Do Drugs Really Help Fatigue
Thereâs conflicting evidence about which drugs, if any, ease MS-related fatigue. Some studies show that amantadine may have a moderate effect for some people. Other research found that modafinil or methylphenidate could improve wakefulness in people with excessive daytime sleepiness .
Some people with MS say drugs donât get rid of their fatigue. But medicine can keep them awake and make their tiredness easier to handle.
Even if a drug helps you, it may not work as well over time. Tell your doctor if that happens. You may need to take a âdrug holiday.â That means youâll quit for a weekend or a few weeks. Your doctor will let you know when you can start your treatment back up again.
Management Of Fatigue In Persons With Multiple Sclerosis
- 1Department of Rehabilitation Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
- 2The University of Melbourne, Melbourne, VIC, Australia
- 3School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
Fatigue is one of the most common symptoms of multiple sclerosis. Despite advances in pharmacological and non-pharmacological treatment, fatigue continues to be the disabling symptom in persons with MS , affecting almost 80% of pwMS. In current practice, both pharmacological and non-pharmacological interventions are used in combination, encompassing a multi-disciplinary approach. The body of research investigating the effect of these interventions is growing. This review systematically evaluated the existing evidence on the effectiveness and safety of different interventions currently applied for the management of fatigue in person with multiple sclerosis in improving patient outcomes, to guide treating clinicians.
Some Side Effects Can Be Serious If You Experience Any Of These Symptoms Call Your Doctor Immediately:
- hallucinations
- believing things that are not true
- not trusting others or feeling that others want to hurt you
- depression
- suicidal
- lack of interest, enthusiasm, or concern
- dizziness, lightheadedness, fainting, or blurred vision
- swelling of the hands, feet, ankles, or lower legs
- difficulty urinating
- shortness of breath
Amantadine may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s MedWatch Adverse Event Reporting program online or by phone .
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What Other Drugs Will Affect Amantadine
Using amantadine with other drugs that make you drowsy can worsen this effect. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures.
Tell your doctor about all your other medicines, especially:
-
glaucoma medication or
-
medicine that contains sodium bicarbonate .
This list is not complete. Other drugs may interact with amantadine, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.
Rated For Chronic Fatigue Syndrome Report
Boosted my energy without the caffeine buzz Amantadine, in subtle ways, has helped improve my energy throughout the day. I stopped taking Amantadine between February of 2006 and September of 2006 and have noticed a marked decrease in energy. I am back on Amantadine again for the past week, and it has helped me get through the day. When I am experiencing mental and physical fatigue, Amantadine aids in cognitive improvement and energy so that I can concentrate and finish a task rather than lie down because of a heavy-feeling head. The only caution I mention here is that Amantadine does not get along with coffee taken simultaneously. Unpleasant headaches and grogginess resulted because of mixing Amantadine and strong coffee. Although I love my coffee, I have opted to go decaffeinated or to drink herbal tea instead. Coffee is not the best antidote for CFIDS anyway. I presently seek micro-roasted decaffeinated coffee to control my urge.
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The Effect Of Amantadine For The Treatment Of Fatigue In People With Multiple Sclerosis
Multiple sclerosis is a chronic disease affecting young and middle-aged adults. One of the most common and disabling symptoms of MS is fatigue. Different approaches have been used to try and improve this, including energy conservation, specialised fitness training and drug treatments. Amantadine has been used to try to relieve fatigue in MS. This review found that Amantadine efficacy in reducing MS-related fatigue and its tolerability are poorly documented and more research is needed.
The efficacy of amantadine in reducing fatigue in people with MS is poorly documented, as well as its tolerability. It is advisable to: improve knowledge on the underlying mechanisms of MS-related fatigue achieve an agreement on accurate, reliable and responsive outcome measures of fatigue perform good quality RCTs.
Fatigue is one of the most common and disabling symptoms of people with Multiple Sclerosis . The effective management of fatigue has an important impact on the patient’s functioning, abilities, and quality of life. Although a number of strategies have been devised for reducing fatigue, treatment recommendations are based on a limited amount of scientific evidence. Many textbooks report amantadine as a first-choice drug for MS-related fatigue because of published randomised controlled trials showing some benefit.
Evidence For Pharmacological Interventions For Fatigue In Persons With Ms
Currently, different pharmacological agents are used for treatment for fatigue in pwMS, which include amantadine, modafinil, and pemoline . Modafinil, a wake promoting agent that selectively works in the hypothalamic pathways used in narcolepsy, has been reported to improve fatigue in progressive MS . The efficacy of pemoline, a CNS stimulant, is still unclear . Amino pyridines and amantadine have been trialed however, systematic reviews failed to find evidence for efficacy or safety for their use . There is empirical support for use of antidepressants in MS-related fatigue, as depression is considered to be one of the major contributing factors .
