Fludrocortisone, a drug prescribed to treat low blood pressure, has little or no effect on symptoms of chronic fatigue syndrome in adults when it is used as the only form of treatment, according to a joint study by the Johns Hopkins Children’s Center and the National Institute of Allergy and Infectious Diseases (NIAID). A report of the study appears in this week’s Journal of the American Medical Association.
In a preliminary study published in 1995, Peter Rowe, M.D., leader of the Johns Hopkins team, reported that many patients diagnosed with chronic fatigue syndrome (CFS) developed lightheadedness, fatigue, and sometimes fainted when they stood for prolonged periods of time. When tilted head-up on a special diagnostic table, most patients developed a sudden drop in blood pressure known as neurally mediated hypotension (NMH). Some study participants reported substantial relief in their lightheadedness and CFS symptoms when treated with a combination of an increase in dietary sodium chloride (table salt), fludrocortisone, and other medications. Fludrocortisone helps to maintain a normal blood pressure by reducing the loss of sodium from the bloodstream.
Since this current study began in 1996, other studies have identified four drugs effective in treating some people with recurrent fainting due to NMH.
“One of these medications may prove more effective than fludrocortisone in treating NMH among those with CFS,” says Rowe. “Over 60 percent of the patients we screened for this study had abnormal heart rate and blood pressure responses during tilt testing, and most had worse symptoms brought on early in the test. Their responses to upright posture suggest a need to better define the optimal way to treat NMH in people with CFS. In the patients we studied, clearly, fludrocortisone alone was insufficient.”