Below is the text of the booklet "The Facts About Chronic Fatigue Syndrome" published in August 1994 by the U.S. Centers for Disease Control and Prevention (CDC). An earlier draft of this text was scanned into an electronic file by Chuck Moss, and that was revised by Maryka Ford and Roger Burns to yield the current file. ------------------------------------------

THE FACTS ABOUT CHRONIC FATIGUE SYNDROME

Answers to Commonly Asked Questions
About Chronic Fatigue Syndrome

National Center for Infectious Diseases
Centers for Disease Control and Prevention
Atlanta, Georgia, August, 1994

Use of trade names or commercial sources is for identification only and does not imply endorsement by the Public Health Service or the U.S. Department of Health and Human Services.

BACKGROUND

Chronic fatigue syndrome, or CFS, is a debilitating disorder characterized by profound tiredness or fatigue. Patients with CFS may become exhausted with only light physical exertion. They often must function at a level of activity substantially lower than their capacity prior to the onset of illness. In addition to these key defining characteristics, patients generally report various nonspecific symptoms, including weakness, muscle aches and pains, excessive sleep, malaise, fever, sore throat, tender lymph nodes, impaired memory and/or mental concentration, insomnia, and depression. CFS can persist for years.

The cause of CFS has not been identified and no specific diagnostic tests are available. Moreover, incapacitating fatigue can be associated with a wide range of well-defined illnesses, such as cancer, depression, autoimmune diseases, hormonal disorders, and subacute infections. Since many of these disorders are treatable, other causes of fatigue must be ruled out before a diagnosis of CFS can be made. Although it can be diagnosed only through this process of elimination, CFS is a genuine clinical condition whose cause and treatment are the focus of intense research.

Reports about CFS have been presented at scientific meetings and published in peer-reviewed research journals. However, the body of information is still small, and many findings are preliminary. Finally, unsubstantiated anecdotal information about CFS has confused some patients and physicians regarding what is speculation and what is scientific fact.

The purpose of this brochure is to provide answers to the most commonly asked questions about CFS and to clarify areas that are often misunderstood.

CLINICAL ASPECTS AND DEMOGRPAHICS

Why is this illness called chronic fatigue syndrome?

A number of names have been proposed over the years to describe clinical features similar to the syndrome we now call CFS. These names include chronic Epstein-Barr virus disease, chronic fatigue immune dysfunction syndrome, epidemic neuromyasthenia, and myalgic encephalomyelitis. The term "chronic fatigue syndrome" was agreed upon in 1988 by a group of experts studying the illness. The group unanimously selected chronic fatigue syndrome because they believed the use of a more specific name would be misleading, given the current knowledge about the disease, and would apply only to some symptoms and patients. For example, no characteristic profile of immune dysfunction has been identified that defines chronic fatigue syndrome, and most patients do not have encephalomyelitis (inflammation of the brain and spinal cord).

If my symptoms do not fit the published case definition of CFS does that mean I do not have CFS?

The case definition published in 1988 (Holmes et al, Ann Intern Med 108:387-9) was produced by medical and public health experts at a meeting sponsored by the Centers for Disease Control (CDC)(Appendix A). The case definition was deliberately designed to define a narrow group of patients for research purposes. Scientists working on CFS need to study patients who have the same, carefully defined illness characteristics. Only by studying relatively homogenous groups of patients are researchers likely to identify a causative agent, physiologic abnormality, or laboratory marker for CFS. This research definition was not designed to be used in the clinical diagnosis of CFS.

How many people in the United States have CFS?

On the basis of results from the first 3 years of its ongoing physician referral-based surveillance study, CDC estimates the minimum prevalence rate of CFS in the United States at 4 to 10 cases per 100,000 adults 18 years of age or older (adjusted for age, sex, and race). Although some media reports have indicated that more than 5 million persons in the United States have CFS, these estimates are not supported by scientific studies.

Who gets CFS?