One comprehensive systematic review exploring efficacy of different pharmacological treatments on non-specific fatigue in palliative care included 10 studies investigating amantadine , pemoline, and modafinil in pwMS . The authors reported mixed results with weak and inconclusive data. Amantadine was found to demonstrate some improvement in fatigue in pwMS . Both pemoline and modafinil failed to demonstrate a significant effect for management of fatigue in pwMS .
Commonly used pharmacological agents for fatigue and MS are summarized in Table 3, along with indications, doses, and side effects.
Table 3. Commonly used pharmacologic treatments for MS-related fatigue.
Summary
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Why Is This Medication Prescribed
Amantadine is used to treat the symptoms of Parkinson’s disease and other similar conditions. It is also used to control movement problems that are a side effect of certain medications used to treat Parkinson’s disease. Amantadine extended-release capsules are used along with the combination of levodopa and carbidopa to treat ”off” episodes in people with Parkinson’s disease. It also is used to prevent symptoms of influenza A virus infection and for treatment of respiratory infections caused by influenza A virus. Amantadine is in a class of medications called adamantanes. It is thought to work to control movement problems by increasing the amount of dopamine in certain parts of the body. It works against influenza A virus by stopping the spread of the virus in the body.
Does Ms Medication Help With Fatigue Multiple Sclerosis
While medications used to treat multiple sclerosis may not help ease fatigue, they may help keep you awake and manage your tiredness.
Presently, there are no FDA-approved drugs for treating MS-related fatigue. Doctors may prescribe off-label medications, such as:
Besides medications, doctors may prescribe other measures to manage fatigue, which include:
- Sufficient physical activity
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What Should I Know About Storage And Disposal Of This Medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture .
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
What Should I Do If I Forget A Dose
If you are taking the capsules, tablets, or liquid, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
If you are taking the extended-release capsules or the extended-release tablets, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. If you have forgotten to take the extended-release capsules or extended-release tablets for several days, call your doctor.
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Data Collection And Analysis
Three reviewers selected studies for inclusion in the review and they extracted the data reported in the original articles. We requested missing and unclear data by correspondence with the trials principal investigator. A meta-analysis was not performed due to the inadequacy of available data and heterogeneity of outcome measures.
Tips To Conserve Energy
Use Adaptive Aids.Reachers, dressing aids, and other adaptive equipment can significantly help conserve energy when dressing, bathing, and performing other household and personal activities. Many of these items may be obtained through MSAAs Equipment Distribution Program . Please visit mymsaa.org or call 532-7667 for more information.
Shop from Home.Rather than using valuable energy walking around stores, use catalogs or order items online. In addition to avoiding the crowds and exhaustion from walking through stores or malls, ordering clothes allows you to try them on at your leisure when your energy level is highest. Many grocery stores also offer online ordering with either free delivery or a minimal charge for delivery.
Take Fewer Steps.Try to take care of as many things as possible in one room to eliminate extra trips.
Consider Telecommuting.A great way to conserve energy is to reduce the amount of time spent traveling to and from work. Ask your employer about working part of the week from home.
Dont Get Overheated.This can cause fatigue. Wear your cooling vest or other cooling apparel and try to go outside either early in the morning or later in the evening, when temperatures are at their coolest.
Antidepressants
Selective Serotonin Reuptake Inhibitors including Zoloft® , Paxil® , and Prozac®
Wellbutrin® is a NDRI antidepressant , and is one of the most energizing and most effective of the non-SSRI antidepressants against fatigue.
Stimulants
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What Was The Research About
Multiple sclerosis, or MS, is an illness that affects the central nervous system. Fatigue is a common and disabling symptom of MS.
In this study, the research team wanted to learn how well three commonly used medicines work to help patients with MS feel less fatigued and improve quality of life. The medicines were amantadine, methylphenidate, and modafinil. The team compared these medicines with a placebo. A placebo is a pill with no active ingredients. Using a placebo helps researchers learn if results are due to a medicine or chance.
Patients took each of the medicines and the placebo in a specific order over seven to eight months.
The research team also looked at whether patients took the medicines as prescribed and if they had adverse events. An adverse event is when a medicine causes harm an example is an allergic reaction.
What Are The Side Effects Of Amantadine
Amantadine is a drug that helps treat Parkinsons disease and other conditions. People can experience mild to severe side effects while taking this medication.
Amantadine comes in capsule, tablet, or liquid forms. The brand names for amantadine are Gocovri and Osmolex ER.
