Provigil For Ms Related Fatigue

What Other Medications May Interact With Provigil

Several medications may interact with Provigil, including:

• Hormonal birth control methods: Hormonal birth control may not work as well when used at the same time as Provigil and for one month after stopping Provigil.
• Gengraf : Blood levels of Gengraf can increase while taking Provigil.
• Cytochrome P450 2C19 substrates: When taken together, Provigil can increase exposure to medications that are CYP2C19 substrates, such as Prilosec , Dilantin , and Valium .

If you are taking a medicine that interacts with Provigil, your healthcare provider may need to change your dose, choose an alternative medicine, and/or monitor certain drug levels.

Safety And Efficacy Of Amantadine Modafinil And Methylphenidate For Fatigue In Multiple Sclerosis: A Randomised Placebo

• Bardia NourbakhshCorrespondenceCorrespondence to: Dr Bardia Nourbakhsh, Department of Neurology, Johns Hopkins University School of Medicine, Pathology 627, Baltimore, MD 21287, USA
• Department of Neurology, Johns Hopkins University, Baltimore, MD, USADepartment of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
• Search for articles by this author

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 visit MSAAs online aquatic center.

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A Diagnostic Approach To Fatigue

An open ended question, followed by a series of more focused inquiries will often prove to be a productive approach. This should be followed by screening for other confounding conditions such as sleep disorders or depression. A systematic approach to the assessment and treatment of fatigue in patients with MS is summarized in .

Effect Of Modafinil On Subjective Fatigue In Multiple Sclerosis And Stroke Patients

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What Are Symptoms Of Fatigue

There are two major types of fatigue in MS. These two types of fatigue are probably separate problems related to the MS.

The first type is a general feeling of tiredness. It may feel as if one has not slept the night before. This feeling may be worse in the afternoons or after activity. People may feel that they are unable to do as many tasks without getting tired as they did before.

A second type of fatigue is muscular. In this type, there is increased weakness after repeated activity. Often, this occurs with walking. People may find that they are dragging one leg or are more unsteady.

Treating Fatigue In Patients With Multiple Sclerosis May Significantly Improve Quality Of Life And Requires A High Index Of Suspicion For Coexisting Sleep Disorders

Jonathan L. Carter, MD

Fatigue is a ubiquitous and often under-recognized symptom in patients with multiple sclerosis . Prevalence estimates for fatigue are as high as 70% to 90% in unselected patients with MS, and it may be the leading cause of disability in patients with mild or early relapsing-remitting MS.1-3 Fatigue is a complex and multifaceted symptom that is poorly understood despite extensive study. Patients with MS may have differing definitions for fatigue. Sleep disorders are more common in patients with MS compared to the general population, including obstructive sleep apnea , central sleep apnea, and restless legs syndrome and resulting from conditions such as neuropathic pain, nocturnal leg spasms, and others. Therapy for MS-related fatigue may be partially successful, but many patients continue to have significant fatigue despite treatment. Chronic sleep deprivation can lead to worsening fatigue, depression, cognitive inefficiency, and fibromyalgia symptoms. Treatment of sleep disorders may significantly improve quality of life but requires a high index of suspicion for the presence of coexisting sleep disorders along with MS-related fatigue. In this article, we address differences between primary and secondary fatigue in patients with MS, possible physiologic mechanisms of MS-related fatigue, nonpharmacologic and pharmacologic therapy for fatigue, recognition and diagnosis of coexisting sleep disorders, and therapies to treat sleep disorders.

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Sleep Disorders In Patients With Multiple Sclerosis

Sleep disturbances are underreported and underrecognized in patients with MS and may be a contributing factor to MS-related fatigue. Reviews have shown higher incidences of sleep disturbances reported in patients with MS including prevalence of narcolepsy ranging from 0% to 1.6%, RLS from 14.4% to 57.5%, REM sleep behavior disorder from 2.22% to 3.2%, and OSA from 7.14% to 58.1%.23-29 . Referral bias, incomplete ascertainment, and other biases may influence these rates. Anxiety, reduced motivation, and mental fatigue are associated with poor sleep quality in patients with shorter MS duration, and pain, depression, and mental fatigue are associated with poor sleep quality in those with longer disease duration.26 Symptomatic narcolepsy occurs in both patients with MS and with neuromyelitis optica spectrum disorder and correlates with hypothalamic lesions seen on MRI. The International Revised Diagnostic Criteria for NMOSD includes symptomatic narcolepsy as a core clinical feature of NMOSD.30 Painful nocturnal spasms, chronic neurogenic pain, and insomnia from drugs used to combat MS-related fatigue or polypharmacy are other causes of secondary sleep disturbances in patients with MS.

In a recent survey, patients with MS reported frequent use of hypnotic medications, most frequently diphenhydramine, and frequent use of hypnotic medications correlated with daytime fatigue in these subjects.30

Treatment

Just One Part Of My Fatigue

One last detail before I go I didn’t start to see these medications really work as well as I’ve described them to until I started looking at them as just one part of my fatigue-management strategy. As counterintuitive as it may sound, once I began to regularly exercise, my fatigue greatly improved, and these medications became so much more effective. Exercise, diet, and stress management are probably just as important as medication when it comes to fighting MS-related fatigue. But as always, talk to your doctor first before making any changes to your treatment regimen.

So, what about you? Do you take any medication to help you manage your fatigue? If so, does it help? How would you describe to people how it works?