In the United States, the majority of diagnosed cases of CFS occur in women, most of whom are white. In the CDC's surveillance study, approximately 80% of the cases identified were in women. Most patients are 25 to 45 years old. However, CFS has been diagnosed in a wide range of age groups, including adolescents, and in persons of different races. How frequently CFS occurs among various demographic groups is uncertain but being investigated. Diagnosis of CFS among some groups may reflect differences in culture and factors such as access to medical care. Carefully designed surveillance studies of CFS must be performed before a clear picture of its distribution in the population emerges.

What types of cognitive dysfunction are associated with CFS?

CFS patients commonly report one or more symptoms of cognitive dysfunction, including confusion, difficulty concentrating, impaired thinking, and forgetfulness. Patients often regard these symptoms among the most debilitating features of CFS.

Are there any long-term health problems associated with having CFS?

No scientific evidence exists for any long-term risks associated with CFS. There are anecdotal reports of increased rates of cancer, multiple sclerosis, and other illnesses among CFS patients, but none of these claims have been scientifically established. Unlike immune deficiency diseases, such as AIDS, CFS is not associated with opportunistic infections. Unsubstantiated claims have been made that CFS patients are more prone to suicide, but there are no data to indicate that the suicide rate among CFS patients is higher than that for the general population.

What is the prognosis for CFS -- will I get better?

Very little is known about the clinical course of CFS. It is among the most important areas of CFS research by both CDC and National Institutes of Health (NIH). The course of this illness differs widely among patients. Some patients recover completely with time, while others seem to grow progessively worse. Often, the illness follows a cyclical course, alternating bewteen periods of illness and relatively good health. Some patients improve to a certain extent but never fully recover.

Is CFS contagious?

There are no published data indicating that CFS is communicable through either casual or intimate contact. Studies of groups of CFS patients and their contacts have shown no evidence of person-to-person transmission of the illness. Several cluster outbreaks of unexplained fatigue reported to CDC in recent years are being investigated. Furthermore, reports that pets are involved in the transmission of CFS, or that they can contract the disorder, are unsubstantiated.

Is it safe for me to become pregnant if I have CFS?

Some physicians have informally noted that the symptoms associated with CFS appear to recede during pregnancy. No controlled studies of CFS and pregnancy have been done.

How is CFS treated?

Without knowing the cause of CFS, it is difficult to identify effective treatments. Medications prescribed for CFS usually are intended to provide symptomatic relief and not a cure. However, a number of unproven and potentially dangerous treatments and diagnostic tests have been given to CFS patients at exorbitant cost. Some of the more common remedies and prescription medicines provided to CFS patients are listed in Appendix B.

Are there certain medications I should avoid?

In most circumstances, patients should trust the advice of their physician. However, certain treatments, such as cyclophosphamide, azathioprene, methotrexate, and hydrogen peroxide injection, are potentially life-threatening, wholly unproven to relieve the symptoms of CFS, and should be avoided. If in doubt, call your local medical society, university medical school, or another physician.

Is a particular dietary or vitamin supplement regimen recommended for people with CFS?

There are no studies to suggest that dietary or vitamin supplements relieve the symptoms of or cure CFS. A list of dietary supplements and vitamins commonly used by CFS patients is included in Appendix B.

Does exercise relieve symptoms or make them worse?

Exercise, as well as other physically and mentally challenging activities, can exacerbate fatigue and other symptoms associated with CFS. Patients report that the effects of exercise may not be felt until 1 or 2 days after the activity. Studies are under way to determine the cause and to characterize the nature of this phenomenom. It is clear, however, that lack of exercise leads to deconditioning. Therefore, a regular regimen of moderate exercise, determined by individual tolerance, is generally recommended.

Can I continue to work if I have CFS (or, can my child with CFS continue to attend school)?

CFS patients may experience a variety of potentially debilitating conditions, including fatigue, arthralgia/myalgia, and difficulty concentrating, that can affect their performance on the job or in school. There is no evidence, however, that CFS can be spread from person to person. Therefore, if you feel well enough to continue working, there is no reason not to.

