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Fatigue and medications
Here is My Question:
My question is regarding fatigue. Besides good sleep habits, avoiding caffeine, and exercise, how often do you recommend medication such as methylphenidate? I know that these medications can also increase anxiety which is a problem for me.
This is a hard question to answer. Fatigue means so many different things to different individuals and has so many causes.
Let’s assume there is no other medical cause for your fatigue (a big assumption since the list of causes is long) and we believe you have primary MS related fatigue. In this case first line treatment is amantadine 100 mg in the am and early afternoon. This rarely causes anxiety or insomnia. If this happens alter the dosing to 100 or 200 mg as a single dose in the morning. Some people require higher doses, but I rarely increase amantadine beyond 400 mg total dose in a day and monitor individuals closely if they are taking doses higher than 200 mg total per day. Common side effects of amantadine are mild nausea, nightmares or sleep disruption, peripheral edema (swelling of the legs) and livedo reticularis (an unusual mottling of the skin). At higher doses visual blurring may occur. People with kidney disease should reduce the daily dose of amantadine to prevent toxicity.
People who do not respond to amantadine, particularly if there is a component of excessive daytime sleepiness without a treatable cause or partially treated depression, often respond to the addition of modafinil or amphetamines. Those with anxiety or headache disorders must use amphetamines with caution and begin with low doses to avoid aggravating these conditions.
Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego
Here is My Question:
Does amantadine (Symmetrel) help with fatigue? I read that it does and you can take it with your MS medications, or is there an herbal med that will help with that? I have become so fatigued it is causing problems in my everyday life. Also is chlordiazepoxide (Librium) better for anxiety than klonopin?
Amantadine has been shown to be helpful in treating mild MS-related fatigue, but how it actually does that is not clear. It was originally developed as a prophylactic agent for the flu decades ago (but not really used for that anymore). Fatigue due to MS is the most reported (and disabling) feature of MS. There are many other factors that can add to fatigue (heat, sleep problems, depression, and many medications used to treat symptoms of MS including those for anxiety that you mention in your question) and should be reviewed with your doctor. Amantadine is a good place to start (for treatment of fatigue due to MS), but if it is not sufficient, there are other stimulant options that your doctor can discuss with you (modafinil, methylphenidate, etc).
I do not have an opinion regarding the relative effectiveness of different anxiety medications (it's hard to know what is best for a certain individual, and requires a trial/experience approach with a doctor who is following you closely). Hope this helps.
Here is My Question:
I was diagnosed with RRMS in 2001. Was recently taken off Copaxone because it seemed to have stopped helping. I have daily symptoms...never-ending. My question is about fatigue. Do most patients feel the extreme fatigue with activity? Simple things like washing a dish, brushing teeth, bending over or carrying groceries can wipe me out and even make me a little lightheaded. I notice I sleep more during the day, but I force myself to keep going. I've had all the cardiac tests which seem to be normal for my age (63). But I just can't seem to do much physical work anymore. I tried PT and water aerobics. The exercise makes things worse. I also have Graves, IBS, Gastritis, osteoarthritis and tendinitis. Also degenerative disc problems. Thanks so much. Appreciate any advice or suggestions.
Your experience with fatigue is common among MS patients. Thankfully, we have lots of information on this site to help with the management of MS related fatigue. Just use the search feature to find the information. However, before you begin your search for answers remember the following: There is no single solution to fatigue; trying something like an exercise program, deciding that it is not helpful and discarding it is a mistake. Most of these strategies will require months of hard work and adjustments to find a successful solution. These solutions always require a combination of management strategies that include most of the following:
You should discuss the comprehensive management of your MS related fatigue with your MS team
PLEASE NOTE: This information/opinions on this site should be used as an information source only. This information does not create any patient-HCP relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.