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Medications for Treating Fibromyalgia

Fibromyalgia medicines can help reduce pain and fatigue, and improve sleep.

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The most proven treatment for fibromyalgia is a combination of self-care, physical activity and cognitive-behavioral therapy. But medication may also be needed. Many drugs prescribed for fibromyalgia work to turn down “pain volume” in the central nervous system (CNS). They can also help reduce fatigue, improve mood, promote sleep and ease other problems associated with fibromyalgia, including irritable bowel and restless legs syndromes. Drugs such as NSAIDs, opioids and corticosteroids have not been found to be effective for fibromyalgia pain.

Duloxetine (Cymbalta), milnacipran (Savella) and pregabalin (Lyrica) are FDA-approved to specifically treat fibromyalgia. Others are used “off-label” – meaning, they’re used by doctors because of observed benefits but are not FDA-approved for fibromyalgia. Some of those drugs are antidepressants but that doesn’t mean that getting a prescription for your fibromyalgia means you are depressed.

The risks, side effects, and warnings listed below are not complete and you may experience than these effects.  Tell your doctor about all medicines you are taking, including over-the-counter drugs. Always read the full prescribing information when starting a new medication.

Gabapentinoids

Gabapentinoids have pain-relieving effects, especially for nerve pain. Medicines in this group that are used to treat fibromyalgia include gabapentin (Gralise, Horizant) and pregabalin (Lyrica).

Benefits and Risks: These medicines are generally well-tolerated with mild side-effects. Gabapentin and pregabalin have been used to ease restless leg syndrome. Possible side effects include decreased cognitive and motor skills, difficulty speaking, dizziness, vision problems, fatigue, fever, jerky movements, sleepiness, temporary memory loss, tremor, unusual eye spasms, viral infection, dry mouth, bloating, male fertility problems and weight gain.

What Else You Need to Know:  These medicines increase the effect of alcohol and other CNS depressants (medicines that make you woozy or drowsy). Check with your doctor before taking medicine for hay fever, allergies, or colds; sleep aids; narcotic pain relievers; or muscle relaxants.

Sedatives

Certain CNS depressants are used to enhance sleep, which may improve other fibromyalgia symptoms. Zolpidem (Ambien, Ambien CR, Edluar, Intermezzo) is commonly used as a sleep aid in people with fibromyalgia.

Benefits and Risks: These medicines slow down the nervous system. Zolpidem will help you fall asleep faster and stay asleep longer. It may also improve restless leg syndrome. Zolpidem should not be taken for longer than prescribed. Possible side effects include abnormal thoughts and behaviors, memory loss, anxiety, drowsiness, dizziness, diarrhea, a “drugged feeling,” fatigue and headache.

What Else You Need to Know:  Go to bed right after you take zolpidem and plan to stay in bed for 7–8 hours. Do not drink alcohol or take any other CNS depressants (like narcotic pain relievers, certain allergy medicines, muscle relaxants) while taking zolpidem .

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs are antidepressant medicines. They affect the levels of brain chemicals that influence emotions and pain. The SNRIs used for fibromyalgia include duloxetine (Cymbalta), Milnacipran (Savella) and venlafaxine (Effexor XR).

Benefits and Risks: SNRIs protect the level of “feel good” chemicals (such as serotonin) available to the brain to help relieve depression, anxiety and pain. These medicines may increase the risk of suicidal thinking in some people. Possible side effects may include nausea, headache, fatigue, high blood pressure, racing heart, excessive sweating, agitation, cholesterol and triglyceride elevation and tremor.

What Else You Need to Know: Medicines that alter the serotonin levels can cause serotonin syndrome, with symptoms that include confusion, agitation, vomiting, diarrhea, tremor, shivering, muscle rigidity, rapid heartbeat and high blood pressure. This most commonly happens when starting a new medicine or increasing the dose of a current medicine, and requires an immediate call to your doctor. Abruptly stopping SNRIs can cause discontinuation syndrome. Symptoms include flu-like feelings, insomnia, nausea, imbalance, and being on edge or irritable. To avoid this, follow the tapering instructions from your doctor.

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are antidepressant medicines. They generally are not considered as effective for fibromyalgia pain as other antidepressants. But some people find them beneficial for emotional symptoms of this condition. SSRIs used to treat fibromyalgia symptoms include fluoxetine (Prozac, Sarafem), paroxetine (Brisdelle, Paxil, Pexeva) and sertraline (Zoloft).

Benefits and Risks: These medicines increase serotonin levels in the brain and helps to reduce symptoms of depression and anxiety. SSRIs have been known to increase suicidal thoughts in some people. Possible side effects include nausea, sexual dysfunction, weight gain and sleep disturbances.

What Else You Need to Know: Serotonin syndrome and discontinuation syndrome may occur (see SNRI What Else You Need to Know above)

Tricyclic Compounds

Tricyclic compounds used to treat fibromyalgia symptoms include an antidepressant and a muscle relaxant. They affect CNS chemicals to help relieve depression and ease nerve pain. They are less commonly used. Drugs in this group that may be used for fibromyalgia include amitriptyline hydrochloride and cyclobenzaprine (Amrix, Fexmid, Tabralol Fuse Paq, Flexeril).

Benefits and Risks: Tricyclics are effective for reducing pain and symptoms of depression, but side effects limit their use. Like SNRIs, tricyclic antidepressants help to protect the level of “feel good” chemicals available to the brain. The muscle relaxant, cyclobenzaprine reduces muscle tension and can induce sleep. Possible side effects include weight gain, fatigue, dry mouth, constipation, and a groggy or drugged feeling.

What Else You Need to Know: Pain relief with tricyclics may be achieved at doses lower than those used for depression. 

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