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Medications for Fibromyalgia

Fibromyalgia Pharmaceutical Medications Most fibromyalgia treatment plans include one or more prescription medications. Unfortunately, no single drug works for every person with fibromyalgia, so discovering which medications work best for each individual patient can be largely a matter of trial and error.

Since FM patients are often more sensitive to medications than the average person, it's important to start with lower doses, which can be gradually increased as needed, to prevent adverse reactions. It is essential that FM patients and their doctors work together to formulate the best possible treatment plan.

There are currently three FDA-approved drugs for the treatment of fibromyalgia - Lyrica (pregabalin), Cymbalta (duloxetine) and Savella (milnacipran). However, a number of other drugs are also prescribed off-label for FM - typically analgesics, antidepressants, anticonvulsants, muscle relaxants, anti-anxiety medications, sleep aids and sometimes narcolepsy medications.

FDA-Approved Drugs for Fibromyalgia

Lyrica - Marketed by Pfizer Inc., Lyrica is an anticonvulsant that was previously approved to treat seizures, diabetic peripheral neuropathy (pain from damaged nerves that can happen in people with diabetes) and post-herpetic neuralgia (pain following the rash of shingles). Lyrica is thought to work on fibromyalgia by acting on chemicals in the brain that send pain signals across the nervous system, thus calming down overly sensitive nerve cells.

Cymbalta - Marketed by Eli Lilly and Co., Cymbalta is a selective serotonin and norepinephrine reuptake inhibitor antidepressant (SSNRI) that was previously approved to treat depression, anxiety, and diabetic peripheral neuropathy. Cymbalta blocks the neurotransmitters serotonin and norepinephrine from re-entering cells, thereby increasing their levels in the rest of the body. This process is thought to improve mood and reduce pain in people with fibromyalgia. Be aware, however, that discontinuing Cymbalta may result in severe withdrawal symptoms.

Savella - Marketed by Forest Pharmaceuticals, Inc., Savella is a selective serotonin and norepinephrine reuptake inhibitor antidepressant (SSNRI) and was the first drug introduced primarily for treating fibromyalgia. Savella's method of action is similar to that of Cymbalta except that Savella exerts a stronger effect on norepinephrine than on serotonin. It is thought that this may scale back the brain's exaggerated reaction to neurochemicals, which is associated with painful sensations.

Drugs Prescribed Off-Label for Fibromyalgia

Other medications that are sometimes prescribed for fibromyalgia generally fall into one of seven categories.

Analgesics (pain killers) include:
  • Over-the-counter medications like aspirin, acetaminophen, ibuprofen and naproxyn. Aspirin, ibuprofen and naproxyn are nonsteroidal anti-inflammatories and may cause gastrointestinal distress, including ulcerations and bleeding. Acetaminophen is a pain reliever and fever reducer that works by changing the way the body senses pain and by cooling the body.

  • Nonsteroidal anti-inflammatories (NSAIDs) such as etodolac, nabumetone and Cox-II inhibitors like Celebrex. Because many of the NSAIDs carry a serious risk of gastrointestinal bleeding and some also have a cardiovascular risk, they should be taken with great caution and care.

  • Corticosteroid anti-inflammatories like prednisone and dexamethasone. While corticosteroids are not considered to be effective for fibromyalgia, they may be prescribed for patients who have other pain conditions, like lupus or arthritis, in addition to FM.

  • Opioids such as codeine, hydrocodone, oxycodone, morphine and fentanyl. Although some studies have found that opioids are not particularly effective for fibromyalgia because the mu-opioid receptors in people with fibromyalgia have a reduced ability to bind to the drugs targeting them, many patients who have severe pain insist opioids are the only medications that help.

  • Tramadol is a narcotic-like opiate agonist. Although it is described as "opiate-like" and is considered an opiate agonist, it differs from other opioids in the way it acts on the central nervous system. Unlike other opioids, it is not considered to be a controlled substance by the federal government in the U.S., however, a number of states have classified it as a controlled substance.
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