Medications

Treatment of Neurally Mediated Hypotension

Treating NMH may be appropriate in the subgroup of CFS patients with this condition. In one study, 76% of patients diagnosed with and specifically treated for neurally mediated hypotension (NMH) experienced improvement within a month, and in 40% of these patients, chronic fatigue symptoms completely or nearly completely resolved. It should be stressed that increasing blood pressure can be very dangerous in individuals with existing normal or high blood pressure. No one should take measures to raise blood pressure without a clear diagnosis of NMH or without a doctor's approval.

Life Style Changes. For treating NHM, the doctor might first recommend non-medicinal measures:

• Increasing salt content in the diet may be warranted in patients with demonstrated low blood pressure.
• Caffeinated beverages may be helpful.
• Before getting out of bed, perform exercises that flex the feet so that the blood moves up toward the head.
• Avoid excessive activity after meals.
• Special support garments may help to prevent circulating blood from pooling in the lower part of the body and to return it to the heart.

Medications. If NMH does not improve with lifestyle measures, certain medications may be tried in combination or alone. A wide range of drugs normally used for other disorders have been used to treat NMH, but doctors have had difficulty adjusting them so that they would be effective for NMH without causing distressing side effects. Such medications include:

• Drugs that narrow blood vessels
• NSAIDs
• Anti-arrhythmic drugs (such as disopyramide)
• Beta-blockers (such as propranolol)
• Stimulants (such as methylphenidate)

Other Drugs Being Investigated for CFS

Galantamine. Galantamine (Razadyne) is a cholinesterase inhibitor used to treat Alzheimer’s disease. A multicenter placebo-controlled trial of 434 patients with CFS tested various doses of galantamine during a 16-week study period. Results published in 2004 in the Journal of the American Medical Association clearly demonstrated that galantamine had no effect. This study was the largest CFS trial to date. Although the trial’s results were disappointing, its rigorous study design may serve as a model for future CFS trials.

Corticosteroids. Some evidence exists that patients with CFS may be deficient in cortisol, a steroid hormone. Studies testing the steroid drug hydrocortisone have reported increased energy and less fatigue in patients taking it. However, side effects, including insomnia, increased appetite, weight gain, and, more seriously, suppression of the adrenal gland, make this therapy unacceptable. One study reporting improvement with very low doses (5 - 10 mg daily) with only minor side effects may make this therapy feasible for some patients, but longer-term and larger studies are needed. Fludrocortisone (Florinef) is an oral steroid used for low blood pressure. This has been tested specifically on CFS subjects with NMH, but studies reported no benefits and side effects may be serious.