Is it safe for me to donate blood if I have been diagnosed with CFS?

Since the cause of CFS is unknown, and since it may represent a general set of symptoms caused by a variety of factors, there is currently no formal policy or recommendation concerning donation of biological products, such as blood, by CFS patients. There are no cases of persons who acquired CFS after blood transfusion. In general, however, persons who are not in good health, including those with CFS, are discouraged from donating blood and blood products. If you suspect you have CFS or a similar condition, inform officals at the blood collection center that you have CFS. The blood bank may have specific regulations concerning CFS or comparable illnesses.

POSSIBLE CAUSES OF CFS

What causes CFS?

The cause of CFS has not been identified, but there are several theories. Numerous well-characterized viruses are known to cause severe fatigue during acute infection. While some viruses, such as Epstein-Barr virus (EBV), occasionally establish a chronic active infection that results in persistent fatigue, no single virus has been firmly associated with CFS. One hypothesis is that a virus, stress, or other transient traumatic condition may chronically activate the immune system. According to this hypothesis, the immune system, which ordinarily gears down after an infection has been eliminated, remains activated after the initiating infection has passed. The result is that unusually high concentrations of immune activating factors, some of which are known to cause fatigue at high doses, persist in the bloodstream. Other theories involve proposed disturbances in the hormonal (endocrine) system, and some fatigue may be induced by psychological conditions. Another possibility is that a single causative agent, as yet unidentified, causes CFS.

Is CFS caused by an uncharacterized human retrovirus?

One report in the scientific literature described possible retrovirus DNA sequences in lymphocytes from CFS patients that were not present in healthy persons. Despite intensive efforts, several laboratories could not confirm the results of this study. Anecdotal reports that CFS is caused by a human spuma virus are unsubstantiated. In addition, CFS does not have any relationship to a recently reported rare disease, human immunodeficiency virus (HIV)-negative AIDS. There is also no evidence to suggest that CFS is caused by HIV 1, the virus that causes AIDS. Reduced CD4 counts are rarely observed in CFS patients. There is no evidence of life-threatening or clinically noteworthy compromise of the immune system in CFS patients. Retrovirus involvement in CFS is unlikely, although it continues to be investigated.

Does human herpesvirus type 6 (HHV-6) cause CFS?

HHV-6 is an extremely common herpesvirus infection that causes roseola in children and infects at least 95% of persons older than 1 year. Like all herpesviruses, HHV-6 normally remains latent within infected persons but can be reactivated periodically. Some studies have reported inconclusive evidence of HHV-6 reactivation in CFS patients; others have found no correlation between HHV-6 infection and CFS. However, since it is virtually ubiquitous in the general population, HHV-6 infection cannot be used to diagnose CFS.

Do enteroviruses cause CFS?

Like herpesviruses, some enteroviruses are known to cause severe fatigue and muscle weakness. Enteroviruses have been studied by several groups for their involvement in CFS. As with other potential viral causes, no strong associations can be made between recent infection by enteroviruses and CFS.

DIAGNOSIS OF CFS

Can CFS be diagnosed by laboratory tests?

No diagnostic test exists for CFS. Currently, laboratory tests are useful solely to rule out other causes of fatigue. The same is true of serologic tests for certain viruses. Numerous scientific reports have documented immunologic differences between groups of CFS patients and healthy controls, but differences are not observed consistently, and test results between individual patients and controls overlap considerably. In other words, the test values for a randomly chosen CFS patient and those for a randomly chosen healthy person may both fall into the normal range for any of these tests.

How is CFS diagnosed?

CFS is currently diagnosed by a history of illness suggestive of CFS, and through the systematic exclusion of other possible causes. A patient must first have profound fatigue for a minimum of 6 months. To complete the diagnosis, a physician must rule out the many clinically defined (and often treatable) causes of chronic fatigue by using a panel of routine diagnostic tests. Consult Appendix A for specific examples of illnesses that may cause severe fatigue.

