Dr. Peter Rowe, a pediatric cardiologist at the Johns Hopkins Children’s Center in the US provides the most extensive overview of the different drugs used to treat orthostatic intolerance in chronic fatigue syndrome (ME/CFS). He makes several general points:
- Few treatment trials have assessed the effectiveness of most of these drugs in ME/CFS.
- Finding the right drug or combination of drugs to treat this problem may take some time and requires persistence and the willingness to experiment on the part of the physician and the patient.
- Because several of these drugs can cause serious side effects such as increased blood pressure and altered electrolyte levels, careful monitoring is needed.
The drugs used to treat OI do one of three things: they increase the ability of the blood vessels to narrow or constrict; they increase blood volume; or they affect norepinephrine/epinephrine activity.
Drugs That Increase Blood Flows by ‘Tightening’ Blood Vessels
- Stimulants (Ritalin, Dexedrine, Adderall)
- Midodrine (ProAmatine, Amatine, Grudron
- Modafanil (Provigil)
- Pseudoephedrine (Sudafed)
- Selective serotonin reuptake inhibitors such as fluoxetine (Prozac), sertraline (Zoloft) and escitalopram (Lexapro) or related medications such as Effexor Cymbalta.
Blood Volume Enhancers
- Fludrocortisone (Florinef)
- Erythropoietin (Procrit, Epoietin-alpha)
- Saline Solution
- Clonidine
- Oral Contraceptive Pills
- Vasopressin
Drugs That Effect Epinephrine/Norepinephrine Release
- Atenolol (Tenormin)
- Propanolol (Inderal)
- Disopyramide (Norpace)
- Angiotensin converting enzyme inhibitors/angiotensin receptor blockers
Others
- Pyridostigmine bromide
This and all sections of the Phoenix Rising website are compiled by a layman. They are not a substitute for a physician and are for informational uses only. Please discuss any treatments in these pages with your physician.