Medicine & Research

Pharmacists play key role in identifying regimens that mitigate symptoms

By Ellen Whipple, Pharma.D.
 About 95 percent of patients with multiple sclerosis experience fatigue, with 15-40 percent of patients considering it  their most debilitating symptom. According to Dr. Ben Thrower, director of the MS Institute at the Shepherd Center in Atlanta, the symptoms of MS-related fatigue vary tremendously from patient to patient. He said, “Some patients are primarily bothered by fatigue during the summer months, whereas other patients suffer from MS-related fatigue almost all of the time. Likewise, fatigue in some patients is debilitating and in other patients only a slight nuisance.”
            MS-related fatigue can be aggravated by medications that cause drowsiness. In addition, symptoms such as spasticity, depression, and weakness can also worsen and/or precipitate MS-related fatigue. In many cases, medications can minimize or eliminate the symptoms of MS-related fatigue. In other situations, modifying medication regimens can help to mitigate the symptoms. For example, administration of the beta-interferon products in the evening compared with the morning, could be beneficial for patients experiencing flu-like symptoms, which can cause fatigue. Thrower went on to explain that pharmacists can play a big role through medication reconciliation in identifying regimens that can aggravate fatigue. “Because patients have multiple doctors prescribing different types of medications, patients should be encouraged to have only one pharmacy. This will allow for a central repository of medication orders.”
            Because there are various causes of MS-related fatigue, it is not surprising that there are also many diverse treatment options. Thrower said, “no one product works for every patient.” Not surprising, many patients have to try multiple products before finding one that is effective for them. The table below examines the most commonly prescribed products used to treat MS-related fatigue. It is important to note that none of the products are approved by the U.S. Food and Drug Administration as treatments of MS-related fatigue. For this reason, insurance companies sometimes deny coverage for these medications when physicians prescribe them to treat MS-related fatigue.