Medications for Chronic Fatigue Syndrome (CFS)

by Michael Jubinville, MPH

Here are the basics about each of the medicines below. Only the most common reactions are listed. Ask your doctor if you need to take any special steps. Use each of these drugs as advised by your doctor or the booklet they came with. If you have any questions, call your doctor.

Many people with CFS may be sensitive to medicines. This is true of those that affect the central nervous system. For this reason, your doctor may begin with very low doses. If needed, the dose can be slowly increased.

CFS is complex. You may need the use of different types of medicine. They're used only to help with symptoms of CFS. Medicine is also used to treat other health problems such as anxiety, depression, pain, and sleep problems. They also have more than one use. For example, antidepressants may be helpful for those who have problems sleeping.

Prescription Medications

Prescription Medications

Stimulants

Common names:

  • Modafinil
  • Armodafinil
  • Methylphenidate
  • Dexamphetamine
  • Amphetamine salts

Stimulants may help with symptoms of fatigue, brain fog, and memory problems. It's helpful for those who are sleepy during the day. Your doctor will watch you closely if you take these.

Some problems are:

  • Insomnia
  • Higher blood pressure
  • Faster heart rate
  • Headache
  • Lack of hunger
  • Irritability
  • Rage
  • Tremor
  • Hearing, seeing, feeling, or smelling something that's really not there
  • Seizures

Sleep Aids

Different types of medicines are used to help people with sleep problems. These include:

Antidepressants

Common names:

  • Amitriptyline
  • Doxepin
  • Nortriptyline
  • Trazodone
  • Mirtazapine

Antidepressants in low doses have a calming effect. They may be helpful for depression or if other treatments haven't helped. It can take up to 6 weeks for these to fully work. Don't stop taking these drugs on your own. The dose has to be lowered over time.

Some problems are:

  • Seizures
  • Higher blood pressure
  • Faster heart rate
  • Dry mouth
  • Mild tremor
  • Problems passing urine
  • Lightheadedness
  • Painful or inappropriate erections (trazodone)
Cyclobenzaprine

Cyclobenzaprine may help with muscle spasms or pain. Don't stop taking this drug on your own. The dose has to be lowered over time.

Some problems are:

  • Drowsiness
  • Lightheadedness
  • Problems passing urine
  • Tolerance and dependency
  • Swelling in the legs
  • Short-term memory problems
Antiseizure Drugs

Common names:

  • Gabapentin
  • Pregabalin

These drugs may help calm restless legs or pain at night. Don't stop taking these drugs on your own. The dose has to be lowered over time.

Some problems are:

  • Drowsiness
  • Lightheadedness
  • Weight gain
  • Clumsiness
  • Tolerance and dependency
  • Increased risk of suicidal thoughts or behavior
Clonazepam

Clonazepam is used to ease anxiety and promote sleep. For people with CFS, it can also help with restless legs and muscle spasms. Don't stop taking this drug on your own. The dose has to be lowered over time.

Some problems are:

  • Drowsiness
  • Lightheadedness
  • Lack of coordination
  • Slow reaction time
  • Tolerance and dependency
Zolpidem

Zolpidem will help you fall asleep faster. It can also help you stay asleep longer depending on the dose. Don't stop taking this drug on your own. The dose has to be lowered over time.

Some problems are:

  • Return of insomnia symptoms
  • Drowsiness
  • Nausea
  • Headache
  • Diarrhea
  • Tolerance and dependency
Zopiclone

Zopiclone is used insomnia, but not for long periods of time. It will help you fall asleep faster and stay asleep longer. Don't stop taking this drug on your own. The dose has to be lowered over time.

Some problems are:

  • Return of insomnia symptoms
  • Drowsiness
  • Nausea or vomiting
  • Lightheadedness
  • Dry mouth
  • Headache
  • Lack of coordination
  • Slow reaction time
  • Tolerance and dependency
Promethazine

Promethazine can be used as a sleep aid. It's can also ease nausea or restlessness. In some countries outside of the US, it's available without a prescription.

Some problems are:

  • Problems thinking clearly (in the elderly)
  • Drowsiness
  • Hives
  • Rash
  • Lightheadedness
  • Dry mouth
  • Nausea or vomiting

Pain Relievers

Pain with CFS can be hard to treat. It's best to start with over-the-counter medications first. If they don't work for you, it's possible your doctor may prescribe medicines for you. Antidepressants, like the ones listed above, are the most common.

Your doctor may prescribe an opioid, but this is rarely done. Opioids must be used with care because of their side effects. If you take these medicines, your doctor will watch you closely. They are highly addictive. Don't stop taking these drugs on your own. The dose has to be lowered over time.

Opioids for CFS include:

  • Oxycodone
  • Hydrocodone
  • Morphine
  • Fentanyl
  • Buprenorphine
  • Tapendatol
  • Tramadol

Some problems are:

  • Drowsiness
  • Lightheadedness
  • Nausea or vomiting
  • Constipation
  • Lack of coordination
  • Slow reaction time

Over-the-Counter Medications

Acetaminophen

  • Tylenol

Acetaminophen can ease pain from headache, or joint or muscle pain. If you decide to use this drug, be sure to follow the directions so you don't take too much.

Some problems are:

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Common names:

  • Naproxen
  • Ibuprofen

NSAIDs may be used to relieve pain and fever. They are generally safe when taken as recommended.

Some problems are:

  • Belly pain
  • Gastrointestinal bleeding
  • Nausea, heartburn, or vomiting
  • Poor kidney function or injury
  • Higher blood pressure

Antihistamines

Common names:

  • Benadryl
  • Unisom
  • Sominex

Antihistamines have a calming effect, which makes them useful as sleep aids. They may also help to ease nausea. If you decide to use these drugs, be sure to follow the directions so you don't take too much.

Some problems are:

  • Drowsiness
  • Faster heart rate
  • Lightheadedness
  • Dry mouth
  • Problems passing urine

Melatonin

Melatonin is a hormone in the body that helps regulate sleep and wakefulness patterns. For some people, it may help with sleep quality, which will can help get you through the day. Melatonin is also useful for people who work on shifts or have jet lag. Melatonin is fairly safe, but it's not meant to be used as a long-term solution. Use the lowest effective dose, usually 2 to 3 milligrams, at bedtime.

Some problems are:

  • Drowsiness
  • Fatigue
  • Nausea
  • Irritability

Special Considerations

If you are taking medicines:

  • Take the medicine as directed. Don’t change the amount or the schedule.
  • Ask what side effects could occur. Report them to your doctor.
  • Talk to your doctor before you stop taking any prescription medicine.
  • Don’t share your prescription medicine.
  • Medicines can be dangerous when mixed. Talk to your doctor or pharmacist if you are taking more than one medicine. This includes over-the-counter products and supplements.
  • Plan for refills as needed.

References:

Chronic fatigue syndrome. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated September 10, 2018. Accessed February 11, 2018.
Chronic fatigue syndrome. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/special-subjects/chronic-fatigue-syndrome/chronic-fatigue-syndrome. Updated July 2018. Accessed February 11, 2018.
Treatment of ME/CFS. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/me-cfs/treatment/index.html. Updated July 12, 2018. Accessed February 11, 2018.
Yancey JR. Thomas SM. Chronic fatigue syndrome: diagnosis and treatment. Am Fam Physician. 2012;8(68):741-746.
2/18/2011 DynaMed's Systematic Literature Surveillance http://www.dynamed...: Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry. 2010;71(10):1259-1272.
Last reviewed December 2018 by EBSCO Medical Review Board Marcin Chwistek, MD
Last Updated: 2/11/2019

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