
CDC-FACT.TXT
------------

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.  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

 Key: X = no proven utility for CFS; S = useful for relief of
 symptoms; U = use unjustified for CFS; F = no known clinical
 value; C = conflicting findings in clinical tests; P = clinical
 findings in progress, no published findings to date


  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

 ==============================================================
_________________
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                