Are there CFS specialists who are more qualified than physicians in general practice to diagnose this illness?

As with any illness, some physicians are more familiar with CFS than others but any licensed physician should be able to diagnose CFS. Persons who suspect they might have CFS should seek a doctor with whom they have a comfortable rapport, and who has knowledge of or is open to learning about CFS. Call the nearest university-based medical center if you have difficulty locating a physician who is familiar with the syndrome.

Can CFS be diagnosed by using extremely sensitive molecular tests to demonstrate the presence of retrovirus-like DNA sequences?

No. One published report has been erroneously interpreted to indicate that CFS can be diagnosed by using the polymerase chain reaction method to detect human T-cell lymphotrophic virus type II (HTLV-II)-like DNA sequences in the Iymphocytes of patients. However, more recent studies do not support this view. As such, this expensive research test is not useful in the diagnosis of CFS (see Possible Causes of CFS).

Should diagnostic imaging techniques, such as MRI, PET scan, and SPECT scan, be used in the diagnosis of CFS?

Several reports in the peer-reviewed clinical literature have described CFS patients with recognizable abnormalities seen in MRI or SPECT scans of the brain. However, these preliminary reports have not been confirmed by definitive follow-up studies and did not identify abnormalities in all CFS patients. Since the importance of these early reports is not known, these costly procedures are not appropriate for the clinical diagnosis of CFS.

CFS patients have been shown to have increased antibody levels (i.e., elevated titers) to various infectious agents, including EBV, cytomegalovirus, HHV-6, rubella, enteroviruses, and Borrelia. Does this observation indicate that CFS can be triggered by the reactivation of latent infections?

Some viruses, most notably the herpesviruses, can establish a state of prolonged dormancy, known as a latent infection, within their host. Such viruses normally reactivate periodically and consequently restimulate the immune system. Published studies have reported elevated titers to a number of these agents among CFS patients compared with controls. However, test values between individual patients and controls broadly overlap, indicating that such tests cannot be used to diagnose CFS. Early studies concluded that there was an association between high levels of serum antibody to EBV (which is known to cause fatigue) and CFS. However, more recent studies have shown that elevated EBV titers are not correlated with CFS. Rubella, enteroviruses, and Borrelia cannot produce a latent infection, but they can persist for prolonged periods in an infected person. Finally, because persons within a given population exhibit a broad range of titers to viruses that establish latent infections, "elevated titer" is difficult to define.

ABNORMALITIES OF THE IMMUNE SYSTEM

Do CFS patients have lower-than-normal numbers of natural killer cells or natural killer cells with impaired function?

Some investigators have reported lower numbers of natural killer cells or lower levels of natural killer cell activity in CFS patients than in controls. Others have been unable to observe any natural killer cell abnormalities among CFS patients. No study of natural killer cells in CFS patients has ever defined an abnormality that consistently identifies the patients. As with other experimental assays, measured levels of natural killer activity varied greatly among patients and controls, and individual test results overlapped considerably; thus no clearly abnormal values separated all (or most) cases from all (or most) controls.

Are T-cell activation markers present on a higher number of immune cells in CFS patients?

One study showed that the CD8 T-cell subpopulation contained an increased number of cells expressing the activation markers CD38 and HLA-DR in a subset of CFS patients who were very ill. This finding was true for a large proportion of CFS patients (90%), but only a small fraction of healthy controls (10%). However, similar shifts in the expression of activation markers have been observed for various acute viral infections and would be expected of any active infection. The usefulness of activation markers in diagnosing CFS remains to be established.

Could elevated levels of serum cytokines indicate CFS?

One of the more intriguing theories about the cause of CFS is that one of a number of possible "triggering events" results in a chronic activation of the immune system in these patients. If this theory is correct, one or more serum cytokine levels of CFS patients may be more elevated than those of healthy controls. Such results have been reported anecdotally for interleukin-1, for example, but no characteristic pattern of serum cytokines has been established.

If I have allergies, am I more prone to get CFS?

