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  Use of drugs to treat CFS/ME can be controversial considering the side effects that they tend to cause. They are most commonly used to treat pain or insomnia. The information is given under three headings:
  • Description
  • Warnings
  • Possible Side-effects

The side-effects, as stated, are not necessarily experienced by all people taking the drug and only some of them may occur.

Amitriptyline

Description Amitriptyline is an antidepressant. It has strong sedative properties. In small amounts it can be used as a muscle relaxant or to treat insomnia.

Warnings Those who have heart disorders, severe liver disorder, diabetes, epilepsy, liver or thyroid disease, glaucoma, urinary retention or who are pregnant or breast feeding may have problems with this drug. Withdrawal must be gradual.

Possible Side-effects Loss of concentrative ability affecting thought and movement, dry mouth, blurred vision, constipation, sweating, irregular heartbeat, behavioural disturbances, a rash, difficulty urinating, a state of confusion and changes in appetite and libido. Blood disorders are a rare side effect. Amrix This is a slow release version of

Baclofen

Description Baclofen is used to treat muscles that are in spasm, especially those in the limbs that have been affected by injury or disease to the central nervous system.

Warnings Those with impaired cerebrovascular (blood flow to the brain) system, epilepsy, psychiatric conditions or who are elderly may have problems with this drug. Withdrawal of treatment should be gradual.

Possible Side-effects Drowsiness, fatigue, weakness, nausea, vomiting and hypotension (low blood pressure). Elderly or debilitated patients may enter a state of confusion.

Carbamazapine

Description Carbamazapine is an anticonvulsant drug normally used to treat epilepsy. In smaller doses it can be used to treat certain forms of neuralgia (nerve pain).

Warnings It should not be given to people with certain heart defects or porphyria (a disorder that causes certain red or purple pigments to be excreted in urine). It should not be given to those using or having recently used any MAOI (monoamine oxidase inhibitor) drugs, which are a type of strong anti-depressant. Those who have impaired liver function or glaucoma or who are lactating may have problems with this drug.

Possible Side-effects Blurred vision and unsteadiness. Sometimes gastro-intestinal disturbances. Occasionally a rash. It can cause liver damage. Hopefully, in the case of smaller doses there should be less likelihood of side-effects.

Cipralex see Escitalopram

Circadin see Melatonin

Citalopram

Description Citalopram is a SSRI drug used to treat depression. It may take two to four weeks before any beneficial effects occur. If depression gets worse talk to your doctor.

Warnings Antidepressants can cause blood sodium level to drop. This can cause drowsiness, confusion, muscle twitching or convulsions. Elderly people may be most at risk to this effect. Withdrawal should start if you experience seizures (or more than normal if you are epileptic). Withdrawal should be gradual. In very rare instances withdrawal symptoms have been experienced after accidentally missing a daily dose. Use with caution in adolescents under 18 years old, those with a history of suicidal behaviour or mania, decreased liver function, severely decreased kidney function, diabetes, epilepsy, history of bleeding disorders and people taking medicine that affects blood clotting. Citalopram should not be taken at the same time as MAOI (monoamine oxidase inhibitor) drugs, which are a type of strong anti-depressant. Citalopram may alter control of blood sugar levels in people with diabetes.

Possible Side-effects Insomnia, fatigue, diarrhoea, constipation, nausea, vomiting or abdominal pain, drowsiness, dry mouth, excessive sweating, headaches, tremors, dizziness, weakness, agitation, nervousness, visual disturbances, indigestion, appetite and weight changes, amnesia and sexual problems. You are more likely to suffer side-effects if you also take lithium, tramadol, tryptophan, St. John's wort or certain 'triptan' drugs used to treat migraine like sumatriptan as these also affect serotonin levels in the brain.

Clonazepam

Description Clonazepam is an anticonvulsant drug. It is normally used to treat epilepsy. Because clonazepam has sedative properties it is sometimes used for sleeping problems and for its muscle relaxing properties.

