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. Amytriptyline has been associated with an increased risk of dementia. |
| 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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