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.

MedicationDoseComments
 Tricyclics: Amitriptyline,   Doxepin, Nortriptyline5-100 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
 Gabapentin100-1500 mg May help nocturnal pain and restless legs syndrome
 Pregabalin50-450 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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