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March 21, 2001

Orthostatic Hypotension and Chronic Fatigue Syndrome

Author Affiliations

Copyright 2001 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2001

JAMA. 2001;285(11):1441-1443. doi:10.1001/jama.285.11.1441

To the Editor: Dr Rowe and colleagues1 found fludrocortisone acetate to be ineffective for treating chronic fatigue syndrome (CFS). This is in sharp contrast with the results of my previous study, which found that fludrocortisone was remarkably beneficial for patients with CFS.2 Rowe et al, by administering the commercial tablets of fludrocortisone in the inappropriate form of capsules may have biased their results, because the dissolution times of tablets that are repackaged as capsules are strikingly prolonged.3 I have stated previously that "[s]lowing down the dissolution rate of a commercial drug used as a control in a clinical trial could severely bias the results of such trials."3 Administration of fludrocortisone in the improper form of capsules could also have prevented the drug from acting synchronously with the peak absorption of sodium-containing foods. This timing may be important because it could allow mineralocorticoid drugs such as fludrocortisone to maximize their sodium-retaining actions.3

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