August 17, 2008
Prescribed Medications for
Fibromyalgia: By Mark Pellegrino, M.D.
This article provides a description of seven different categories of drugs used in the treatment of Fibromyalgia, and
their possible benefits and side effects.
"Muscle Relaxants: Muscle relaxants can decrease pain in people with fibromyalgia. Medicines in this family include
Flexeril, Soma, Skelaxin, and Robaxin. The most common side effect is drowsiness, although Soma and Skelaxin cause less of
it. I have found that muscle relaxants do not really decrease muscle spasms or truly “relax” muscles, because the painful
area still has palpable spasms. Rather, the medicine appears to help by a central neurologic mechanism that reduces muscle
pain. If drowsiness is a side effect, this medicine should only be taken in the evening so it doesn’t interfere with driving
or concentration. Flexeril is a popular medicine for evening. Although it is a muscle relaxant, it is very similar to
amitriptyline in structure and effect, hence the benefits reported."
"Anti-Anxiety Medicines: Anxiety is a common problem in fibromyalgia and contributes to pain, muscle tension, and
irritability. It can make depression and insomnia worse. Various medicines including antidepressants and muscle relaxants
treat anxiety. Benzodiazepines such as Klonopin, Ativan, and Xanax, are commonly used medicines. These medicines also cause
sedation and thus can improve sleep. Possible side effects include depression and decreased memory. Sometimes it is hard to
determine whether symptoms are due to fibromyalgia or are side effects of medication."
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FDA Approves Cymbalta (Duloxetine) for Fibromyalgia
The U.S. Food and Drug Administration has approved Cymbalta (duloxetine) as a prescription drug for treatment of Fibromyalgia pain, according to an announcement today by the Indianapolis-based drug maker Eli Lilly & Co. It is only the second drug approved explicitly for treatment of Fibromyalgia. The first, the anticonvulsant and pain drug Lyrica (pregabalin), gained FDA approval in June 2007. Both drugs come with serious safety information.
Duloxetine is a serotonin-norepinephrine reuptake inhibitor (elevator), previously approved to manage major depressive disorder, general anxiety disorder, and diabetic peripheral nerve pain. Serotonin and norepinephrine in the brain and spinal cord (central nervous system) are believed to mediate core mood symptoms and help regulate the perception of pain. Fibromyalgia is generally considered a disorder of increased CNS sensitivity to pain characterized by chronic widespread pain and other symptoms.
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FDA Gives Milnacipran Green Light for Fibromyalgia Treatment
The drug milnacipran (to be marketed under the brand name Savella) received FDA approval as a prescription treatment for symptoms of fibromyalgia (FM) on January 14, 2009 – and reportedly will be available in U.S. pharmacies by March.
Milnacipran – a selective serotonin and norepinephrine dual reuptake inhibitor (SSNRI) developed as an antidepressant – has been tested in multiple trials for ability to demonstrate concurrent improvement in fibromyalgia pain, physical function, and overall impression of change (global assessment).
Milnacipran "is the only product approved for the management of fibromyalgia that used this complete responder analysis as its primary endpoint," observes Cypress Bioscience CEO Jay D. Kranzler, MD, PhD.
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Inexpensive drug naltrexone appears to relieve fibromyalgia pain in Stanford pilot study
Naltrexone, used more than 30 years for opioid addiction, and tested in recent trials for alcohol & smoking addictions, would cost only about $40 a month and has limited side effects.
For Tara Campbell, the onset of her fibromyalgia began slowly with repeated sore throats, fevers and fatigue. By the time she was diagnosed, a year later, she had become so debilitated by flu-like symptoms and exhaustion that she often couldn't get off the couch all day.
"Fall, a year ago, I hit my very, very worst," said Campbell, 39, of Walnut Creek, California. "I felt overall pain to the point that even when my children or husband just touched me it hurt."
Campbell's symptoms still linger, but since taking part in a Stanford University School of Medicine clinical trial in the spring of 2008, she's improved enough that she's gone back to working again as an interior decorator and even headed up the fundraising auction at her daughters' school.
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