Warnings It is more sedative than most drugs that are used to treat epilepsy. The effects of alcohol will be increased. Do not use if you are lactating.

Possible Side-effects Dizziness, fatigue, muscular weakness and mood changes. Concentration and speed of thought and movement are affected.

Codeine

Description Codeine phosphate is a narcotic analgesic (opioid) drug that is used to treat pain. It is a little weaker than the opioid, morphine. It can also be use as an antidiarrhoeal treatment.

Warnings Should not be used if you have asthma or poor breathing, or suffer high intracranial pressure or have a head injury. Can cause convulsions with epileptics. Probably not a good idea if you have liver or kidney problems, hypothyroidism, heart problems or if you are pregnant or breast-feeding.

Possible Side-effects Nausea, vomiting, loss of appetite, urinary retention, constipation, confusion, dry mouth, flushed face, sweating, headache, palpitations, slowed heart rate, dizziness on standing, mood swings and hallucinations.

Cyclobenzaprine

Description Cyclobenzaprine is a muscle relaxant, which is used to treat skeletal muscle spasms. It is sold under the labels flexeril, flexmid, apo-cyclobenzaprine and amrix. It has been used as a sleep aid and to treat fibromyalgia. It is only effective for short-term treatment.

Warnings Do not use cyclobenzaprine if you have used an MAOI (monoamine oxidase inhibitor) drug within the past 14 days as this can cause serious, life-threatening side effects. Do not use if you have heart problems. Probably not a good idea if you have liver problems, difficulty urinating, enlarged prostate, glaucoma or if you are breast-feeding. It will increase the drowsiness caused by other drugs. Older adults may be more sensitive to the side effects of this medication.

Possible Side-effects Drowsiness, dizziness, dry mouth, blurred vision, stomach pain, nausea, vomiting, headache, difficulty breathing, agitation, muscle weakness, diarrhoea or constipation.

Cymbalta see Duloxetine

Diazapam

Description Diazapam is used to treat anxiety and insomnia and also has some skeletal muscle relaxant properties.

Warnings Continued use will result in tolerance and may lead to dependence. Prolonged use or abrupt withdrawal should be avoided. Concentration and speed of thought tend to be hampered by this drug. The effects of alcohol consumption will be increased. Those with respiratory difficulties, glaucoma, kidney or liver damage, who are in the last stages of pregnancy or who are elderly or debilitated may have problems with this drug.

Possible Side-effects Drowsiness, dizziness, headache, dry mouth, urinary retention and shallow breathing. It may also cause hypersensitivity reactions.

Duloxetine

Description Duloxetine is a drug similar to an SSRI except that it affects noreprinephrine (noradrenaline) as well as serotonin. It is known as a SSNRI. It is used to treat anxiety and depression. However, results in tests were disappointing. Duloxetine turned out to be less effective and less tolerable than other drugs. There were also concerns about liver toxicity and suicidal effects. It is also used to treat nerve pain in diabetics. Trials indicated that it helped women with fibromyalgia, but not men. It is sold under the names Cymbalta and Yentreve.

Warnings Do not use duloxetine if you have used an MAOI (monoamine oxidase inhibitor) drug within the past 14 days as this can cause serious, life-threatening side effects. Do not use if you have glaucoma. Probably not a good idea if you have liver or kidney problems, seizures or epilepsy, bipolar disorder or have a history of drug abuse or suicidal thoughts or if you are pregnant or breast feeding.

Possible Side-effects Nausea, dry mouth, taste disturbances, dizziness, fatigue, nightmares, insomnia, fainting, sweating, decreased appetite and weight loss, headache, blurred vision, stomach pain, constipation or diarrhoea, indigestion, vomiting, difficulty urinating, tremor, anxiety, agitation, irritability, aggressiveness, nervousness, hyperactivity, palpitations, decreased sex drive, impotence, hot flushes, increased blood pressure or heart rate, poor circulation in extremities, jaundice, inflammation of the liver, clenching of jaw muscles, drowsiness, loss of coordination, mood changes, hallucinations, suicidal thoughts, coma.

