Rowe, P C, Calkins, H, DeBusk, K et al. · JAMA · 2001 · DOI
Many people with ME/CFS experience a drop in blood pressure when standing up (called neurally mediated hypotension), which may contribute to symptoms like dizziness and fatigue. This study tested whether a medication called fludrocortisone could help reduce ME/CFS symptoms in 100 patients with this blood pressure problem. After 9 weeks of treatment, the medication did not work better than placebo, suggesting it may not be an effective standalone treatment for this group.
Orthostatic intolerance and blood pressure dysregulation are common, disabling features of ME/CFS, and identifying effective treatments could meaningfully improve quality of life. This rigorous trial provides evidence that fludrocortisone monotherapy is ineffective, guiding clinical practice and directing future research toward combination approaches or alternative interventions for orthostatic symptoms in ME/CFS.
This study does not prove that neurally mediated hypotension is unrelated to ME/CFS symptoms—only that fludrocortisone monotherapy does not ameliorate them. The failure to show benefit does not exclude the possibility that other medications, combination therapies, or dose adjustments might be effective. Lack of symptom improvement also does not exclude NMH as a pathophysiological contributor to the condition.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Rowe, P C, Calkins, H, DeBusk, K, McKenzie, R, Anand, R, Sharma, G, et al. (2001). Fludrocortisone acetate to treat neurally mediated hypotension in chronic fatigue syndrome: a randomized controlled trial.. JAMA. https://doi.org/10.1001/jama.285.1.52
BibTeX
@article{mecfsatlas-rowe-2001-fludrocortisone-acetate,
author = {Rowe, P C and Calkins, H and DeBusk, K and McKenzie, R and Anand, R and Sharma, G and Cuccherini, B A and Soto, N and Hohman, P and Snader, S and Lucas, K E and Wolff, M and Straus, S E},
title = {Fludrocortisone acetate to treat neurally mediated hypotension in chronic fatigue syndrome: a randomized controlled trial.},
journal = {JAMA},
year = {2001},
doi = {10.1001/jama.285.1.52},
note = {PubMed: 11150109},
url = {https://www.mecfsatlas.com/evidence/rowe-2001-fludrocortisone-acetate},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/rowe-2001-fludrocortisone-acetate
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