), Metadate (methylphenidate), and Ritalin (methylphenidate) are use to increase adrenalin. They can be very helpful in increasing a person’s energy. But you may remember the saying “speed kills.” With the exception of Provigil, these medications are nothing more than various forms of amphetamines (“speed”). These drugs are incredibly hard on the adrenal glands. Long-term use can cause adrenal fatigue or burnout at least and full blown Addison’s Disease (adrenal failure) at worst.
Potential Side effects include:
insomnia (big problem), Tourette’s syndrome (movement disorder consisting of grimaces, ticks, and involuntary outbursts), nervousness, unstable mood (anxiety, mania, depression, irritability, aggression, etc) tachycardia (rapid heartbeat), hypertension (high blood pressure), tics (abnormal muscle movements), psychosis (abnormal behavior), headaches, seizures, visual disturbances, anorexia (unwanted weight loss), aplastic anemia (arrested development of bone marrow), liver dysfunction, and blood dyscrasias (disease).
Antidepressants - Prozac, Zoloft, Celexa, Paxil, Etc.
Selective Serotonin Re-Uptake Inhibitors (SSRIs). SSRIs work by increasing the brain’s use of the neurotransmitter serotonin. Serotonin deficiency is linked to depression, lowered pain tolerance, poor sleep, and mental fatigue. All SSRIs are partially or wholly broken down in the liver. This can create liver dysfunction in some patients, so patients with a sluggish liver should be cautious in taking these medications. Examples of SSRIs include Zoloft (sertraline), Paxil (paroxetine HCL), Celexa (citalopram), Prozac (fluoxetine), Luvox (fluvoxamine), etc.
Common side effects include:
headache, muscle pain, chest pain, anxiety, nervousness, sleeplessness, drowsiness, weakness, changes in sex drive, tremors, dry mouth, irritated stomach, loss of appetite, dizziness, nausea, rash, itching, weight gain, diarrhea, impotence, hair loss, dry skin, chest pain, bronchitis, abnormal heart beat, twitching, anemia, low blood sugar, and low thyroid.
Tricyclic Antidepressants - Elavil, Pamelor, Doxepin, Etc
Tricyclic antidepressants block the re-uptake of the hormones serotonin and norepinephrine. This produces a sedative effect. They also reduce the effects of the hormone acetylcholine. Like other antidepressant medications, these drugs are processed by the liver and can cause liver toxicity. Common side effects include sedation, confusion, blurred vision, muscle spasms or tremors, dry mouth, convulsions, constipation, difficulty in urinating, and sensitivity to light. Examples of tricyclic antidepressants include Pamelor (nortriptyline) and Elavil (amitriptyline).
Integrative Medicine
Integrating natural therapies with a judicious amount of prescription drugs (only when natural fail) is the best approach. An integrative approach that combines the judicious use of prescription drugs and nutritional therapy offers the best chance of reducing the symptoms associated with CFS.
Learn more about the integrative medicine therapy and our all-natural supplements, click here.
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