Escitalopram

Escitalopram is a slightly more refined version of Citalopram. It is sold under the names of Lexapro, Cipralex and Seroplex.

Flexeril see Cyclobenzaprine

Flexmid see Cyclobenzaprine

Fluoxetine

Description Prozac or fluoxetine is an SSRI that is used to treat depression. It is also used to treat bulimia and obsessive-compulsive disorders. It has less sedative properties than some other antidepressants.

Warnings Those who have heart, liver or kidney disorders, diabetes, epilepsy or who are pregnant or breast feeding may have problems with this drug.

Possible Side-effects Nausea, vomiting, diarrhoea, abdominal pain, acidic stomach, weight loss, constipation, dry mouth, anxiety or drowsiness, tremor, palpitations, convulsions, fever, headache, insomnia, confusion, sweating, weakness, hypothermia and sexual dysfunction. Also discontinue if a rash occurs. The drug can cause blood disorders, inflammation of inner organs, violent behaviour and hair loss. Withdrawal can cause vaginal bleeding.

Gabapentin

Description Gabapentin is an anti-convulsant drug. It is normally used to help control seizures. It has been used to deal with nerve pain in people with chronic fatigue syndrome. It has also been used to treat anxiety and mood problems.

Warnings Those with certain kidney disorders, or who are pregnant or breast-feeding should be careful using this drug. Withdrawal should be gradual.

Possible Side-effects Dizziness, sleepiness, fatigue, unsteady gait, double vision, headaches, tremor, nausea, vomiting, rhinitis, weight gain, convulsions, dyspepsia, cough, nervousness and amnesia.

Lexapro see Escitalopram

Lustral see Sertraline

Lyrica see Pregabalin

Melatonin (Circadin)

Description Melatonin is the most prominent hormone produced by the pineal gland. Recently melatonin has gained a reputation for being an effective sleep aid. Research looking at the effects of melatonin on healthy adults found that those prescribed the drug took less time to fall asleep and slept more soundly. Melatonin has also been used to help people with severe depression to get to sleep. This application is controversial, as some evidence suggests that melatonin might intensify depression. Synthetic melatonin, is available as a prescription-only medicine known as Circadin. Doctors may be cautious about prescribing this product to people with chronic fatigue syndrome. This is because the manufacturer states that it is not recommended for use in people with autoimmune diseases.

Warning It is not recommended for use in those under the age of 18. It should not be administered to those with liver damage, hereditary galactose intolerance or lapp lactase deficiency or those taking fluvoxamine, cimetidine, carbamazepine or to those taking oestrogens in contraceptive or hormone replacement therapy.

Possible Side-effects Drowsiness, headaches, memory problems, mood alteration, vertigo, white blood cell and platelet disturbances. Some people with ME/CFS have experienced more vivid nightmares when using circadin. Methocarbamol

Description Methocarbamol is a skeletal muscle relaxant. It works directly on the central nervous system. It is used especially to relieve muscle spasm in the limbs, caused by injury.

Warnings It should not be given to those with epilepsy, glaucoma, rapid heart rate, enlargement of the prostrate gland, a weak bladder or those who have brain damage or are in a comatose state. It tends to increase the effects of alcohol consumption.

Possible Side-effects Concentration and speed of thought and movement are negatively affected. Dizziness, light-headedness, drowsiness, nausea, restlessness, anxiety and mild confusion. Some patients experience sensitivity reactions like a rash. In rare instances the drug can cause convulsions. Metoclopramide

Description Metoclopramide hydrochloride is used to prevent vomiting and nausea. It targets the vomiting center of the brain, strengthens the gullet and speeds up the rate at which food leaves the stomach and moves along the intestine.

Warnings Those who have liver or kidney problems, porphyria or who are pregnant or breast feeding may have problems with this drug. It should be administered with caution to those under twenty years old.

