Dr Jacob Teitelbaum | Medicatie  bij onderzoek
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                        Bij onderzoek gebruikte medicatie:

Table 2a: Medicines That All Patients Received
For Sleep:


 
A Melatonin 3/10 mg P.O. QHS28 and
B Valerian 180 mg/Melissa 90 mg combination (Valerian Rest by To Your Health), 1-2 tablets P.O. QHS29
Plus the below treatments as needed to result in 7-8 hours of solid sleep without waking or next-day sedation. Mixing of a low dose of several medications was used instead of a high dose of a single agent in order to decrease next-day sedation.
A Zolpidem (Ambien) 10 mg, -1 P.O. QHS and/or
B Trazodone (Desyrel) 25-200 mg P.O. QHS and/or
C Cyclobenzaprine (Flexeril) 10 mg, -2 P.O. QHS30,31 and/or
D Carisprodol (Soma) 350 mg, -1 P.O. QHS and/or
E Amitriptyline (Elavil) 10 mg, -5 P.O. QHS31,32 and/or
F Clonazepam (Klonopin) mg, -8 tablets P.O. QHS
For nutritional support (these two supplements are used long-term):


 
A Daily One Cap Multivitamin (Twinlab), 1 tablet P.O. QAM
B Magnesium with malic acid (Fibrocare by To Your Health), 2 tablets p.o. Tid


 
Table 2b: Treatments That Were Individualized Based on Test Results or Clinical History
Treatment: If:
Ferrous Fumarate (Chromagen) 1 P.O. QD between 2 and 6 PM on an empty stomach. Ferritin 40 ng/mL (ug/L) or iron % saturation 22%.
B12 1,000 mcg/cc, 1cc I.M. 1-3x a week for 12 doses then PRN or B12 1,000 mcg SL QD (if patient was unable to obtain injections). B12 level < 540 pg/mL (398 pmoL/L).18,19,33
Levothyroxine (Synthroid) 25 mcg, 1-4 QAM or dessicated thyroid (Armour) 30 mg -3 tablets QAM (adjust to a clinically optimal dose based on relief of symptoms while keeping the free T4 within normal range). If TSH > 2.5 or < .9 U/mL and/or total T3 is < 95 ng/dL (1.5 nmoL/L) and/or free T4 is < 1.0 ng/dL (13 pmoL/L) and patient has 3 of the following symptoms: weight gain, oral temp < 98.3, dry skin, thin hair, constipation, achiness, and/or cold intolerance.
Cortisol (Cortef) 5 mg, 1-3 tabs QAM, -1 tabs at noon and tab at 4 PM, using lowest clinically optimal dose (usual dose 5-12 mg/dayup to 20-25 mg/d).34,35 Cortrosyn stimulation test with cortisol baseline 12 ug/dL, (33 1nmoL/L) and/or hour increases < 7 ug/dL (193 nmoL/L), or 1 hour increase < 11 ug/dL (303 nmoL/L) with a 1 hour cortisol level < 28 ug/dL (773 nmoL/L) or HgbA1C < 5.1% and/or patient has 3 of the following: sugar craving, shakiness relieved by eating, dizziness, moodiness, recurrent infections that persist longer than expected, high stress at illness onset or low B/P.
 
DHEA 5-50 mg P.O QD (decrease the dose if acne or darkening of facial hair in females) occurs.
 
DHEA-Sulphate (mcg/dl) (x.02714=umoL/L)


 
In Males In Females

 
DHEA-Sulphate RX ( mg/d) DHEA-Sulphate RX ( mg/d)
umoL/L mcg/DL umoL/L mcg/DL
0-2.7 0-100 50 0-0.8 0-30 25
2.8-5.4 101-200 40 0.9-2.2 31-80 20
5.5-7.6 201-280 25 2.3-3.0 81-110 10
7.7-8.7 281-320 10 3.1-3.8 111-114 5
Testosterone Enanthate (Delatestryl) 100 mg I.M. QWK (in males) or natural Testosterone 2 mg P.O. QD or BID in females. Free testosterone in lowest quintile for age.
Estrogen replacement (in females) offered to patient:26 if < 40 Y.O.-Ovcon 35, if > 40 Y.O. or side effects on Ovcon, Estradiol -2 mg QD or Triestrogen (10% Estradiol, 10% Estrone, 80% Estriol) 1-5 mg/d P.O. on day 1-25 of cycle and (if uterus present) natural progesterone 100 mg P.O. qhs or 200 mg P.O. qhs day 16-25 of cycle. Estradiol < 75pg/mL (275pmoL/L) and/or FSH & LH > 10 mI.U./mL (I.U./L) and/or irregular periods, hot flashes, inadequate vaginal lubrication, low libido, flaring of FMS symptoms before periods or S/P TAH or tubal ligation.
Oxytocin 10 units P.O. QD Severe cold hands /feet and pallor.
Fludrocortisone (Florinef) .1 mg/d (and increase dietary salt, water & potassium) beginning at tab/day & increasing by a tab Q 3-7 days B/P < 100/60, or orthostatic dizziness or FMS symptoms worsened by standing against wall for 10 minutes.
Sertraline (Zoloft) 50 mg, -2 QHS OR Paroxetine (Paxil) 20 mg, -2 QAM OR Fluoxetine (Prozac) 20 mg, 1-2 QAM OR Nefazodone (Serzone) 100 mg B.I.D. If NMH symptoms above, depression or persistent severe pain.
Nystatin 500,000 units 2 P.O. T.I.D. x 3-5 months plus, in more severe cases, Itraconazole (Sporanox) 100 mg 2 P.O. QD with food x 6-12 weeks (begin 4 weeks after Nystatin begun). Do not take Seldane, Hismanal, Propulsid or antacids with Itraconazole. If stool microscopic exam showed higher than normal fungal levels or symptoms suggesting fungal overgrowth (e.g., thrush, recurrent yeast vaginitis or antibiotic use, onchomycosis)by questionnaire.25
Metronidazole (Flagyl) 250 mg P.O. QID x 10 days. or 750 mg P.O. TID x 10 days followed by iodoquinol (Yodoxin) 650 mg P.O. TID. If stool was positive for Clostridium difficile. or If other Metronidazole (Flagyl) sensitive parasites were present.
Doxycycline 100 mg P.O. B.I.D. x 6 weeks. Recurrent body temperatures >98.6 F.

 

Table 2C. Number of Patients on Each Treatment (at Some Time During the Study) Out of 38 Active Patients

Treatment # of Patients on Treatment
Daily One Multivitamin 38
Valerian Rest 38
Magnesium/Malic Acid (Fibrocare) 38
Melatonin 3/10 mg 38
Chromagen (iron) 24
Vitamin B-12 30
SSRI (Sertraline, Paroxetine, Fluoxetine, Nefazodone) 29
Amitriptyline (Elavil) 10
Cyclobenzaprine (Flexeril) 10
Desyrel 24
Ambien 23
Klonopin 8
Soma 22
Synthroid 18
Armour Thyroid 15
Cortef 29
DHEA 24
Florinef 19
Oxytocin 15
Estrace 7
Triestrogen 6
Progesterone 9
Testosterone 12
Nystatin 35
Sporanox 27
Flagyl 10
Doxycycline 4