Provigil May Reduce MS Fatigue

Taken from Real Living with MS, June 2000
By Vicki Hinson-Smith

Persons experiencing fatigue associated with multiple sclerosis (MS) may benefit from a relatively new drug originally prescribed to promote wakefulness and treat the excessive daytime sleepiness of narcolepsy.

Data from a 72-patient, placebo-controlled MS fatigue study showed that 200 mg daily of Provigil (modafinil) reduced fatigue in persons with the disease, when measured by several validated fatigue rating scales. About 80% of the 250,000 to 350,000 people in the US with MS experience fatigue. Cephalon Inc., the pharmaceutical company that makes Provigil, plans additional MS fatigue studies later this year.

Provigil is the first nonaddicting drug available for people with narcolepsy. A study published in Neurology (2000; 54:1166-1175), verified that Provigil does not create dependency or lingering withdrawal symptoms. Previous treatments for both Narcolepsy and MS-associated fatigue usually involved the use of amphetamines and amphetamine-like stimulant drugs, which can cause high blood pressure, altered heart rhythms, liver toxicity, and anxiety, and could lead to drug dependency and serious withdrawal symptoms.

Provigil was approved by the FDA in late 1998, and its off-label use to treat MS fatigue was first reported in January 2000. It is generally well-tolerated and has a low incidence of side effects, which might include nervousness, nausea, dry mouth, headache, and diarrhea.

Dr. Glovinsky, clinical director of the Capitol Region Sleep-Wake Disorders Center in Albany, NY, advises persons with MS to "Make every decision in conjunction with one's doctor." Before beginning Provigil treatment, patients should talk with their health care providers about any other drugs they are taking, even over-the-counter, "because the potential for interaction is there." Provigil may reduce the effectiveness of some contraceptive drugs, and women who are attempting to prevent pregnancy might ask their health care providers to change the dose of their birth control pills or recommend another method of contraception.

"This drug can make a huge difference in quality of life," Dr. Glovinsky concluded. "It is a choice that definitely should be considered."

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