ME/CFS TREATMENT RECOMMENDATIONS US ME/CFS Clinician Coalition - Version 1 February 20, 2021

For more information on diagnosis and management and on terms of use for those using these recommendations, see the US ME/CFS Clinician Coalition website and handout. [...] Can be very sedating for some and can cause increased (see below for use in cognitive impairment and difficulty in tapering off. [...] Alpha blockers For sleep and also may be helpful for mast cell Clonidine 0.1-0.2 mg activation syndrome and hyperadrenergic POTS Guanfacine 1-2 mg Prazosin 1-6 mg Diphenhydramine 25 mg Take at bedtime or 30-60 minutes before. [...] Patients should be cautioned not to exceed the level of activity they can generally tolerate to avoid “crashing.” Medication Dose Comments on Usage Methylphenidate 5-20 mg up to TID For difficulty concentrating and other cognitive issues, daytime sleepiness and for some with orthostatic intolerance or orthostatic hypotension. [...] Recommendations may need to be tailored for bedbound patients and those who need to be recumbent to minimize symptoms such as orthostatic intolerance.