While doctors prescribe a lot of different medications as chronic fatigue syndrome treatments, none of them is FDA-approved for the condition. A New Drug Application, however, has been filed for the antiviral/immune regulator Ampligen.
Just as chronic fatigue syndrome (CFS or ME/CFS) affects everyone differently, so do the medications used to treat it. It's essential that you work closely with your doctor to find what's right for you. You should be familiar with the side effects of the drugs you're taking, and let your doctor know about any you may develop. If you're on more than one medication (prescription or over-the-counter), let your doctor and pharmacist know so you can avoid negative interactions. About.com's Drugs A-Z is always available for you to quickly look up side effects and interactions.
ME/CFS researchers are hopeful that their current work establishing patient subgroups will help lead to more effective treatments and less trial-and-error drug therapy.
Classes of Drugs Used as Chronic Fatigue Syndrome Treatments
Several categories of drugs are used to treat ME/CFS. They include:
- Antimicrobial drugs (includes antiviral, antibiotic)
- Antidepressants (SSRIs/SNRIs and tricyclic)
- Anxiety or anxiolytic agents
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Blood-pressure medications
- Experimental treatments
Because all of these medications are used for off-label purposes (meaning they're not FDA approved specifically for ME/CFS), your insurance company may not cover them.
"Antimicrobial" refers to a variety of drug types, including antivirals, antibiotics, antifungals and antiprotozoals. Researchers say the bodies of many people with ME/CFS constantly act as if they're fighting viral infection. While no specific virus has been linked conclusively to ME/CFS, some research supports the possibility of the Epstein-Barr virus (which causes mononucleosis), human herpes virus 6 (HHV-6, which causes roseola) and enteroviruses.
- Ampligen (poly I: poly C12U)
This experimental drug is awaiting FDA approval for ME/CFS, and is not yet on the market for any use. Ampligen works by jump-starting your body's natural anti-viral pathway and regulating levels of Rnase L (a substance in your cells that attacks viruses), which can be high in people with ME/CFS.
Studies show Ampligen is more effective and has far fewer side effects than other drugs in its class. Philadelphia drug manufacturer Hemispherx Biopharma is hoping evidence from Phase III trials will be strong enough to convince the FDA to approve it.
- Valcyte (valganciclovir)
The antiviral valganciclovir treats HHV-6, which multiple studies have found in a significant percentage of people with ME/CFS. Small studies have had encouraging results, but experts agree that larger and better designed studies need to be done before they can draw reliable conclusions.
Because researchers haven't identified a particular infection that leads to ME/CFS, doctors don't usually prescribe other antimicrobials for it, unless you have an active infection.
Just because some people with ME/CFS take antidepressants, it doesn't mean that they are depressed or have any kind of psychological condition. (While many people with the condition are clinically depressed, it's generally considered a result of the symptoms and change in lifestyle and not a cause of the illness itself.) The two types of antidepressants commonly used for treating ME/CFS are SSRI/SNRIs and tricyclic agents.
The reason antidepressants work is because they raise levels of important neurotransmitters that are low in some people with ME/CFS. These drugs are called selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs or NSRIs). Serotonin helps process pain signals and is also important to your sleep-wake cycle, while norepinephrine (a type of adrenaline) is involved in the stress response and bursts of energy.
Examples of SSRIs and SNRIs are:
- Cymbalta (duloxetine)
- Prozac (vluoxetine)
- Zoloft (sertraline)
- Paxil (paroxetine)
- Effexor (venlafaxine)
- Desyrel (trazodone)
- Wellbutrin (bupropion)
Low doses of tricyclic agents sometimes improve sleep and relieve mild, widespread pain in people with ME/CFS. Some examples are:
- Adapin, Sinequan (doxepin)
- Elavil, Etrafon, Libitrol, Triavil (amitriptyline)
- Norpramin (desipramine)
- Pamelor (nortriptyline)
Be sure you're familiar with the side effects of any antidepressants you're taking, especially since many antidepressants come with a warning of heightened risk of suicidal thoughts and behaviors. If you decide to stop taking any of these drugs, talk to your doctor about how to properly wean off of them. Stopping cold-turkey can lead to some potentially serious problems.
Doctors sometimes prescribe anti-anxiety drugs for those ME/CFS patients with panic disorder. They include:
- Xanax (alprazolam)
- Klonopin (clonazepam)
- Ativan (lorazepam)
Common side effects of anxiety drugs include sedation, amnesia, insomnia, muscle cramps and convulsions. Stopping them also can lead to withdrawal symptoms.
These drugs sometimes are used to relieve the pain and fever associated with ME/CFS. Several are available over-the-counter, including:
- Advil, Bayer Select, Motrin Nuprin (ibuprofen)
- Aleve, Anaprox, Naprosen (naproxen)
- Feldene (piroxicam)
Your doctor may also prescribe other types of NSAIDs, and it's important not to combine different drugs in this class. That can put you at greater risk of developing dangerous side effects, including kidney damage and gastrointestinal bleeding.
- On Page 2: Blood-Pressure Medication, Experimental Treatments