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Medications for Chronic Fatigue Syndrome (CFS)

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included. Ask your doctor if you need to take any special precautions. Use each of these medications only as recommended by your doctor, and according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
Many people with chronic fatigue syndrome (CFS) appear particularly sensitive to drugs, especially those that affect the central nervous system. For this reason, your doctor may begin with very low doses. The dose will be gradually increased as necessary.
The complex symptoms in CFS may require the use of different types of medication. The medications are used only to help with symptoms associated with the condition. Medication may also be given for anxiety and depression, pain control, and sleep disturbance.

Prescription Medications

  • Doxepin
  • Amitriptyline
  • Desipramine
  • Nortriptyline
  • Imipramine
  • Citalopram
  • Fluvoxamine
  • Paroxetine
  • Fluoxetine
  • Sertraline
  • Trazodone
  • Venlafaxine
  • Bupropion
  • Lorazepam
  • Flurazepam
  • Clonazepam
  • Triazolam
  • Chlordiazepoxide
  • Temazepam
  • Oxazepam
  • Clorazepate
  • Diazepam
  • Alprazolam

Over-the-Counter Medications

Prescription Medications

Tricyclic Antidepressants
Common names include:
  • Doxepin
  • Amitriptyline
  • Desipramine
  • Nortriptyline
  • Imipramine
Your healthcare provider may prescribe low-dose tricyclic agents to help improve your sleep and relieve mild, generalized pain. Improvement is usually seen in 2-6 weeks after beginning treatment.
Possible side effects include:
  • Lightheadedness
  • Dry mouth
  • Blurred vision
  • Constipation
  • Difficulty urinating
  • Weight gain
  • Low blood pressure
  • Sexual dysfunction
  • Rapid heart rate
  • Risk of severe mood and behavior changes, including suicidal thoughts in some people—young adults may be at a higher risk for this side effect
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are used to treat the depression that may accompany CFS. They may also be beneficial for CFS even if you are not depressed. Improvement may be seen in 4-6 after beginning treatment.
Common names include:
  • Citalopram
  • Fluvoxamine
  • Paroxetine
  • Fluoxetine
  • Sertraline
Possible side effects include:
  • Nausea
  • Diarrhea
  • Insomnia
  • Sexual dysfunction
  • Weight gain
  • Headache
  • Risk of severe mood and behavior changes, including suicidal thoughts in some people—young adults may be at a higher risk for this side effect
Atypical Antidepressants
Common names include:
  • Trazodone
  • Venlafaxine
  • Bupropion
Atypical antidepressants are used to treat depression that may accompany CFS. Improvement is usually seen in 4-6 weeks after beginning treatment.
Possible side effects include:
  • Nausea
  • Nervousness
  • Diminished sex drive
  • Risk of severe mood and behavior changes, including suicidal thoughts in some people—young adults may be at a higher risk for this side effect
Benzodiazepines
Common names include:
  • Lorazepam
  • Flurazepam
  • Clonazepam
  • Triazolam
  • Chlordiazepoxide
  • Temazepam
  • Oxazepam
  • Clorazepate
  • Diazepam
  • Alprazolam
Benzodiazepines are used to reduce anxiety and panic that may accompany CFS. They may also be used to promote sleep. Benzodiazepines are fast acting, but can be habit-forming when used long-term or in excess. In such cases, withdrawal must be accomplished slowly, over a period of weeks or months.
Possible side effects include:
  • Drowsiness
  • Lightheadedness
  • Incoordination
  • Slow reaction time or impaired driving

Over-the-Counter Medications

Acetaminophen

  • Common name: Tylenol
Acetaminophen may be used to relieve pain from headache, joint pains, or muscle pain. To avoid stomach upset, this medication should be taken with food. Acetaminophen is generally safe when taken as recommended.
Possible side effects include:
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Common names include:
  • Naproxen
  • Ibuprofen
NSAIDs may be used to relieve pain and fever associated with CFS. These medications should be taken with food to prevent stomach upset. They are generally safe when taken as recommended.
Possible side effects include:
  • Abdominal pain
  • Gastrointestinal bleeding
  • Nausea, heartburn, or vomiting

Special Considerations

If you are taking medications, follow these general guidelines:
  • Take the medication as directed. Do not change the amount or the schedule.
  • Ask what side effects could occur. Report them to your doctor.
  • Talk to your doctor before you stop taking any prescription medication.
  • Plan ahead for refills if you need them.
  • Do not share your prescription medication with anyone.
  • Medications can be dangerous when mixed. Talk to your doctor if you are taking more than one medication, including over-the-counter products and supplements.
When to Contact Your Doctor
Contact your doctor if you have any questions about your medication, any side effects that are troublesome, or if you feel that the medication is not working after the allotted time period.

References

Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273. Updated August 12, 2010. Accessed December 13, 2013.
Chronic fatigue syndrome. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115094/Chronic-fatigue-syndrome. Updated August 1, 2016. Accessed October 3, 2016.
Chronic fatigue syndrome: treatment. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/chronic-fatigue-syndrome/treatment.html. Updated November 2010. Accessed December 13, 2013.
Craig T, Kakumanu S. Chronic fatigue syndrome: evaluation and treatment. Am Fam Physician. 2002;65(6):1083-1090.
Devanur LD, Kerr JR. Chronic fatigue syndrome. J Clin Virol. 2006;37(3):139-150.
Management of CFS. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/cfs/management/index.html. Updated May 14, 2012. Accessed December 13, 2013.
Prins JB, van der Meer JW, Bleijenberg G. Chronic fatigue syndrome. Lancet. 2006;367(9507):346-355.
2/18/2011 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115094/Chronic-fatigue-syndrome: Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry. 2010;71(10):1259-1272.

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