Medications That May Help MS Fatigue

Fatigue is an unrelenting, disabling depletion of physical and mental energy, and it affects 80% of people living with multiple 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.

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.

Symmetrel (amantadine)

Symmetrel is an antiviral drug normally used to prevent or treat influenza ("flu") infections and to help treat Parkinson's disease. While its mechanism of action in easing MS fatigue remains unclear, experts suspect that it may work by balancing out dopamine levels in the brain.

Dose

The usual dosage of Symmetrel for treating fatigue in MS is 100mg twice daily.

Side Effects

While generally well-tolerated, some side effects to watch out for include:

• Insomnia
• Dizziness
• Headache
• Hallucinations
• Swelling
• Dry mouth
• Loss of appetite
• Nausea
• Constipation

Provigil (modafinil)

Since Provigil promotes wakefulness, it's 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.

Dose

The dose for Provigil is usually 100mg twice a day; although some people opt for 100 to 200g in the am only to prevent insomnia.

Side Effects

Side effects to watch out for with Provigil include insomnia, nervousness, dizziness, headache, nausea, and weakness.

Prozac (fluoxetine)

Prozac is an antidepressant, specifically a selective serotonin reuptake inhibitor (SSRI), that may help relieve fatigue in MS.

Dose

The usual starting dose is 10 to 20mg once a day with an escalation of the dose as needed and monitored by your healthcare provider.

Side Effects

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.

Black Box Warning

Short-term studies have found that antidepressants, like Prozac, increase the risk of suicidal thinking and behavior in children, teenagers, and young adults with depression and other psychiatric conditions.

Ritalin (Methylphenidate)

Ritalin is a central nervous system stimulant that is normally used to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy. Ritalin works by increasing dopamine levels in the brain, further supporting the dopamine imbalance theory as the potential culprit behind MS fatigue.

Healthcare providers are particularly cautious when prescribing Ritalin due to its potential for dependency and abuse.

Dose

The usual dose is around 10 to 20 mg early in the morning followed by a second dose at around noon. People with no morning MS fatigue may opt to skip the morning dose and take a single dose of 10 to 20 mg in the early afternoon.

Side Effects

Some potential side effects of Ritalin include the following:

• Insomnia
• Headache
• Irritability
• Decreased appetite
• Dry mouth
• Nausea

Next Steps

No doubt about it, fatigue is one of the most disabling symptoms of MS.

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.