Possible Side-effects Muscle tremor or rigidity, involuntary muscle movements, raised level of the hormone, prolactin, in the blood, restlessness, drowsiness, depression and diarrhoea.

Mirtazapine (Zispin)

Description Mirtazapine is an antidepressant used to treat major depressive disorder. It has also been used to treat insomnia even though this is also stated as a possible side-effect.

Warnings Do not use mirtazapine if you have used an MAOI (monoamine oxidase inhibitor) drug, within the past 14 days as this can cause serious, life-threatening side effects. Mirtazapine should be administered with caution to those who have liver or kidney disease, seizures, heart problems or suicidal thoughts or are pregnant or breast feeding. Older adults may be more sensitive to the side-effects of this medication.

Possible Side-effects Mood or behaviour changes, anxiety, panic attacks, insomnia, irritability, agitation, hostility, aggressiveness, restlessness, hyperactivity, increased depression, suicidal or self-harm thoughts.

Nortriptylene

Description Nortriptylene is an antidepressant drug that has mild sedative properties. In low doses it can be used to suppress nerve pain.

Warnings It should not be given to those with heart disease or psychosis. Those with diabetes, epilepsy, liver or thyroid disease, glaucoma or urinary disease or those who are pregnant or lactating may have problems using this drug. Withdrawal of treatment should be gradual.

Possible Side-Effects Loss of concentration, and speed of movement and thought, dry mouth and blurred vision are common. Difficulty in urinating, sweating, irregular heartbeat, behavioural disturbances, a rash, a state of confusion and loss of libido can also occur. In rare instances the drug can cause blood deficiencies. Hopefully the side-effect risks should be considerably lower if taken in small doses.

Paracetamol

Description Paracetamol is a non-narcotic drug used to treat mild pain. It can also reduce raised body temperature. It is similar to aspirin except that it does not cause irritation of the stomach lining or reduce inflammation.

Warnings Anybody with liver problems should be wary of using this regularly.

Possible Side-effects Large amounts may cause a rash, blood disorders or acute pancreatic. Very large amounts may affect the liver.

Paramax

Paramax is a compound preparation of metoclopramide hydrochloride and paracetamol It is used to treat vomiting and nausea.

Paroxetine

Paroxetine (Seroxat) is an antidepressant that is very similar to Fluoxetine (Prozac). It has the additional possible side-effect of facial muscle spasms, which may be unpleasant for those with CFS/ME. Withdrawal effects may be worse, also.

Pregabalin (Lyrica)

Description Pregabalin is used to treat seizures, anxiety and nerve pain in diabetics. It has been used to treat fibromylgia.

Warnings Probably not a good idea if you have heart or kidney problems or if you are pregnant or breast-feeding. Withdrawal should be gradual to avoid insomnia, nausea, anxiety, restlessness, diarrhoea or headaches.

Possible Side-effects Dizziness, drowsiness, blurred vision, tremor, lethargy, memory problems, constipation, dry mouth, weight gain, decreased sex drive, impotence, swelling of the hands and feet, euphoria, speech problems, lack of coordination, depression, confusion, agitation, hallucinations, sweating, rash, hot flushes, muscle cramps, muscle twitches, muscle pain, joint pain, incontinence, painful urination, increased heart rate, increased salivation, increased or decreased sensory sensitivities, decrease in blood platelet count, kidney stones. Rarely: Decrease in neutrophils (type of white blood cell) in the blood, heart problems, low or high blood pressure, pancreatitis, difficulty swallowing, decreased production of urine, skeletal muscle breakdown, suicidal thoughts or behaviour.

Prozac see Fluoxetine

Seroplex see Escitalopram

Seroxat see Paroxetine

Sertraline

Description Sertraline is an SSRI drug that is used to treat depression. It has less sedative properties than some other antidepressants.

Warnings Those who have heart, liver or kidney disorders, diabetes, epilepsy or who are pregnant or breast feeding may have problems with this drug.

