Interview with Carmelita P. Escalante, MD, FACP, Professor and Chair Department of General Internal Medicine The University of Texas MD Anderson Cancer Center
From the October 2016 MPN Town Meeting, the question, “Is there any drugs or maybe even vitamin B-12 that can be used to combat the fatigue associated with an MPN?” Check out the full video below to see how MPN expert, Dr. Carmelita Escalante, answers.
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Jeff Folloder: I have a question for Dr. Escalante. Mark from the internet wants to know if there’s any drugs or maybe even vitamin B-12 that can be used to combat the fatigue associated with an MPN.
Dr. Carmelita Escalante: For fatigue – specifically fatigue we look at other conditions. So, we try to treat those conditions, whether they’re depression, etc. Specifically, for fatigue, we would not use B-12 unless your B-12 deficient. There’s not literature to say that B-12 supplements are helpful unless you’re low on B-12.
The drugs that we have used and there is mixed evidence, is stimulants. Stimulants are drugs like methylphenidate, which is Ritalin, which has been used in children with ADHD, attenuation deficit disorders. It’s probably the most studied of all the stimulants. We’ve also used provigil and nuvigil, which is modafinil and armodafinil. They are approved for sleep dysfunctions; such as sleep apnea.
There’s been a scattering of others that have been used, like Adderall. The data is mixed. There is probably more negative trials than positive. But, in severe fatigue, there is a small – there’s some data that shows improvement.
I specifically try to get the behavioral and exercise treatment going, but for some patients the stimulants can be very helpful. And we use them in fairly small doses. There’s very negligible side effects. So, I think it’s a win if I use it and the patient feels better and can do more.
There is a big placebo effect. So, when we do trials with it we always have to have a placebo on. But, the bottom line is if it’s helpful and the patient is tolerating it and doing the other things that we’ve prescribed to try to improve the fatigue and we have everything controlled that we can, and it helps, I think it’s a good thing. Especially, I’ve noticed if there are cognitive deficits, which is – which methylphenidate has been used for in kids to try to get them to focus, it can be very helpful.
We use it a lot in our brain tumor patients. I’ve used it especially inpatients that have jobs where they really have to focus and they tell me I just can’t do my work because I can’t keep focus, and it can be extremely helpful for them.
Andrew Schorr: Okay, what about the obvious one? I’m drinking a lot of coffee. Coffee’s okay?
Dr. Carmelita Escalante: Coffee’s okay. It’s a fairly week stimulant. I think if you have very mild fatigue and it helps you. I’d be careful in those energy drinks because sometimes, especially if you’re on other medications or if you have heart conditions, you need to be very careful about drinking several a day – may not be in your best interest, especially if you feel your heart racing or you feel jittery.