If you experience excessive daytime sleepiness due to your FMS/CFS, talk to your physician about Provigil (modafinil).  It’s a stimulant, different from traditional amphetamines, that has been approved for the treatment of narcolepsy and Parkinson’s disease.  One small case report involving four FMS patients taking 100 mg to 250 mg each morning, two of whom took a 50 mg booster in the afternoon, showed that this drug significantly improved alterness during a three-month trial period.  A study designed to treat fatigue in multiple sclerosis patients indicates that the drug is well-tolerated.  The common side effects in healthy controls taking 400 mg each morning were usually mild in nature and often consisted of headache, nausea, nervousness/anxiety, dizziness, and insomnia.

Narcolepsy is a sleep disorder that causes people to fall asleep uncontrollably.  It isn’t the same as the sleep disorder and fatigue problems faced by people with FMS/CFS.  Low-dose Provigil (50 to 100 mg) may, however, aid your symptoms of fatigue, cognitive impairment, and excessive daytime sleepiness, as well as improve your motivation to exercise.  Should you consider asking your doctor about this drug?  It depends upon the impact that fatigue has on your daily function, and your willingness to take a medicine that could increase preexisting problems of headache and insomnia (the small case report in FMS involved patients whose jobs were in jeopardy because they could not stay awake).  A study comparing caffeine to Provigil (200-400 mg) in healthy controls showed that each agent produced similar benefits in terms of daytime performance and alertness.  The mechanisms of action for these two drugs differ, but caffeine is by far the cheaper. 

If you can’t tolerate caffeine and your fatigue level is greatly impeding your function, then low-dose Provigil might be a viable option for you.  If Provigil aggravates your sleep, try a lower dose.  If that doesn’t work, consider taking it on workday mornings only.

7.  Beusterien KM, et. al. SLEEP 1999; 22(6):757-765.

8.  Schaller JL, Behar D. J Neuropsych Clin Neurosci 2001; 13(4):530-1.

9.  Rammohan KW, et. al. J Neurol Neurosurg Psych 2002; 72(2):179-183.

10. Hellriegal ET, et. al. J Clin Pharmacology 2002; 42(4):448-458.

11. Jones KD, Clark SR. Rheum Dis Clin N Am 2002; 28(2):419-436.

12. Wesensten JM. et. al. Psychopharmacology 2002; 159(3):238-247.

Posted on November 3rd, 2008 by cher
Filed under: Front Page