Several studies have demonstrated that some, but by no means all, CFS patients have a history of allergies. Allergy could be one predisposing factor for CFS, but it cannot be the only one, since not all CFS patients have allergies.

APPENDIX A

The case definition of CFS for research purposes, from Holmes et al, Ann Intern Med (1988) 108:387-9.

A case of chronic fatigue syndrome must fulfill both major criteria listed below, and the following minor criteria: 6 or more of the 11 symptom criteria and two or more of the three physical criteria; or eight or more of the 11 symptom criteria.

Major Criteria

  1. New onset of persistent or relapsing, debilitating fatigue or easy fatiguability in a person who has no previous history of similar symptoms, that does not resolve with bedrest, and that is sufficiently severe to reduce or impair average daily activity below 50% of the patient's activity before onset, for a period of at least 6 months.
  2. Other clinical conditions that may produce similar symptoms must be excluded by thorough evaluation, based on history, physical examination, and appropriate laboratory findings. These conditions include malignancy, autoimmune disease, localized infection (such as occult abscess), chronic or subacute infection (such as endocarditis, Lyme disease, or tuberculosis), fungal disease (such as histoplasmosis, blastomycosis, or coccidiomycosis), and parasitic disease (such as toxoplasmosis, amebiasis, giardiasis, or helminthic infestation); disease related to (HIV) infection; chronic psychiatric disease, either newly diagnosed or by history (such as endogenous depression, hysterical personality disorder, anxiety neurosis, schizophrenia, or chronic use of major tranquilizers, lithium, or antidepressive medications); chronic inflammatory disease (such as sarcoidosis, Wegener granulomatosis, or chronic hepatitis); neuromuscular disease (such as multiple sclerosis or myesthenia gravis); endocrine disease (such as hypothyroidism, Addison disease Cushing syndrome, or diabetes mellitus); drug dependency or abuse (such as alcohol, controlled prescription drugs, or illicit drugs), side effects of a chronic medication or other toxic agent (such as a chemical solvent, pesticide, or heavy metal); or other known or defined chronic pulmonary, cardiac, gastrointestinal, hepatic, renal, hematologic disease.

Minor Criteria

Symptom Criteria

For inclusion in the definition of a case, a symptom must have begun at or after onset of fatigue, and must have persisted for at least 6 months (individual symptoms may or may not have occurred simultaneously):

  1. Mild fever (37.5 C to 38.6 C) or chills
  2. Sore throat
  3. Painful lymph nodes
  4. Unexplained generalized muscle weakness
  5. Muscle discomfort or myalgia
  6. Prolonged (24 hours or greater) generalized fatigue after levels a exercise that would have been easily tolerated prior to the onset of chronic fatigue
  7. Generalized headaches (of a type, severity, or pattern that is different from that of headaches the patient may have had before onset of the chronic fatigue)
  8. Migratory arthralgia without joint swelling or redness
  9. Neuropsychologic complaints (one or more of the following: sensitivity to light, temporary visual blind or dark spots, forgetfulness, excessive irritability, confusion, difficulty thinking, inability to concentrate, depression)
  10. Sleep disturbance (hypersomnia or insomnia)
  11. Description of the main symptom complex as initially developing over a few hours to a few days (this is not a true symptom, but may be considered as equivalent to the above symptoms in meeting the requirements of the case definition).

Physical Criteria

  1. Low grade fever (oral temperature between 37.6 C and 38.6 C, or rectal temperature between 37.8 C and 38.8 C)
  2. Nonexudative pharyngitis
  3. Palpable or tender anterior or posterior cervical or axillary lymph nodes (note: lymph nodes greater than 2 cm in diameter suggest other causes. Further evaluation is warranted)

APPENDIX B

Medications, herbal preparations, and miscellaneous treatments which have been used against CFS



