Table of ContentsView AllTable of ContentsSymmetrel (amantadine)Provigil (modafinil)Prozac (fluoxetine)Ritalin (Methylphenidate)Next Steps
Table of ContentsView All
View All
Table of Contents
Symmetrel (amantadine)
Provigil (modafinil)
Prozac (fluoxetine)
Ritalin (Methylphenidate)
Next Steps
Fatigue is an unrelenting, disabling depletion of physical and mental energy, and it affects 80% of people living withmultiple sclerosis. While fatigue in MS is related to the disease itself, other MS-related factors may contribute to or exacerbate a person’s fatigue.
Some of these factors include medications used to treat symptoms of MS-like bladder problems or spasticity, poor sleep quality, and depression.
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Of course, non-pharmacologic strategies are suggested as the initial step for treating MS fatigue, such as daily exercise, sleep regulation, and energy conservation techniques. However, sometimes, medication is needed for optimal relief.
It is important to note, however, there are currently no United States FDA-approved medications for treating fatigue in MS. Therefore, the medications listed below are all used “off-label” for the management of MS fatigue.
With the exception of Symmetrel (see below), the research backing up the usefulness of these medications is very poor, meaning there are few studies done and little benefit (if any) has been found.
Still, one of these medications may work for you. Sometimes, it’s worth the trial, especially if you feel like your fatigue is getting the best of you. It’s best to discuss these options with your healthcare provider to determine if one may be right for you.
Dose
The usual dosage of Symmetrel for treating fatigue in MS is 100mg twice daily, in the morning and mid-day.
Side Effects
While generally well-tolerated, some side effects to watch out for include:
SinceProvigilpromotes wakefulness, its intended use is to treat narcolepsy, shift work sleep disorder, and obstructive sleep apnea. Like Symmetrel, Provigil is used off-label to treat MS fatigue and may work through dopamine regulation.
The dose for Provigil is usually 100mg twice a day, in the morning and mid-day, although some people opt for 100 to 200g in the morning only to prevent insomnia.
Side effects to watch out for with Provigil include insomnia, nervousness, dizziness, headache, nausea, and weakness.
Prozac is an antidepressant, specifically a selective serotonin reuptake inhibitor (SSRI), that may help relieve fatigue in MS.
While not an exhaustive list, there are some possible side effects of Prozac including insomnia, headache, drowsiness, anxiety, yawning, and decreased libido (sex drive).
Others may involve nausea, diarrhea, loss of appetite, and dry eye.
Healthcare providers are particularly cautious when prescribing Ritalin due to its potential for dependency and abuse.
Some potential side effects of Ritalin include the following:
No doubt about it, fatigue is one of the most disabling symptoms of MS. The upside is that there are several ways to combat your fatigue; although, it often takes a combination of strategies to do the job.
First, it’s important to properly treat secondary causes of fatigue, such as poor sleep, infection, depression, or medication side effects. Then, you can tackle your primary MS fatigue. Perhaps your healthcare provider will suggest a delicate combination of medication, daily physical activity, and a psychological intervention like cognitive-behavioral therapy or mindfulness meditation.
A Word From Verywell
The bottom line is that finding ways to manage your fatigue will likely be a trial and error process, and your strategies may evolve or shift over time. Try to remain resilient as you navigate this difficult but manageable MS symptom. Work closely with your healthcare provider to discover what new combinations of therapies may cause unwanted side effects as well as what may work for you and ease your symptoms.
Depression in Multiple Sclerosis
SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Dobrakova E, Genova HM, DeLuca J, Wylie GR.The Dopamine Imbalance Hypothesis of Fatigue in Multiple Sclerosis and Other Neurological Disorders.Front Neurol. 2015;6:52.Nourbakhsh B, Revirajan N, Waubant E.Treatment of fatigue with methylphenidate, modafinil and amantadine in multiple sclerosis (TRIUMPHANT-MS): Study design for a pragmatic, randomized, double-blind, crossover clinical trial.Contemp Clin Trials. 2018 Jan;64:67-76.Tur C. Fatigue management in multiple sclerosis.Curr Treat Options Neurol. 2016;18:26. doi:10.1007/s11940-016-0411-8Yang TT, Wang L, Deng XY, Yu G. Pharmacological treatments for fatigue in patients with multiple sclerosis: A systematic review and meta-analysis.Neurol Sci.2017 Sep 15;380:256-61. doi:10.1016/j.jns.2017.07.042
Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Dobrakova E, Genova HM, DeLuca J, Wylie GR.The Dopamine Imbalance Hypothesis of Fatigue in Multiple Sclerosis and Other Neurological Disorders.Front Neurol. 2015;6:52.Nourbakhsh B, Revirajan N, Waubant E.Treatment of fatigue with methylphenidate, modafinil and amantadine in multiple sclerosis (TRIUMPHANT-MS): Study design for a pragmatic, randomized, double-blind, crossover clinical trial.Contemp Clin Trials. 2018 Jan;64:67-76.Tur C. Fatigue management in multiple sclerosis.Curr Treat Options Neurol. 2016;18:26. doi:10.1007/s11940-016-0411-8Yang TT, Wang L, Deng XY, Yu G. Pharmacological treatments for fatigue in patients with multiple sclerosis: A systematic review and meta-analysis.Neurol Sci.2017 Sep 15;380:256-61. doi:10.1016/j.jns.2017.07.042
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Dobrakova E, Genova HM, DeLuca J, Wylie GR.The Dopamine Imbalance Hypothesis of Fatigue in Multiple Sclerosis and Other Neurological Disorders.Front Neurol. 2015;6:52.Nourbakhsh B, Revirajan N, Waubant E.Treatment of fatigue with methylphenidate, modafinil and amantadine in multiple sclerosis (TRIUMPHANT-MS): Study design for a pragmatic, randomized, double-blind, crossover clinical trial.Contemp Clin Trials. 2018 Jan;64:67-76.Tur C. Fatigue management in multiple sclerosis.Curr Treat Options Neurol. 2016;18:26. doi:10.1007/s11940-016-0411-8Yang TT, Wang L, Deng XY, Yu G. Pharmacological treatments for fatigue in patients with multiple sclerosis: A systematic review and meta-analysis.Neurol Sci.2017 Sep 15;380:256-61. doi:10.1016/j.jns.2017.07.042
Dobrakova E, Genova HM, DeLuca J, Wylie GR.The Dopamine Imbalance Hypothesis of Fatigue in Multiple Sclerosis and Other Neurological Disorders.Front Neurol. 2015;6:52.
Nourbakhsh B, Revirajan N, Waubant E.Treatment of fatigue with methylphenidate, modafinil and amantadine in multiple sclerosis (TRIUMPHANT-MS): Study design for a pragmatic, randomized, double-blind, crossover clinical trial.Contemp Clin Trials. 2018 Jan;64:67-76.
Tur C. Fatigue management in multiple sclerosis.Curr Treat Options Neurol. 2016;18:26. doi:10.1007/s11940-016-0411-8
Yang TT, Wang L, Deng XY, Yu G. Pharmacological treatments for fatigue in patients with multiple sclerosis: A systematic review and meta-analysis.Neurol Sci.2017 Sep 15;380:256-61. doi:10.1016/j.jns.2017.07.042
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