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What Does It Feel Like

Not everyone experiences fatigue the same way, and the feeling can be difficult to explain to others. In general, there are two types of MS fatigue: a general feeling of extreme tiredness and muscular fatigue.

MS fatigue is different from regular tiredness. Some people with MS describe the fatigue as feeling like youre weighed down and like every movement is difficult or clumsy. Others may describe it as an extreme jet lag or a hangover that wont go away.

For others, fatigue is more mental. The brain goes fuzzy, and it becomes difficult to think clearly. Fatigue may affect the eyesight, as well as your ability to speak without slurring your words.

MS fatigue is also distinguished by the following characteristics:

• occurs on a daily basis
• often occurs in the morning even after a good night of sleep
• tends to worsen as the day progresses
• is aggravated by heat and humidity
• may come on suddenly

People with MS fatigue may need to recharge their batteries with frequent rest and a short daily nap, but its also possible to plan and schedule your daily activities to help conserve energy.

To conserve energy, try these tips:

While conserving energy is important, too much rest can be counterproductive. Exercising daily is essential for maintaining muscle strength and building endurance. Try these exercises and activities for MS.

There are several other lifestyle changes and remedies that can help you battle fatigue. These include:

How Provigil Works

MS is a disease characterized by the immune system mistakenly attacking the fatty coating that protects nerve fibers from damage and increases the speed of nerve signals along the fibers. Without this protective coating, nerve cells are easily damaged, causing the symptoms of MS.

More than 70 percent of MS patients experience fatigue. Fatigue management plans can be used to improve patients quality of life, but medications like Provigil are also often prescribed.

The precise mechanism of action of Provigil is not known. Experiments using cells grown in the laboratory have shown that Provigil binds to the dopamine reuptake pump, a protein involved in clearing dopamine after a nerve signal has been sent. It is thought that Provigil may lead to an increase in dopamine by blocking its clearance, making more dopamine available for the transmission of nerve signals.

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How To Treat It

If youre experiencing fatigue, make an appointment with your doctor to discuss possible treatment options. A doctor will likely want to run some tests to find out more about what may be causing your fatigue.

Based on the results of these tests, your doctor may prescribe medications or recommend counseling, physical therapy, and occupational therapy.

What Are Reasons I Shouldnt Take Provigil

You should not take Provigil if you have a known allergy or sensitivity to Provigil or any of its ingredients.

Let your healthcare provider know if you have a history of high blood pressure or mental health, heart, or liver problems. Your healthcare provider may need to monitor these underlying conditions while you are taking Provigil.

Moreover, Provigil is not approved to treat children for any health condition. Studies of children taking Provigil showed serious side effects, including severe skin rashes and psychiatric or nervous system reactions.

Lastly, Provigil is a controlled substance and may be habit forming or lead to dependence. As a result, Provigil should be used cautiously in people who have a history of substance abuse disorder.

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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.

A Little More Strength To Carry The Weight

In my experience, it’s not like you take a pill and, just like that, no more fatigue until the pill wears off. When I take my medication, the fatigue is still there, but it becomes easier to work through it kind of like how cold medication doesn’t eliminate a cold, but it may help reduce the symptoms of one. If you think of fatigue like the weight of a huge boulder on your back that you have to walk around with, I would say that these medications don’t really remove the weight of the boulder but instead give you a little more strength to carry it. The heaviness in my body caused by my fatigue is always there, but these medications make it a little less difficult to not be crushed by it. At least that how it feels to me.

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What Causes Fatigue In Patients With Multiple Sclerosis

The exact cause of MS-related fatigue is still unknown. There are several theories on the subject:

• One theory is that fatigue is related to the general activation of the immune system. Chemical messengers are called cytokines these levels are higher in patients with MS and may be higher still in patients with fatigue. One way of describing this is that you may feel like you have a virus all of the time.
• Another theory is that people with MS may have to use more parts of their brain to do the same task as someone without MS in essence, they are working harder.
• Another theory is that fatigue is related to reduced electrical transmission of signals in the brain.

Whatever the theory, we know that fatigue from MS is a very real part of the disease.

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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Clinical Aspects Of Ms

In clinical practice, the first step is to investigate whether there is an underlying cause or trigger for the fatigue, which needs to be treated before starting any specific treatment for it. Causes and triggers of fatigue may be related to MS, such as pain, night spasms and urine dysfunction, which can lead to sleep disturbances and increased tiredness, or being unrelated to MS, as it is described in Table Table11.

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.

The following medications, among others, are prescribed for depression. These have been found to help lessen fatigue in certain individuals. Antidepressants may need to be taken for several weeks before seeing an effect.

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Fatigue Treatment Using Provigil

Multiple sclerosis and fatigue Fatigue is one of the most common symptoms of multiple sclerosis , occurring in 30%-80% of patients and for many of them fatigue is the most disabling symptom .

Definition of fatigue according to the MS Council for Clinical Practice Guidelines is as follows: “A subjective lack of physical and/or mental energy that is perceived by the individual or caregiver to interfere with usual and desired activities”.

As fatigue is a subjective and non-specific symptom, and can easily be confused with either weakness or depressed mood, both common in MS, the following characteristics have been defined to better diagnose MS-associated fatigue:

• MS-related fatigue generally occurs on a daily basis.
• It tends to worsen as the day progresses.
• It tends to be aggravated by heat and humidity.
• It is not directly correlated with either depression or the degree of physical impairment.
• It may occur first thing in the morning even if the patient has had a restful full night’s sleep.