What medications can be used to treat fatigue in cancer patients?

From the Guidelines

Methylphenidate (Ritalin) at doses of 5-10 mg twice daily is the most effective medication for treating fatigue in cancer patients, as it has shown to improve energy levels in several studies, including a meta-analysis of 2 studies comparing methylphenidate to placebo 1. However, it's essential to note that the effectiveness of medications for cancer-related fatigue can vary among patients, and addressing underlying causes of fatigue, such as pain, anemia, depression, or sleep disturbances, is crucial for comprehensive management. Some studies have also suggested that modafinil (Provigil) at 100-200 mg once daily may be beneficial for patients with severe fatigue 1. Additionally, non-pharmacological approaches, such as exercise, proper nutrition, and good sleep hygiene, should be used alongside medications to manage fatigue. It's also important to start with low doses and gradually increase while monitoring for side effects, as the therapeutic efficacy of psychostimulants has not been convincingly and reproducibly proven in all cases 1. Other medications, such as corticosteroids, antidepressants, and erythropoiesis-stimulating agents, may also be considered, but their use should be individualized based on the patient's specific situation, cancer type, treatment regimen, and underlying causes of fatigue. Key points to consider when treating fatigue in cancer patients include:

• Methylphenidate is the most effective medication for treating fatigue in cancer patients
• Modafinil may be beneficial for patients with severe fatigue
• Non-pharmacological approaches, such as exercise and proper nutrition, should be used alongside medications
• Treatment should be individualized based on the patient's specific situation and underlying causes of fatigue
• Addressing underlying causes of fatigue, such as pain, anemia, depression, or sleep disturbances, is crucial for comprehensive management.

From the FDA Drug Label

RETACRIT has not been shown to improve quality of life, fatigue, or patient well-being. The medication epoetin alfa (SQ) is not indicated for improving fatigue or quality of life in cancer patients. It is used to treat anemia due to chemotherapy in patients with non-myeloid malignancies.

• Epoetin alfa (SQ) is indicated for the treatment of anemia in patients with non-myeloid malignancies where anemia is due to the effect of concomitant myelosuppressive chemotherapy.
• The medication is not a substitute for red blood cell (RBC) transfusions in patients who require immediate correction of anemia. 2 2 2

From the Research

Medications for Treating Fatigue in Cancer Patients

• Methylphenidate, a psychostimulant, has been shown to be effective in treating cancer-related fatigue in some studies 3, 4.
• A meta-analysis of two studies indicated that methylphenidate was superior to placebo in treating cancer-related fatigue, with a standardized mean difference of -0.30 (95% CI = -0.54 to -0.05; P = .02) 3.
• However, another study found that methylphenidate did not improve fatigue in patients with end-stage cancer, with a mean difference of 3.2 (95% credible interval -2.0,9.0; posterior probability of favorable effect 0.890) 5.
• Erythropoietin, a hematopoietic agent, has been shown to be effective in relieving cancer-related fatigue caused by chemotherapy-induced anemia, with a standardized mean difference of -0.30 (95% CI = -0.46 to -0.29; P = .008) 3.
• Darbepoetin, another hematopoietic agent, has also been shown to improve fatigue in anemic patients, with a standardized mean difference of -0.13 (95% CI = -0.27 to 0.00; P = .05) 3.
• Epoetin alfa, a recombinant human erythropoietin, has been shown to improve quality of life in anemic cancer patients, particularly in terms of reducing fatigue 6.
• A systematic review and meta-analysis of psychostimulants, including methylphenidate, found preliminary evidence for their use in treating cancer-related fatigue, with an overall standardized mean difference of -0.28 (95% CI -0.48, -0.09; P=0.005) 7.

Key Findings

• Methylphenidate and erythropoietin may be effective in treating cancer-related fatigue, particularly in patients with chemotherapy-induced anemia.
• Darbepoetin and Epoetin alfa may also be effective in improving fatigue in anemic patients.
• Further research is needed to confirm the efficacy and safety of these medications in treating cancer-related fatigue.
• The use of psychostimulants, including methylphenidate, requires further confirmation before firm recommendations can be made 7.