Possible Side-effects Nausea, vomiting, diarrhoea, abdominal pain, acidic stomach, weight loss, constipation, dry mouth, anxiety, tremor, palpitations, convulsions, fever, headache, insomnia, confusion, sweating, weakness, hypothermia and sexual dysfunction. Also discontinue if a rash occurs. The drug can cause blood disorders, inflammation of inner organs, violent behaviour and hair loss. Withdrawal can cause vaginal bleeding.

Spasmonal

Description Spasmonal is a preparation of the antispasmodic drug Alverine Citrate. It is used to help IBS

Warnings Do not use if you have paralytic ileus. Probably not a good idea if you are pregnant or breast-feeding.

Possible Side-effects Side effects are rare, but could include sickness, dizziness, headache, allergy, rash or itching.

Tramadol

Description Tramadol Hydrochloride or Zydol is similar to morphine and used to treat pain.

Warnings Should not be used if you have asthma or poor breathing, or suffer high intracranial pressure or have a head injury. Can cause convulsions with epileptics. Probably not a good idea if you have liver or kidney problems, hypothyroidism, heart problems or if you are pregnant or breast feeding.

Possible Side-effects Nausea, vomiting, loss of appetite, urinary retention, constipation, confusion, dry mouth, flushed face, sweating, headache, palpitations, slowed heart rate, dizziness on standing, mood swings and hallucinations.

Trazadone

Description Trazadone Trazadone Hydrochloride is an anti-depressant, which has very similar effects to Amitriptyline but affects natural involuntary muscle reactions a little less.

Tryptophan

Description Tryptophan is an amino acid from which the neurotransmitter, serotonin, is produced. It is naturally found in many foods. Tryptophan has been used to treat depression. It is administered in solution or tablet form.

Warnings It should not be given to those who have any disease of the bladder or those known to have problems utilising tryptophan in the diet.

Possible Side-effects Concentration and speed of thought and movement may initially be affected. There may be headaches or nausea with drowsiness.

Venlafaxine

Venlafaxine is an anti-depressant, which is very similar to Fluoxetine Prozac). It may cause changes in liver enzymes.

Yentreve see Duloxetine

Zimovane is a non-prescription version of Zopiclone

Zispin see Mirtazapine

Zolpidem

Description Zolpidem Tartrate is used to treat insomnia.

Warnings This should not be taken by those with a weak heart or lungs or those with severe liver impairment, myasthenia gravis or who are pregnant or breast feeding. Anyone with depression or with liver or kidney disorders may have problems with this drug.

Possible Side-effects Diarrhoea, nausea, vomiting, dizziness, vertigo, headache, memory problems, confusion, depression, visual disturbances like double vision, tremors, lack of coordination when walking. Although it is used to treat insomnia it may cause restlessness at night and nightmares. It may also cause drowsiness during the day. Zopiclone

Description Zopiclone is used for the short-term treatment of insomnia.

Warnings Those with liver impairment, psychiatric disorders or who are pregnant or breast feeding or who have a history of drug abuse may have problems with this drug. It may cause drowsiness and impair the performance of skilled tasks like driving. Prolonged use may cause dependency and depression.

Possible Side-effects A bitter or metallic taste in the mouth, nausea, vomiting, gastro-intestinal disturbances, drowsiness, light-headedness, dizziness, depression, sensitivity reactions including rashes, amnesia, hallucinations, irritability and behavioural disturbances including aggression.

Zydol

Description Tramadol Hydrochloride or Zydol is similar to morphine and used to treat pain.

Warnings Should not be used if you have asthma or poor breathing, or suffer high intracranial pressure or have a head injury. Can cause convulsions with epileptics. Probably not a good idea if you have liver or kidney problems, hypothyroidism, heart problems or if you are pregnant or breast-feeding.

Possible Side-effects Nausea, vomiting, loss of appetite, urinary retension, constipation, confusion, dry mouth, flushed face, sweating, headache, palpitations, slowed heart rate, dizziness on standing, mood swings and hallucinations.

 
     
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