                      Vitamins, coenzymes, and minerals

       ________________________________________________________________



           Treatment Name   Value in        Side effects associated

                            treating        with the use of this treatment

                              CFS*

       ----------------------------------------------------------------

           Coenzyme Q-10       F            harmful effects unknown



           Vitamin B-12        X            harmful effects unknown



           Vitamin C           X            long term use at high dose

                                            may cause development

                                            of kidney stones



           Vitamin A           X            high doses of this vitamin

                                            can cause a wide variety

                                            of clinical symptoms

                                            including permanent liver

                                            damage



           Selenium            X            compounds of this

                                            element may cause

                                            gastrointestinal

                                            disturbances and some

                                            are carcinogenic



           Germanium           X            harmful effects unknown



           Zinc                X            harmful effects unknown



           Iron                X            high doses of iron salts

                                            may be toxic



           Adenosine           F            harmful effects unknown

                                            monophosphate



           L-tryptophan        F            contaminated lots have

                                            been implicated in

                                            triggering eosinophilia-

                                            myalgia syndrome



           Magnesium sulfate   X            harmful effects unknown

       ----------------------------------------------------------------

         *X = no proven utility for CFS; F = no known clinical value





                             Herbal Preparations

       ________________________________________________________________

           Treatment Name   Value in        Side effects associated

                            treating        with the use of this treatment

                              CFS*

       ----------------------------------------------------------------

            Astralagus          X           harmful effects unknown



            Echinacea           X           harmful effects unknown



            Garlic              X           harmful effects unknown



            Ginseng             X           moderate use considered

                                            safe but allergic reactions

                                            have been reported. High

                                            doses may cause a

                                            variety of adverse

                                            symptoms



            Gingko biloba       F           harmful effects unknown



            Comfrey             X           contains tannin and

                                            lasiocarpine both of which

                                            are considered

                                            carcinogenic. Alkaloids in

                                            comfrey may result in liver

                                            damage



            Primrose oil        C           harmful effects unknown



            Shitake mushroom    F           harmful effects unknown

            extract



            Borage seed oil     F           harmful effects unknown



            Quercetin           X           harmful effects unknown



            Bromolain           X           "therapeutic doses" may

                                            cause nausea vomiting

                                            diarrhea skin rash and

                                            menorrhagia



      -----------------------------------------------------------------

       *X = no proven utility for CFS; F = no known clinical value; C =

                   conflicting findings in clinical trials





                                  Analgesics

      _________________________________________________________________

        Treatment Name   Value in   Examples   Side effects associated

                         treating              with the use of this

                           CFS*                treatment

      -----------------------------------------------------------------

        Nonsteroidal anti-  S      naproxen   abdominal pain/dyspepsia/

        inflammatory               ibuprofen  nausea/vomiting

        drug (NSAID)               piroxicam   /drowsiness/headache/

                                              depression/fatigue/

                                              naproxen may impair some

                                              immune functions



        Other               S      cyclobenza-  gastrointestinal

                                   prine        bleeding/drowsiness/

                                                dry mouth/dizziness

      _________________________________________________________________

                      *S = useful for relief of symptoms





                                Acute anxiety

      _________________________________________________________________

       Treatment Name   Value in   Examples    Side effects associated

                        treating               with the use of this

                          CFS*                 treatment

      -----------------------------------------------------------------

       Benzodiazepines     S       alprazolam  sedation/anterograde

                                   lorazepam   amnesia/withdrawal

                                               symptoms



       Other               S        buspirone  dizziness/headache/

                                               drowsiness/nausea

       ________________________________________________________________

                      *S = useful for relief of symptoms





                                  Hypnotics

       ________________________________________________________________

       Treatment Name   Value in   Examples    Side effects associated

                        treating               with the use of this

                          CFS*                 treatment

       ----------------------------------------------------------------

       Benzodiazepines     S       clonazepam  hallucinations/ataxia/