The most common side effects are nausea, dizziness, and sleeping problems. Some less common but more severe side effects include changes to the central nervous system and the heart, as well as suicidal thoughts or actions.
This article looks into the uses for amantadine and the side effects that a person might experience.
Amantadine can treat a few conditions, and doctors most often prescribe it to treat Parkinsons disease.
Amantadine can also help with movement-related side effects of antipsychotic medications. The medical name for these effects is extrapyramidal symptoms .
Extrapyramidal symptoms are similar to the movements that characterize Parkinsons disease. They may involve muscle spasms, jerkiness, tremors, and slowness.
Amantadine can also prevent and treat the influenza A virus by helping to stop the virus from replicating. It is not, however, a substitute for an annual flu vaccination.
The most common side effects of amantadine, affecting 510% of people who take the recommended dosage, include:
- nausea
Infrequent side effects, affecting 0.1 to 1% of people, include:
- vomiting
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Exercise Can Boost Energy
Certain types of easy exercise, such as gardening and yoga , have been shown to boost energy levels, reduce stress, improve joint range of motion, help manage spasticity, and increase strength. Because of its natural buoyancy, water allows many men and women with MS to perform exercises they cannot do outside of the pool. Water exercise helps increase flexibility, strengthen the upper and lower extremities and trunk, improve ambulatory skills, increase coordination and balance, and condition the overall body to raise endurance levels and lessen fatigue.
For more information on the benefits of aquatic therapy and aquatic exercise for individuals with MS, please see the Health and Wellness column from the Summer/Fall 2012 issue of The Motivator. This may be found on MSAAs website at mymsaa.org/publications/motivator/summer-fall12/health
Central Nervous System Effects
Some people who have taken amantadine have reported falling asleep while performing routine activities, such as driving. The risk is higher in people who take at least one other sedating medication and in people who experience sleep disorders.
Anyone with a history of epilepsy or another condition that causes seizures should monitor any change in seizure activity while taking amantadine.
Symptoms such as dizziness, low blood pressure, and feeling faint have occurred in people taking amantadine. Alcohol consumption could increase this risk.
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How Should I Take Amantadine
Take amantadine exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.
If you take amantadine to treat influenza A, start taking the medicine within 24 to 48 hours after flu symptoms begin. Keep taking this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared.
You may take amantadine with or without food. You may need to take this medicine only at bedtime. Follow your doctor’s instructions.
Measure liquid oral solution carefully. Use the dosing syringe provided, or use a medicine dose-measuring device .
Swallow the capsule or tablet whole and do not crush, chew, or break it.
If you cannot swallow a capsule whole, open it and sprinkle the medicine into a spoonful of applesauce. Swallow the mixture right away without chewing. Do not save it for later use.
Call your doctor if your symptoms do not improve, or if you have a fever with a headache, cough, skin rash, or other new symptoms.
If you take amantadine for Parkinson symptoms: You should not stop using amantadine suddenly or your condition may become worse. Stopping suddenly may also cause unpleasant withdrawal symptoms. Ask your doctor how to safely stop using this medicine.
Store at room temperature away from moisture, heat, and light. Keep the bottle tightly closed when not in use.
Relieving Fatigue Through Cooling
Research has shown that nerves with damaged myelin are sensitive to changes in temperature. A rise in temperature may cause nerve conduction to be less efficient, whereas a reduction in temperature may allow more signals to be transmitted across a damaged nerve.
The idea of cooling people with MS to alleviate symptoms has been researched and practiced for many years, but practical methods of cooling an individual had not been perfected until the 1990s. At this time, MSAA and NASA joined forces to develop and test a cool suit.
Cooling someone too quickly such as taking cold baths or sitting close to the air conditioner can cause shivering and vasoconstriction. This reaction does not help to alleviate MS symptoms. By slowly cooling down the body, an individual with MS may experience improvement in areas of physical performance, cognitive processing, and motor function. Cooling also significantly reduces fatigue, helping a person with MS perform his or her daily activities.
Controlled cooling is now achieved through passive cooling garments. These are portable and allow the wearer to enjoy symptom relief indoors or out. Passive cooling garments, such as a vest and wraps for the neck, wrists, or ankles, use ice or gel packs to give people with MS immediate and simple relief from heat and certain MS symptoms. Some passive garments are dampened and chilled before use.
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Suicidal Thoughts Or Actions
Suicidal thoughts or actions are a rare side effect of amantadine, occurring in fewer than 0.1% of people.
Many people affected in this way have taken amantadine for influenza prevention or treatment. This side effect can develop in people with no history of psychiatric illness.
People taking amantadine, and those close to them, should look carefully for any behavioral changes, including agitation, personality changes, paranoia, depression, and anxiety.
