| Spasticity | Baclofen (Lioresal), 10 to 40 mg three times daily; in high doses, can cause weakness and fatigue |
| Tizanidine (Zanaflex), 2 to 8 mg three times daily; in high doses, can cause weakness and fatigue |
| Gabapentin (Neurontin), 300 to 900 mg three or four times daily; in high doses, causes fatigue |
| Pain and paroxysmal disorders | Gabapentin, 300 to 900 mg three or four times daily; in high doses, causes fatigue |
| Carbamazepine (Tegretol), 100 to 600 mg three times daily; in high doses, causes rash and neurologic side effects; requires monitoring of complete blood count and liver function |
| Other anticonvulsants |
| Amitriptyline (Elavil), 10 to 150 mg per day at bedtime |
| Bladder urgency | Oxybutynin (Ditropan), 5 mg once daily to 20 mg per day in divided doses; causes dry mouth and can exacerbate glaucoma or worsen urinary retention |
| Tolterodine (Detrol), 2 to 4 mg twice daily; causes dry mouth and can exacerbate glaucoma or worsen urinary retention (these side effects occur less often than with oxybutynin) |
| Depression | SSRIs preferred because of activating properties; can have sexual side effects |
| Alternatives to SSRIs when sexual side effects occur: extended-release venlafaxine (Effexor) 75 to 225 mg per day, or sustained-release bupropion (Wellbutrin), 150 mg per day to 150 mg twice daily |
| Third-line drug or for use when a patient has a sleep disorder or concomitant headaches: amitriptyline, 10 to 150 mg per day at bedtime |
| Fatigue | Amantadine (Symmetrel), 100 mg twice daily; can cause rash, edema, and anticholinergic effects |
| Modafinil (Provigil), 100 to 200 mg given in the morning; can cause jittery sensation and palpitations |
| SSRIs, can have sexual side effects |