                                   triazolam   depression

                                   temazepam



       Other               S       zolpidem    dizziness/headache



       Other               S       trazodone   drowsiness/headache/

                                               gastrointestinal

                                               bleeding

       ________________________________________________________________

                      *S = useful for relief of symptoms





                               Antidepressants

       ________________________________________________________________

       Treatment Name   Value in   Examples    Side effects associated

                        treating               with the use of this

                          CFS*                 treatment

       ----------------------------------------------------------------

       Tricyclic           S       doxepin       dry mouth/drowsiness/

                                amitriptyline    weight gain/

                                desipramine      tachycardia/weakness/

                                nortriptyline    fatigue





       Serotonin           S       fluoxetine    headache/tremor/

       reuptake                    sertraline    agitation/nervousness

       inhibitors                  paroxetine





       Other               S       bupropion     anxiety/agitation/

                                                 insomnia/tremor/

                                                 anorexia/seizures

       ________________________________________________________________

                      *S = useful for relief of symptoms





                          Additional drug therapies

       ________________________________________________________________

       Treatment Name   Value in   Examples    Side effects associated

                        treating               with the use of this

                          CFS*                 treatment

       ----------------------------------------------------------------

       Calcium channel     X       nimodipine    dizziness/

       blockers                    nicardipine   hypotension/

                                   cardene       headache/nausea



       H-2 blockers        X       ranitidine    headache/dizziness/

                                   cimetidine    nausea/rashes/

                                                 myalgia/impotence/

                                                 has been reported to

                                                 alter immune function



       Immune              U       cyclophos-    destruction of immune

       suppressants                phamide       cells/hair loss/liver

                                   azathioprine  damage/kidney damage/

                                   methotrexate  toxicity to developing

                                                 embryos/ interstitial

                                                 pneumonitis



       Other               X       naltrexone    insomnia/liver damage



       Other               X       pentoxifylline gastrointestinal

                                                  upset/dizziness

       ________________________________________________________________

         *X = no proven utility for CFS; U = use unjustified for CFS





                             Allergy medications

       ________________________________________________________________

       Treatment Name   Value in   Examples    Side effects associated

                        treating               with the use of this

                          CFS*                 treatment

       ----------------------------------------------------------------

        Non-sedating       S      terfenadine  drowsiness/interaction

       antihistamines             astemizole   with erythromycin

                                  loratidine



       Antihistamines      S      diphenhydra- drowsiness

                                  mine



       Other               S      hydroxyzine  sedation

       ________________________________________________________________

                      *S = Useful for relief of symptoms





                           Miscellaneous therapies

       ________________________________________________________________

           Treatment Name   Value in        Side effects associated

                            treating        with the use of this treatment

                              CFS*

       ----------------------------------------------------------------

           Gamma globulin      C            harmful effects unknown



           Ampligen            P            harmful effects unknown



           Kutapressin         X            allergic reactions



           Hydrogen            F            this treatment is considered

           peroxide injection               highly unorthodox and could

                                            initiate a stroke



           High colonic        F            known to promote

           enemas                           intestinal disease

       ________________________________________________________________

       *x = no proven utility for CFS; F = no known clinical value; C =

                   conflicting findings in clinical trials





                       Generic and trade names of drugs

                       used to manage patients with CFS

                 ____________________________________________

                       Generic name         Trade name

                 --------------------------------------------

                       Alprazolam           Xanax

                       Amitryptline         Elavil, Endep,

                                            Etrafon, Limbitrol,

                       Triavil

                       Bupropion            Wellbutrin

                       Buspirone            BuSpar

                       Cimetidine           Tagament

                       Clonazpam            Klonopin

                       Cyclobenzaprine      Flexeril

                       Desipramine          Norpramin

                       Doxepin              Adapin, Sinequan

                       Fluoxetine           Prozac

                       Lorazepam            Ativan

                       Nortriptyline        Aventyl, Pamelor

                       Paroxetine           Paxil

                       Pentoxifylline       Trental

                       Ranitidine           Zantac

                       Sertraline           Zoloft

                       Temazepam            Restoril

                       Trazodone            Desyrel

                       Triazolam            Halcion

                       Zoldipem             Ambien

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