Clinical Experience: The Use of Amantadine in CFS

By David S. Bell MD, FAAP

Published in Lyndonville News, April 1999

There are relatively few medical papers discussing treatment results in chronic fatigue syndrome. In clinical practice, I attempt to reduce symptoms in patients with CFS with medicines known to be of value in other disease states, and sometimes they actually work. But observations such as these are rarely reported in medical journals because of the need for strict accuracy and the expense of performing double blind studies. If a medication is not overwhelmingly successful, reports are rarely made. I would like to report on my clinical experience with certain medications, both those that help and those that do not. It may be that some readers will be helped by this information.

It should be remembered that these clinical observations are not the same as rigorously conducted "double blind" trials, and results may be affected by the placebo response. This type of review is also useful for myself, and I sometimes come to overestimate the usefulness of certain medications. With the obvious limitations of clinical experience in mind, let us review amantadine. Amantadine (Symmetrel™) is a medication used to treat the fatigue of multiple sclerosis. Its actions are to increase the amount of the neurotransmitter dopamine in the brain, and as such it has found usefulness in treating Parkinson's disease. A separate effect, almost found as a side effect, was that it has antiviral actions in preventing certain strains of influenza A. The widest use of amantadine now exists in its effects against influenza A. The dosage used to treat fatigue in MS is usually a full dose of 100 mgs twice daily, but I have found few patients with CFS ever can tolerate this dosage. It causes jitteriness and a worsening of symptoms in general. A liquid preparation comes at 50 mgs per teaspoon, and I usually start with very low doses such as a half teaspoon once daily. If no effects are noticed the dose is gradually increased. Because of this wide variation in dosage, it would be hard to attempt a clinical trial using a fixed dose. I find that only a narrow range of amantadine can be used in patients with CFS.

The effect I am looking for is a combination of increased activity with decreased sensation of fatigue. If useful, sleep is not adversely affected. Because amantadine works as a stimulant, I do not use it if patients have severe insomnia, increased deep tendon reflexes, myoclonus (intense jerking motions), or anxiety. I suspect that amantadine would worsen the course for these patients but do not know this for sure.

Over the past three months I have treated sixteen patients with amantadine as part of their treatment regimen. I have no results as yet on one patient. Of the remaining fifteen, 6 (40%) were uncomfortable with the medication at any dosage and stopped it, usually because of anxiety, mood changes, or jitteriness. Two (13%) noticed no effect and stopped the medication. One (7%) noticed a nice effect, which lasted for two months and then seemed to disappear.

The remaining have had a positive result with amantadine. One patient (7%) had a doubling of daily activity, from about 4 hours to 9 hours daily with an improvement of mood. Three (20%) had a good effect, but not to this degree and two (13%) have said that it helps "somewhat" and would like to continue with it. Thus, overall, 60% have stopped amantadine because of side effects, unpleasant reactions or no benefit, and 40% choose to continue with it. No patient has had any dangerous side effects, but it should be noted that I have not used it with anxious or jittery patients with CFS. In looking at the characteristics of those in whom it has been useful, most have tiredness rather than exhaustion or orthostatic intolerance. They tend to be in the 5 to 6 hour activity range to start with, rather than the more severe activity limitation.

Amantadine like other stimulants may be ineffective or uncomfortable for certain patients with CFS. However it does seem to have a place in the symptomatic treatment of CFS. It does not produce miracles, and only one patient has had a doubling of daily activities. But 40% of these selected patients felt better with amantadine. It would be of great benefit to understand why certain medications produce responses in CFS. Most likely it is due to variations of levels of certain neurotransmitters both within individuals and due to the abnormalities of CFS.

Return to the CFS Page

Return to the Medical Page

Home	News	Forum	Contribute	Store	Articles	Links	Help
The Pediatric Network website and forum are run by Mary Robinson and Rebecca Moore. When you follow links on our site to Amazon.com and make purchases, a portion of the sales cost supports our work. Visit our store for shopping suggestions:  gifts for kids or parents, tools for adapting activities, medical and special education books, coping strategies, and more.

Disclaimer: The views in this website and forum are the feelings and opinions of the individual authors and do not necessarily reflect all of the current theories that are being explored and published. Ask your doctor or other health care provider about all medical information that you consider applying to your situation, including the information you read in our website and forum. We take no responsibility for the decisions you or your family members make about medical care. It is up to you to verify that the information you read is correct and applies to your unique situation.