The ‘First Symptom’ – Sleep

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Prescription Drugs

The IACFS/ME ME/CFS Primer For Clinical Practitioners (2012) written by CFS physicians provides the following recommendations for sleep medications.

Medication Dose Comments
 Tricyclics: Amitriptyline,   Doxepin, Nortriptyline 5-100 mg  Take 5 hours before bedtime. May worsen dry mouth, con-stipation, orthostatic intolerance, or cause daytime sedation
 Cyclobenzaprine  5-10 mg  Same comments as tricyclics above
 Trazodone  12.5-200 mg  May be the least likely to lose effectiveness for sleep
 Quetiapine  12.5-100 mg  May cause weight gain or extrapyramidal symptoms
 Gabapentin 100-1500 mg  May help nocturnal pain and restless legs syndrome
 Pregabalin 50-450 mg  Helpful for nocturnal pain, but very sedating for some
 Antihistamines: Promethazine, Diphenhydramine  10 mg/50 mg  Anticholinergic side effects
 Clonazepam  0.25-1 mg  For restless legs, muscle spasms or anxiety.
 Orphenadrine  100 mg  For restless legs or muscle spasms (not available every-where)
 Ropinirole or pramipexole  0.125-0.25 mg  For restless legs or muscle spasms (not available every-where)
 Melatonin  1-3 mg or more, 2-3 hours before bedtime  May help patients who have altered circadian rhythms
 Zolpidem  2.5-10 mg  Short duration of action may lead to rebound insomnia
 Zopiclone  7.5 mg  Short duration of action may lead to rebound insomnia
 Mirtazapine  7.5-15 mg  May cause daytime sedation; tolerance may develop

 

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