Just as this condition 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 possible side effects 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.
Classes of Drugs
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 this condition makes your body constantly act as if it's fighting an infection. While no specific virus or bacteria 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.
This experimental drug was rejected by the FDA 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. Manufacturer Hemispherx Biopharma is continuing trials of other conditions, hoping to someday win approval.
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 this condition, doctors don't usually prescribe other antimicrobials for it, unless you have an active infection.
Just because antidepressants are a common treatment, it doesn't mean all the people taking them 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 most common types of of antidepressants prescribed 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.
A form of low blood pressure called neurally mediated hypotension (NMH) is common in people with ME/CFS. It's caused by an abnormal interaction between the heart and the brain, even though both organs are normal and healthy. Also called the fainting reflex, NMH can cause dizziness and fainting and is sometimes diagnosed by what's called a tilt table test.
Some people with diagnosed NMH take a low blood-pressure medication called Florinef (fludrocortisone), while others take the high blood-pressure medication Tenormin (atenolol). If you're on Tenormin, you'll probably need to be watched for low blood pressure and may be advised to increase your salt and water intake.
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