A Little Clonazepam Goes a Long Way in CFS

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A Little Clonazepam Goes a Long Way in CFS

Source: Family Pratice News, by Sherry Boschert

SAN FRANCISCO -- Small doses of clonazepam may reduce neurally

mediated symptoms in patients with chronic fatigue syndrome, a small

uncontrolled trial suggests.

Neurally mediated symptoms declined in 13 patients who were treated with

0.25-0.75 mg/day (a mean of 0.41 mg/day) of clonazepam. Prospective,

placebo-controlled trials are needed to confirm these findings, Dr. Tom T. Hee

said in a poster presentation at the annual meeting of the American College

of Chest Physicians.

All of the patients had been diagnosed with chronic fatigue syndrome and

were referred to the cardiac center at Creighton University, Omaha, Neb., for

neurally mediated symptoms including orthostatic presyncope in eight

patients and weakness, exercise intolerance, and inability to participate in

normal day-to-day activities in all 13 patients, said Dr. Hee of the university.

On clonazepam, the frequency of orthostatic presyncope decreased from

daily episodes to 0-2 episodes per month in seven (88%) of eight patients

with the symptom. Symptoms as a whole declined enough in 12 patients

(92%) that they were able to resume their normal lifestyles.

The symptoms were reproduced by head-up tilt table tests in 10 of 13 patients

before treatment with clonazepam. After treatment, one patient continued to

have abnormal head-up tilt table results, six had normal results, and three

showed some improvement in their ability to tolerate the tilt table for longer

periods.

All patients experienced significant early morning sedation when they started

using clonazepam. Later side effects included noncardiac chest discomfort in

one patient and excessive sedation in two patients that subsided when the

dosage was reduced.

The cohort included 10 females and 3 males aged 14-53 years.

Clonazepam should be added to the list of potentially useful therapies to treat

neurocardiogenic syncope--[beta]-blockers, selective serotonin reuptake

inhibitors, disopyramide, and volume expansion, Dr. Hee said.