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Consult Your Pharmacistity, in the incapacitatingfeeling that patientsexperience, and in thefact that bed rest doesnot relieve it. 1,9 Thedegree of fatigue limitsor halts social engagements,educationalefforts, work, and personalactivity. Studiesfrom the CDC revealthat the disabling effectsof CFS rival those ofsuch overwhelming conditionsas chronicobstructive pulmonarydisease (COPD), rheumatoidarthritis, lupus,multiple sclerosis, heartdisease, and end-stagerenal disease.The degree of disabilityvaries widely amongpatients and in the samepatient from episode toepisode. Some patientsexperience periods wherethey are relatively free ofsymptoms, followed by aperiod of extreme disability.1 This cyclical patternis often seen with CFS.To meet the formaldiagnosis of CFS,patients should haveexperienced symptomsfor 6 months or more. 1Further, the fatigue isnot caused by any underlyingmedical conditionsand is accompanied bysuch nonspecific ancillarysymptoms as sorethroat, joints that arepainful but lack erythemaor inflammation,unrelenting muscle pain,headaches that differfrom the norm in severityor symptoms, andlymph node tenderness(axillary or cervical). 1Patients do not feelrefreshed after sleep, andthey also notice thatphysical or mental exerciseproduces a malaisethat persists for morethan 24 hours. Theirability to concentrate ontasks is reduced, andtheir memory isimpaired. These arereferred to as the eightsymptoms that defineCFS.Treatment options forCFS are diverse and ofvariable use. The CDCurges practitioners toadapt treatment plans tothe individual patient’spresent symptoms. 10Sleep disturbances maybe initially treated withsimple sleep hygienemeasures, followed bynonprescription antihistaminesleep aids such asSominex and Unisom. Ifthese medications areneeded beyond 14 days,however, the patientshould be urged to seekcare from a physician.Muscle and joint painWhat’s in Red Bull?The popular product known as Red Bull claims to be an“energy drink.” The company Web site does not directlystate that the taurine (an amino acid) in the product providesenergy, but it does mention other beneficialeffects. 13 It says that “one can of Red Bull Energy Drinkcontains approximately the same amount of caffeine as acup of coffee,” a vague statement that should be clarifiedto disclose the exact amount. The drink also containsglucuronolactone, B vitamins, sucrose, and glucose.Patients should not assume that its formula is safer ormore effective than caffeine alone.and headache may beamenable to nonprescriptionacetaminophen, ibuprofen,or naproxen.The CDC alertspatients to the fallaciesof using nutritional andherbal supplements forCFS. 10 Although somepatients report relieffrom these products,they are not regulated bythe FDA, and thusobjective data to provetheir efficacy and safetyare often lacking. TheCDC warns patientsagainst such herbs ascomfrey, ephedra, kava,germander, chaparral,bitter orange, licoriceroot, and yohimbine dueto reports of toxicitycoupled with lack of efficacydata. 10The CDC also mentionsthe use of alternativetherapies such asacupuncture, aquatictherapy, gentle massage,meditation, deep breathing,biofeedback, yoga,and tai chi. 10 The agencyurges patients to discussthese options with ahealth care provider tomake sure that they havebeen proven safe andeffective.Medications That CauseFatigue: Medicationsthat are reported to causefatigue include antihistamines,antihypertensives,corticosteroids, diuretics,and sleep aids for insomnia.2 Some agents inducetoxic myopathy that canlead to fatigue. 11 If prescriptionmedications aresuspected to be the causeof fatigue or of CFS,patients should be askedto visit their prescriberfor a full evaluation andconsideration of alternativemedications.DrowsinessDrowsiness differs fromfatigue in that it is a subjectivefeeling that sleepis needed. A patient maynot be tired at all, butfalls prey to an overwhelmingneed for sleepat an inappropriate timeor in an inappropriatesituation. 12Counseling PatientsWith Drowsiness: It isnormal to experiencedrowsiness after inadequatesleep because thepatient has a “sleep debt.”However, some patientscomplain of abnormalsleepiness in spite of havingobtained sufficientsleep the night before.The pharmacist can questionthese patients abouttheir sleep patterns, howmuch they normally14U.S. Pharmacist • November 2009 • www.uspharmacist.com