Home' Australian Pharmacist : Australian Pharmacist July 2015 Contents Australian Pharmacist July 2015 I © Pharmaceutical Society of Australia Ltd.
Fatigue can be debilitating and have a significant impact on the lives of
those suffering from it.
Fatigue is common in cancer patients
and patients suffering from progressive
life-threatening conditions such
as multiple sclerosis, respiratory,
heart, kidney and liver conditions.
Furthermore, drugs used in palliative
care settings have sedative properties
and can be associated with fatigue.
Examples of these medications
include; analgesics, benzodiazepines,
antidepressants and anticonvulsants.2,3
There is lack of consensus on the
definition and management of
fatigue due to its subjective nature.
Moreover, the pathyphysiological nature
of fatigue is also not well understood.
Fatigue is associated with high cytokine
load and other symptoms such as sleep
disturbances, infections, hypothyroidism
Pharmacological management of
fatigue includes a variety of classes
of medications that work by different
mechanisms of actions such as treating
metabolic disorders and supplementing
physiological depletions such as
Characteristics of the studies
Randomised controlled trials including
palliative care adult patients with a focus
on pharmacological treatment of fatigue
were included in the review. Palliative
care patients were defined as patients
with a terminal illness such as advanced
stage of cancer, HIV/AIDS, multiple
sclerosis, cardiac, lung or kidney
diseases and who have a life expectancy
of six months or less. The number of
participants in the included studies
varied between six and 544 patients.
The duration of treatment also varied
and ranged from one to 12 weeks.
Quality of the research
Studies included in the report were
of moderate to high methodological
quality. Biases such as allocation,
blinding of outcome assessments and
the small sample size in some of the
studies were major drawbacks.
The following databases were searched
Cochrane Central Register of Controlled
Trials (CENTRAL; 2014 issue 3) MEDLINE
(OVID from 1974 to 28April 2014), and
EMBASE (1974 to Apr 2014) and PsycINFO
(from inception to 28 Apr 2014).
A total of 45 studies with 4,696
participants and 18 drugs were included.
Drugs such as acetylsalicylic acid,
amantadine, dexamethasone, donepezil,
methylprednisolone, carnitine and
The main outcome measures include;
patient reported fatigue using a
self-reported tool and improvement
of fatigue where there was evidence
of 33% improvement or more from
There is weak and inconclusive
evidence to support the indications of
amantadine, pemoline and modafinil in
multiple sclerosis and for carnitine and
donpezil in cancer related fatigue.
Only one study showed evidence of
improvement of methylphenidate
and pemoline in HIV patients.
» EVIDENCE SUMMARIES
Dr Hanan Khalil is the Director of the Centre for
Chronic Disease Management, a collaborating centre
of the Joanna Briggs Institute, Faculty of Medicine,
Nursing and Health Sciences, Monash University, and
a reviewer for the consumer group of the Cochrane
Collaboration. Dr Khalil is also the Editor in Chief of the
International Journal of Evidenced Based Health Care.
However, methylhenidate was shown to
be effective in cancer related fatigue.
Only one study showed a small benefit
of acetylsalicylic acid in patients with
Only one randomised controlled trial
included corticosteroids as a short term
treatment option for palliative care
patients with unclear benefit.
Therapeutic benefits could not be
established for the other medications
due to the variety of measured
outcomes reported in the studies.
To date, the current research focuses
on the use of modafinil in fatigue
management for palliative care patients.
Future studies should focus on using
defined outcome measures and large
The current evidence does not support
one specific medication for the treatment
of fatigue in palliative care patients.
However most of the benefits seem to
focus on modafinil and methylphenidate.
1. Mücke M, Mochamat, Cuhls H, et al. Pharmacological
treatments for fatigue associated with palliative care.
Cochrane Database of Systematic Reviews 2015, Issue 5.
Art. No.: CD006788. DOI: 10.1002/14651858.CD006788.
2. Spathis A, Fife K, Blackhall F, et al. Modafinil for the
treatment of fatigue in lung cancer: results of a placebo-
controlled, double-blind, randomized trial. Journal of
Clinical Oncology 2014;32:1–8 .
3. Bernabei, Roberto, et al. Management of pain in elderly
patients with cancer. JAMA 1998;279(23):1877–82.
4. Bhatnagar S, et al. Pain management in palliative care.
Indian Journal of practical paediatrics. 2013;15(2):86.
for fatigue in palliative care
BY DR HANAN KHALIL
The purpose of this evidence summary is to provide
the best available evidence for the effectiveness of
pharmacological treatments for fatigue in palliative
care patients. For the full review, please refer to Mücke
M, Mochamat, Cuhls H, Peuckmann-Post V, Minton
O, Stone P, Radbruch L. Pharmacological treatments
for fatigue associated with palliative care. Cochrane
Database of Systematic Reviews 2015, Issue 5. Art. No.:
CD006788. DOI: 10.1002/14651858.CD006788.pub3.
Links Archive Australian Pharmacist June 2015 Australian Pharmacist August 2015 Navigation Previous Page Next Page