A new study using sensitive PCR testing found that 24% of people with CFS/ME tested positive for Epstein-Barr virus (EBV) compared to only 4% of healthy people. The testing showed cytomegalovirus (CMV) positive in 3.4% of cases and HHV-6 positive in 1.7% of cases. That compared to 0% positive of either in healthy people. Fifty-eight people were in the CFS group, while 50 were in the healthy control group.
These findings are consistent with a 2017 study by Dr. William Pridgen that suggested taking the anti-EBV medications Famvir and Celebrex for six months can help a subset of people with CFS and fibromyalgia. I’ve also seen this in thousands of people that I’ve treated.
Meanwhile, another recent study shows that an old diuretic called spironolactone (Aldactone) is also active against Epstein-Barr syndrome. Combining it with other antiviral treatments may enhance their effectiveness, although this must be done cautiously, as the diuretic can lower both testosterone and blood volume. And both of these are already low in people with fibromyalgia.
The price of spironolactone treatment is only $0.20 a day. For most healthy people, it’s also quite safe. However, there are concerns using it to treat CFS/FMS:
- Because it’s a diuretic, spironolactone can dehydrate people. But people with chronic fatigue syndrome and fibromyalgia already tend to be chronically dehydrated. This is because having CFS/FMS lowers your antidiuretic hormone, which leaves you “drinking like a fish and peeing like a racehorse.” Some people I’ve treated have improved with prescription antidiuretic hormone pills (DDAVP or vasopressin, the same medication used for bed wetting). In those needing spironolactone who have low blood pressure or orthostatic intolerance, it can be combined with the DDAVP.
- Spironolactone lowers testosterone levels, which are already in the lowest 30% of the population in 70% of men and women with CFS and fibromyalgia. Research by Prof. Hillary White of Dartmouth showed that treating women who had fibromyalgia with testosterone, despite normal blood levels, decreased their pain. So testosterone levels need to be monitored and optimized when using this treatment.
- Anything that kills off a chronic infection can trigger a “Herxheimer reaction,” which is a severe flare up in symptoms. Years ago, a young woman I was treating was put on spironolactone for high testosterone (called polycystic ovarian syndrome). The first dose put her in the emergency room. I assumed it was because of the diuretic effect and her orthostatic intolerance. But now I suspect it was a Herxheimer reaction. So when adding spironolactone, especially combined with other antivirals, it’s important to start with a very low dose.
Spironolactone offers another potential tool for treating people whose CFS and fibromyalgia began with an acute viral infection, have the severe form that leaves them housebound, or who have chronic flu-like symptoms. However, it needs to be used cautiously for the reasons noted above. Fortunately, simple measures can prevent these problems.